To assess the impact of an integrated community-based micronutrient and health (MICAH) programme on anaemia (Hb < 120 g/l) among non-pregnant rural Malawian women aged 15–49 years from communities that participated in the 1996–2005 MICAH programme.

Prospective study of two large-scale cross-sectional surveys conducted in 2000 and 2004 as part of programme evaluation in MICAH and Comparison areas.

Rural areas across Malawi. The MICAH programme implemented a comprehensive package of interventions to reduce anaemia, based on a broad range on direct and indirect causes in Malawi. The project approaches included: Fe supplementation; dietary diversification and modification; food fortification; and strengthening primary health care.

Non-pregnant women of childbearing age (15–49 years old, n 5422), from randomly selected households that responded to a household questionnaire, had their Hb measured from finger-prick blood samples using the HemoCue®.

In 2000, there was no significant difference in Hb concentration between MICAH and Comparison areas (mean (se): 117·4 (0·4) v. 116·8 (0·5) g/l, P > 0·05) and the corresponding prevalence of anaemia (53·5 % v. 52·9 %, P > 0·05). By 2004, Hb concentration had increased significantly in MICAH but not in Comparison areas (mean (se): 121·0 (0·4) v. 115·7 (0·6) g/l, P < 0·001), and the prevalence of anaemia had declined significantly in MICAH areas (53·5 % to 44·1 %, χ2 = 28·2, P < 0·0001) but not in Comparison areas (52·8 % to 54·0 %, χ2 = 0·3, P = 0·6).

The MICAH programme was an effective public health nutrition programme that was associated with significant reductions in the prevalence of anaemia among non-pregnant rural Malawian women.