INTERVENTION TO FIGHT ANEMIA AND IMPROVE WELL-BEING IN A VERY LOW INCOME SETTING

6.在极低收入环境中进行干预以对抗贫血和改善福祉 缺铁被认为是当今世界上最常见的营养缺乏症，与成年人的低生产力有关;儿童的认知和身体发育缓慢;老年人认知障碍，身体残疾和肌肉力量下降的风险增加。它还可能影响生产力和工资收入等经济指标。问题的核心是， 制定可持续的铁补充剂分发方法。先前对铁强化面粉的一项研究发现，摄入量的下降抵消了任何积极影响。双重强化盐（DFS）被提议作为一种改进的替代品，因为盐在社会各阶层中的广泛使用以及集中强化和分配计划中的相对后勤便利。 该子项目将调查补贴DFS对印度Bhojpur地区主要贫血、低收入农村人口的健康和经济影响。具体目标是：（1）与比哈尔邦政府的国家卫生协会合作，在私营和政府赞助的商店进行DFS补贴效果的集群水平随机对照试验。(2)衡量获得补贴的DFS对几个结果的影响。(3)专门调查该政策对老年人认知衰退的影响。(4)如果DFS可以减少贫血，则使用DFS的可用性作为衡量血红蛋白水平增加对经济和健康结果以及认知能力的影响的工具。(5)调查盐的摄入量和最终效果是否因以前的贫血状况、贫困程度和教育水平而不同。(6)收集并公开提供关于比哈尔邦约10 000户家庭健康和福祉的丰富数据集。

6. INTERVENTION TO FIGHT ANEMIA & IMPROVE WELL-BEING IN A VERY LOW INCOME SETTING Iron deficiency is believed to be the most common nutrient deficiency in the worid today, linked to low productivity in adults; slowing of cognitive and physical growth among children; and increased risk of cognitive impairment, physical disability and decreased muscle strength in the elderly. It may also impact economic indicators such as productivity and wages earned. At the heart of the problem is the difficulty of putting in place a sustainable method of distributing iron supplements. A previous study of iron-fortified flour found that declining take-up muted any positive impacts. Double-fortified salt (DFS) was proposed as an improved alternative, given salt's broad use among all strata of society and the relative logistical ease in a centralized fortification and distribution program. This subproject will investigate the health and economic effects of subsidizing DFS in a predominantly anemic, low-income, rural population in Bhojpur district, India. The specific aims are: (1) To conduct, in collaboration with the State Health Society of the Government of Bihar, a cluster level randomized control trial of the effect of DFS subsidization in private and government sponsored shops. (2) To measure the effect of the availability of subsidized DFS on several outcomes. (3) To specifically investigate the effect of the policy on cognitive decay among older adults. (4) If DFS reduces anemia, to use the availability of DFS as an instrument to measure the effect of increased hemoglobin level on economic and health outcomes, and cognitive capacity. (5) To investigate whether the take up of the salt and the final effect differ by previous anemia status, poverty levels, and education level. (6) To collect and make publicly available a rich data set on health and well-being for about 10,000 households in Bihar.