Assessing the Adoption and Proper Utilisation of Double-Fortified Salt in a Subsidised Voucher Programme for Pregnant Women in Dar es Salaam's Urban Settlements

Nutritional deficiencies, particularly of iron and iodine, remain a significant public health concern for pregnant women in urban settlements of low-income countries. Programmes distributing double-fortified salt (DFS) via subsidies aim to address this, but data on actual adoption and proper use in real-world settings are limited. This study assessed the adoption and correct utilisation of DFS among pregnant women enrolled in a subsidised voucher programme in Dar es Salaam's urban settlements. Its objectives were to measure household uptake, identify knowledge and practices regarding DFS use, and determine barriers to its proper utilisation. A cross-sectional community-based survey was conducted among a random sample of pregnant women who had received DFS vouchers. Data were collected via structured questionnaires administered face-to-face, capturing socio-demographics, voucher redemption, DFS procurement, cooking practices, and knowledge. Descriptive and inferential statistics were used for analysis. DFS voucher redemption was high (87%). However, only 62% of users demonstrated correct utilisation by adding salt at the end of cooking. A key barrier identified was a lack of specific knowledge about the heat-labile nature of the iron fortificant, with 41% of respondents adding DFS during cooking. While the subsidised voucher programme successfully facilitated access to double-fortified salt, correct utilisation was suboptimal. This gap between procurement and proper use likely diminishes the intended nutritional benefits for maternal health. Public health programmes distributing DFS must integrate comprehensive and repeated behaviour change communication, specifically educating on correct cooking practices. Programme monitoring should move beyond distribution metrics to include assessments of actual use. double-fortified salt, pregnancy, voucher programme, utilisation, urban settlements, Tanzania, nutrition This study provides empirical evidence on the critical gap between access and correct use of double-fortified salt, highlighting the need for enhanced educational components within subsidy programmes to achieve public health objectives.