Interventions

The caregivers of children in treatment group 1 received one-on-one health education training on nutrition and feeding practices. Sample caregivers also received a free 6-month supply of micronutrient supplement packets containing a home fortification powder along with instructions on how to use the powder. This group served as our free delivery group (FDG).

The caregivers of children in treatment group 2 (text messaging group, or TMG) received the same treatment as the FDG; however, the TMG caregivers also were enrolled in a daily text message reminder program. In partnership with a cellular communications provider based in Shaanxi Province (China Mobile Communications Corporation), daily reminder messages were sent to the TMG for 6 months. The messages are shown in Table A (available as a supplement to the online version of this article at http://www.ajph.org).

In both the FDG and TMG, we used a Heinz-produced micronutrient powder called “NurtureMate.” The powder is tasteless and contains a mix of iron; zinc; vitamins A, C, D, B₁, B₂, B₆, and B₁₂; and folic acid (online Table B). Approved by China’s government, NurtureMate is recommended for infants aged 6 to 36 months. It is recommended that caregivers give infants 5 packets per week or 1 packet per day.

In both intervention groups, enumerators gave each household a plastic storage envelope in which to store the NurtureMate packets, with instructions to return the empty packets to the survey team at the end of the study. Enumerators tallied unused and empty packets to assess compliance.