Effect of Micronutrient Sprinkles on Reducing Anemia

Jack, Susan; Ou, Kevanna; Chea, Mary; Chhin, Lan; Devenish, Robyn; Dunbar, Mary; Eang, Chanthol; Kroeun, Hou; Ly, Sokhoing; Mengkheang, Khin; Prak, Sophanneary; Reach, Ratana; Talukder, Aminuzzaman; Tokmoh, La-ong; Barra, Sophia Leon de la; Hill, Philip C.; Herbison, Peter; Gibson, Rosalind S.

doi:10.1001/archpediatrics.2012.1003

Cited by 63 publications

(84 citation statements)

References 27 publications

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“…On average, children consumed between 96% 8 and 75% of the sachets. 2,9,16 We found that the prevalence of vitamin A deficiency was similar at baseline and follow-up. These findings are similar to those of three other studies of home fortification products in which there was no significant impact of the intervention on vitamin A status.…”

Section: Discussionmentioning

confidence: 67%

“…In a cluster randomized trial of children 6-11 months in Cambodia conducted by Jack et al, children were assigned to either a treatment group that received both IYCN and MNP sachets (12.5 mg iron) or a control group that received IYCN alone. 9 At 12 months, compared with the control group, children in the treatment group showed a 20.6-PP reduction in anemia (84.7% vs 66.7%, P<0.001). In a series of cross-sectional surveys conducted in Bhutanese refugee children living in camps in Nepal, Bilukha assessed the anemia status of children 13 months before and at 26 months after distribution of MNP sachets (10 mg iron), which were to be consumed every other day.…”

Section: Discussionmentioning

confidence: 85%

“…7 The study by Jack et al was conducted over a 6-month period, whereas the Lundeen and Menon studies were both conducted over a 2-month period and were small-scale interventions. 2,8,9 With regard to adherence, at our 1-year follow-up, 71.2% of children were reported to currently consume the MNP (data not shown). In the refugee population, Bilukha found that 90% of children were reported to currently consume the MNP at last follow-up.…”

Section: Discussionmentioning

confidence: 88%

“…These findings are similar to those of three other studies of home fortification products in which there was no significant impact of the intervention on vitamin A status. 3,9,17,18 In our population, the lack of impact might be partially attributable to concurrent vitamin A capsule distribution, the insensitivity of current indicators to assess vitamin A status, 19 and the relatively low prevalence of vitamin A deficiency in the population without inflammation.…”

Section: Discussionmentioning

confidence: 91%

“…8 Two previous studies conducted in a general population were of 2-6 months duration. 2,9 With one exception, 9 none have measured iron deficiency or accounted for effects of inflammation, which can influence concentration of biomarkers. 10,11 We used a pre-post survey design to examine the prevalence of anemia, iron deficiency, iron deficiency anemia and vitamin A deficiency before and after the initiation of a large-scale integrated IYCN/MNP program, taking inflammation status into account.…”

Section: Introductionmentioning

confidence: 99%

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Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

et al. 2013

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BACKGROUND/OBJECTIVES-To combat iron and other micronutrient deficiencies, the Ministry of Health of the Kyrgyz Republic launched a regional Infant and Young Child Nutrition (IYCN) program in 2009, which included promotion of home fortification with micronutrient powder (MNP) containing iron (12.5 mg elemental iron), vitamin A (300 μg) and other micronutrients. Every 2 months children aged 6-24 months were provided 30 sachets to be taken on a flexible schedule. The objective was to assess biochemical indicators of iron and vitamin A status among children aged 6-24 months at the baseline and follow-up surveys.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

et al. 2013

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Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Park

