| Summary: | A sustainable primary prevention strategy for infant iron deficiency anemia (IDA) was implemented and evaluated in a community with at-risk infants in northern Quebec, Canada. Communication strategies were used to promote iron-rich complementary food rather than iron-fortified formula, which can interfere with breastfeeding practice. This food-based approach has been successfully implemented in developing countries, but has not been applied in an industrialized country setting. Mass media (i.e., radio dialogues, key messages, print material, point-of-purchase grocery store display) and interpersonal (i.e., homemade baby food cooking activity) communication strategies were developed in collaboration with community members and implemented in partnership with an existing community program. Reach and exposure of the strategies were measured using a questionnaire administered to a post-intervention sample (n = 45). Sales of promoted iron-rich infant food were examined pre- and post-intervention period. A repeat cross-sectional design was used for the impact evaluation. Two groups of mothers with infants, aged 7-10 months at Time 1 (n = 32) and Time 2 (n = 22) were interviewed. Outcome variables were infants' total iron and complementary food iron intakes measured by two 24-hour recalls. Secular trends in infants' hemoglobin values and milk type consumption were examined in the study community and two comparison communities. Multiple communication channels increased awareness of IDA and influenced self-reported use of iron-rich infant food. Iron-rich infant food sales increased from pre- to post-intervention (p < 0.05). Complementary food intake iron increased between Time 1 (3.2 +/- 0.8 mg) and Time 2 (4.4 +/- 1.1 mg) (p < 0.05). The proportion of infants with anemia (hemoglobin < 110 g/L) significantly decreased from the period before (37.2%) to during (14.3%) the intervention (p < 0.05). No significant difference was found for this variable within the comparison communities. The proportion of infants receiving iron-fortified formula in the study community did not differ between Time 1 and Time 2, but increased from Time 1 (55%) to Time 2 (73%) (p < 0.05) in the comparison communities, indicating an erosion of breastfeeding practice. These results suggest the effectiveness of communication strategies to improve infant iron nutrition in a community with good access to iron-rich infant food. The potential for this strategy in other communities warrants further investigation.
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