Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and young children: a randomized effectiveness study
Rivera, J.A.; Sotres-Alvarez, D.; Habicht, J-Pierre.; Shamah, T.; Villalpando, S.
JAMA 291(21): 2563-2570
2004
ISSN/ISBN: 0098-7484 PMID: 15173147 DOI: 10.1001/jama.291.21.2563Document Number: 234000
Context: Malnutrition causes death and impaired health in millions of children. Existing interventions are effective under controlled conditions; however, little information is available on their effectiveness in large-scale programmes. Objective: To document the short-term nutritional impact of a large-scale, incentive-based development programme in Mexico (Progresa), which included a nutritional component. Design, Setting, and Participants: A randomized effectiveness study of 347 communities randomly assigned to immediate incorporation to the programme in 1998 (intervention group; n=205) or to incorporation in 1999 (crossover intervention group; n=142). A random sample of children in those communities was surveyed at baseline and at 1 and 2 years afterward. Participants were from low-income households in poor rural communities in 6 central Mexican states. Children (N=650) 12 months of age or younger (n=373 intervention group; n=277 crossover intervention group) were included in the analyses. Intervention: Children and pregnant and lactating women in participating households received fortified nutrition supplements, and the families received nutrition education, health care, and cash transfers. Main Outcome Measures: Two-year height increments and anaemia rates as measured by blood haemoglobin levels in participating children. Results: Progresa was associated with better growth in height among the poorest and younger infants. Age- and length-adjusted height was greater by 1.1 cm (26.4 cm in the intervention group vs. 25.3 cm in the crossover intervention group) among infants younger than 6 months at baseline and who lived in the poorest households. After 1 year, mean haemoglobin values were higher in the intervention group (11.12 g/dl; 95% confidence interval, CI, 10.9-11.3 g/dl) than in the crossover intervention group (10.75 g/dl; 95% CI, 10.5-11.0 g/dl) who had not yet received the benefits of the intervention (P=0.01). There were no differences in haemoglobin levels between the 2 groups at year 2 after both groups were receiving the intervention. The age-adjusted rate of anaemia (haemoglobin level <11 g/dl) in 1999 was higher in the crossover intervention group than in the intervention group (54.9% vs. 44.3%; P=0.03), whereas in 2000 the difference was not significant (23.0% vs. 25.8%, respectively; P=0.40). Conclusion: Progresa, a large-scale, incentive-based development programme with a nutritional intervention, is associated with better growth and lower rates of anaemia in low-income, rural infants and children in Mexico.