Economic Cost of Iron Deficiency Anemia The ... - The INCLEN Trust

PepsiCo Pilot in Andhra Pradesh: Guntur and Tenali Districts

Iron deficiency Anemia is rampant in India
Anemia is prevalent at all income levels
• Low income Group :76% / Middle income Group :69% / High
Income Group :56%
Impacts most vulnerable age groups
• India : Women :56%, Children 70%
• State - A.P: Women: 63% Children: 71%
• Pregnant women age 15-49 who are anemic: 57.9%
• Ever-married women age 15-49 who are anemic: 56.2
%
Source: NFHS 2005-06
Estimated economic cost of iron deficiency to S. Asia (India, Bangladesh,
Pakistan, Sri Lanka) is appx. $4.2BN annually: World Bank
2

In India, consumption of nutrient iron is
also a concern
65.7% of women, and 71% of children
consume less than 50% of the RDA for iron
The issue remains un-changed much in latest NNMB
Report (2004-05)* National Nutrition Monitoring
Bureau
3

Andhra Pradesh is one state with severe Anemia. Our
pilot test is being undertaken here
• Population Base – Large - 5 th most populous, 75
Million People, 55 Million Rural
• Condusive Infrastructure: Good network of
roadways, 85 % villages connected by road and
60% electrification
• Human Development Index: Relatively high literacy
( 60%), 8 th in HD index at 0.344 & healthy Female :
Male ratio (1.02)
• Good market access: Highest self help groups,
Highest NGO presence, 2 nd highest in Rural
markets (“Mandi)
• One of the top states in Per-capita income in the
country
Source: Census 2001, NCAER 2001-02, RMAI 2008

PepsiCo Pilot Project Overview
1)Affordable Product Development
2)Reach and Education Process
3)Key learning’s and, Way forward
In line with PepsiCo “Performance with Purpose” agenda leverage PepsiCo’s
expertise to provide sustainable Affordable Nutrition to the deserving communities
5

Developing Affordable Tasty fortified products
Program plan

Good nutrients + local ingredients was the focus in the
product development
•Commonly used Food ingredients with strong consumer
beliefs: a) Ragi –Finger Millet, b) Rice etc.
•Health benefits through ingredients: a) Soy flour to
enhance protein quantity and quality b) Iron fortification and
Vitamin premix containing B2, B12 and Folate
•Superior Taste Delivery – through unique technology
• Locally relevant Masala seasoning.
• Higher protein leading to crispier texture
•Superior Consumer Acceptance: Product Mean score of
8.2 in Rural and 8.5 in Urban AP (Monadic, Hedonic)
7

Product added Micro- Nutrient : Vitamin Profile
Nutrient RDA Nutrients Per
Serve
% RDA per
Serve
Benefit
Iron (NaFe
EDTA)
28mg 7mg 25% Reduce Tiredness
Vitamin B12 1mcg 0,50mcg 50% Energy Releasing
Vitamin B2 1,4mg 0,70mg 50% Energy Releasing
Folate 100mcg 50mcg 50% Prevents neural tube and
other birth defects
Soya Ragi Puffs

Consumer Reach Nutrition Education (Target:
Adolescent girls 13-19 Yrs)
100% coverage of 83 villages in intervention geography
100% coverage of all schools in 2 urban towns and 83
villages and, 100% coverage of Target in schools contacted
100% direct coverage of TG households by Change Agents
100% coverage of Retail outlets in villages through Rural
entrepreneurs
74,000 out of 150000 contacted directly
9

Our Commitment to roll out and increase reach is long
term
2011-12 work plan
PepsiCo Pilots Education Program
• 83 villages. 52 schools, 10000+ girls and
mothers in rural enviorns of Guntur and
Tenali
• 2 towns, 72 Mohallas, 254 schools, 25000+
girls and mothers in Guntur and Tenali
Towns
2012-13 plan
Pilot Success Proven
•Roll into 20 Districts in AP
•Rural: 4800 schools in 3450 villages,
0.7Million girls and mothers
•Urban: 4356 schools, 0.8Million girls and
mothers

Our job clearly is to create a social impact and a
behavior change in the target groups
Adolescent girl 13-19
years (Bulls Eye)
Mothers
Product: Offer a tasty and iron +
vitamin fortified affordable
nutrition solution
Iron fortified extruded snack
Education and habitual change:
•What is Iron, and its role
•Symptoms of Iron Deficiency
•Foods that can prevent Iron
deficiency
•Simple tips to reduce Iron deficiency

We have done Iron nutrient education at various touch
points . We are in the right direction
Baseline
Mid Line Impact
September’11- Jan’12
• School + Mohalla (Home / Area)
education
March ‘ 2012
MOHALLA
March- April’ 2012
June to August’11
• School intervention, Education +
Competition
Mid Line Impact
April- June

We have used multiple education modes and materials
including Audi0-visuals and in vernacular language
Awareness of Anemia and
Its Identification
Dos and Don’t’s
Quick facts about Iron
Deficiency

Impact assessment of the education program
Education program exceeded expectations on consumer metrics delivery
Measurement
Metrics
Pre Pilot
(Fieldwork
Mar 2011)
Post Pilot
(Fieldwork
Nov 2011)
Action
Consumption of 7
and more Iron Rich
Food among girls
36% 58%
Understand
Aware
Symptoms of Iron deficiency
I.Unusual tiredness
II. Pale nails
III. Weakness/ decrease in physical performance
Awareness of at least three food items that are
rich in Iron
Iron deficiency causes tiredness which prohibits me from
achieving my dreams
Aware of Iron Deficiency
16% 80%
10% 78%
15% 74%
26% 95%
17% 60%
37% 91%

Measurement of Nutrient Bundle Efficacy being our next
assessment step , is currently progressing
Direct Invasive testing: Increased Hemoglobin Count →
Reduced Severity of Anemia (Clinical measurement)
Indirect measures of success:
• Increased productivity of the test group
• Increased earning potential of the test group as an
outcome of productivity
• Increased muscle strength, stamina, cognitive abilities
of the test group (test)
Social Impact of Education Program will be measured by
Independent Experts

Key Learnings / Key Questions to ask
1. Micro-nutrient
deficiency is wide
spread.
2. Economic cost
impacts are so severe
3. Food fortification is
so inexpensive and
effective
4. How can we harness
support groups to
help scale intervention
support?
1. The Private Sector
community, especially the
Food Industry can make a
significant contribution by
both delivering nutrition
through affordable and
value-added food products
2. Helping to build
awareness for malnutrition
prevention by partnering in
creation and delivery of
communication programs
to the population at large
Partnerships
are critical:
Partnerships
using expertise
of each sector –
Govt,NGOs,foo
d industry,civil
society and
developmental
organizations
can bring about
a positive
change
16

Way Forward – Recommendation to the approach to the
micro-nutrient deficiency problem
Partnerships to
address the issue
Multisectoral
engagement to
create positive
awareness
Scale-up in states
with nutrition
enabled
environment
17

Thank You