Nutritional Interventions Impact on Maternal and Childhood Anemia in Sindh, Pakistan

Lady Health Worker (LHW)–led community delivery of a wheat–soya blend plus targeted lipid-based or micronutrient powders produced a large program-level decline in maternal anemia, with immediate implications for prenatal and postpartum care. The finding also highlights persistent coverage gaps that warrant focused implementation efforts.

Using existing LHW platforms to deliver monthly household wheat–soya rations for pregnant and lactating women and age-targeted supplements for young children offers a feasible alternative to facility-centered supply chains and clinic-based pickup. Unlike usual care, which relies primarily on routine iron–folic acid with variable reach, direct LHW distribution better addresses access and adherence barriers in low-resource settings and appears operationally scalable across similar primary-care networks.

A quasi-experimental evaluation of the supplementation program documented that maternal anemia in intervention areas fell from 80.4% to 62.6%, representing a 10.7–percentage-point greater decline versus controls (p ≤ 0.001), a result consistent with high statistical confidence. In contrast, the program produced no overall reduction in childhood anemia (DID = −0.7 pp, p = 0.73), although subgroup analyses showed substantially larger improvements among male children and children from wealthier households.

Taken together, the data show clear maternal benefit but only selective child benefit, indicating strong program effectiveness for mothers and a need to refine child-targeted components.

Subgroup analysis suggests the largest maternal gains aligned with higher coverage and better adherence rather than immutable demographic traits, and that boys benefited more than girls in the child analyses. The equity signal is clear: improvements clustered in better-resourced households, implying current implementation favored those with fewer access barriers. These subgroup patterns therefore point to specific adaptations needed to achieve equitable impact.

Key Takeaways:

• Community LHW delivery substantially reduced maternal anemia—outreach-based supplementation can close large maternal nutrient gaps and produce measurable hemoglobin gains.
• Mothers experienced broad benefits while children improved only selectively; child gains were concentrated among boys and wealthier households, revealing gender and wealth gradients in outcomes.
• Next steps: prioritize expanding coverage, strengthen adherence supports, and add equity-focused adaptations so benefits extend across socioeconomic and gender groups.