Objectives: To improve the dietary diversity and hemoglobin level of adolescent girls through nutritional counseling and iron-folic acid supplementation in a resource-poor setting of Dhaka, Bangladesh.
Methods: A mixed-model quasi-experimental community-based intervention study was carried out in a resource-poor urban setting in Dhaka, Bangladesh. The slum area was divided into intervention and control zones. Adolescent girls aged 11-17 years were enrolled from both areas. In the intervention zone, participants received fortnightly group counseling on nutrition for six months, along with weekly supplementation of Iron-Folic acid (60 mg elemental Fe and 400 μg folic acid) for three months. Trained female counselors, recruited from the local community, conducted the group counseling sessions. No interventions were implemented in the control zone. The outcome variables assessed were changes in dietary diversity and hemoglobin concentrations between the groups, determined through difference-in-difference analysis. Additionally, five in-depth interviews were conducted with parents to gather insights into the dietary habits of their adolescent daughters.
Results: A total of 700 adolescent girls (intervention 350, control 350) completed a six-month follow-up between April 2022 and November 2023. Their mean (sd) age at enrollment was 13.5 (1.7) years, and the median (IQR) monthly family income was USD 212 (158.4, 271.7). The baseline data were comparable between the groups. The knowledge level of nutrition in the intervention group showed a significant improvement (p < 0.05) at the end of the intervention period. Difference-in-difference analysis demonstrated a substantial increase in hemoglobin levels in the intervention group (AOR: 0.5, 95% CI: 0.2, 0.8, p-value: 0.001). However, there was no observed improvement in dietary diversity (AOR: -0.2, 95% CI: -0.4, 0.1, p-value: 0.210). During focus group discussions with the parents, it was highlighted that food price hikes have been identified as a restricting factor affecting their purchasing power.
Conclusions: The hemoglobin levels of the intervention participants showed improvement; however, there were no observed changes in dietary diversity. Parents cited food price increases as the primary factor constraining their purchasing capacity.