Fang

Harari³

et al. 2019

JAMA Netw Open

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IMPORTANCE The first 1000 days of life represent a critical window for child development. Pregnancy, exclusive breastfeeding (EBF) period (0-6 months), and complementary feeding (CF) period (6-24 months) have different growth requirements, so separate considerations for intervention strategies are needed. No synthesis to date has attempted to quantify the associations of interventions under multiple domains of micronutrient and balanced energy protein and food supplements, deworming, maternal education, water sanitation, and hygiene across these 3 life periods with birth and growth outcomes. OBJECTIVE To determine the magnitude of association of interventions with birth and growth outcomes based on randomized clinical trials (RCTs) conducted in low-income and middle-income countries (LMICs) using Bayesian network meta-analyses. DATA SOURCES MEDLINE, Embase, and Cochrane databases were searched from their inception up to August 14, 2018. STUDY SELECTION Included were LMIC-based RCTs of interventions provided to pregnant women, infants (0-6 months), and children (6-24 months). DATA EXTRACTION AND SYNTHESIS Two independent reviewers used a standardized data extraction and quality assessment form. Random-effects network meta-analyses were performed for each life period. Effect sizes are reported as odds ratios (ORs) and mean differences (MeanDiffs) for dichotomous and continuous outcomes, with 95% credible intervals (CrIs). This study calculated probabilities of interventions being superior to standard of care by at least a minimal clinically important difference. MAIN OUTCOMES AND MEASURES The study compared ORs on preterm birth and MeanDiffs on birth weight for pregnancy, length for age (LAZ) for EBF, and height for age (HAZ) for CF. RESULTS Among 302 061 participants in 169 randomized clinical trials, the network meta-analyses found several nutritional interventions that demonstrated greater association with improved birth and growth outcomes compared with standard of care. For instance, compared with standard of care, maternal supplements of multiple micronutrients showed reduced odds for preterm birth (OR, 0.54; 95% CrI, 0.27-0.97) and improved mean birth weight (MeanDiff, 0.08 kg; 95% CrI, 0.00-0.17 kg) but not LAZ during EBF (MeanDiff, −0.02; 95% CrI, −0.18 to 0.14). Supplementing infants and children with multiple micronutrients showed improved LAZ (MeanDiff, 0.20; 95% CrI, 0.03-0.35) and HAZ (MeanDiff, 0.14; 95% CrI, 0.02-0.25). The study found that pregnancy interventions (continued) Key Points Question Which interventions under the domains of nutrition, deworming, maternal education, and water, sanitation, and hygiene can improve birth and linear growth outcomes during the first 1000 days of life in low-income and middle-income countries (LMICs)? Findings This study used Bayesian network meta-analyses of 169 randomized clinical trials including 302 061 participants and showed that several nutritional interventions demonstrating greater associations with improved outcomes compared with standard of care, whi...

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Effect of a Community Health Worker–Delivered Parental Education and Counseling Intervention on Anemia Cure Rates in Rural Indian Children

et al. 2019

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Iron deficiency anemia, the largest cause of anemia worldwide, adversely affects cognitive development in children. Moreover, the imperceptible childhood anemia prevalence reduction in response to anemia control measures is associated with tremendous social and economic cost.OBJECTIVE To evaluate the effects of community-based parental education/counseling when combined with usual treatment on children's anemia cure rate. DESIGN, SETTING, AND PARTICIPANTSA pragmatic cluster randomized clinical trial in children aged 12 to 59 months from 55 villages from the rural Chamrajnagar district in southern India was conducted between November 2014 and July 2015; 6-month follow-up ended in January 2016. Villages were randomly assigned to either usual treatment (n = 27) or to the intervention (n = 28). Among 1144 participating children, 534 were diagnosed as having anemia (hemoglobin levels <11 g/dL and >7.9 g/dL; to convert to grams per liter, multiply by 10) and constituted the study sample in this analysis. Data were analyzed between July 2016 and September 2017. INTERVENTIONS Iron and folic acid (IFA), 20 mg/d, 5 times daily per week, for 5 months (usual treatment) or health worker-delivered education/counseling combined with usual treatment (intervention). MAIN OUTCOMES AND MEASURESThe primary outcome was anemia cure rate defined as hemoglobin level at or greater than 11 g/dL during follow-up. RESULTSOf the children included in the study, the mean age was 30 months, with a slightly higher ratio of boys to girls. Of 534 children with anemia (intervention n = 303; usual treatment n = 231), 517 were reassessed after 6 months (intervention n = 298; usual treatment n = 219) while 17 were lost to follow-up (intervention n = 5 and usual treatment n = 12). Anemia cure rate was higher in children in the intervention group compared with children receiving usual treatment (55.7% [n = 166 of 298] vs 41.4% [n = 90 of 219]). The risk ratio derived through multilevel logistic regression was 1.37(95%CI,1.04-1.70);themodel-estimatedriskdifferencewas15.1%(95%CI,3.9-26.3).Interventiongroup children demonstrated larger mean hemoglobin increments (difference, intervention vs control: 0.25 g/dL; 95% CI, 0.07-0.44 g/dL) and improved IFA adherence (61.7%; 95% CI, 56.2-67.3 vs 48.4%; 95% CI, 41.7-55.1 consumed >75% of tablets provided). Adverse events were mild (intervention: 26.8%; 95% CI, 21.8-31.9 vs usual treatment: 21%; 95% CI, 15.6-26.4). To cure 1 child with anemia, 7 mothers needed to be counseled (number needed to treat: 7; 95% CI, 4-26).CONCLUSIONS AND RELEVANCE Parental education and counseling by a community health worker achieved perceivable gains in curing childhood anemia. Policy makers should consider this approach to enhance population level anemia control.

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Effect of Micronutrient Sprinkles on Reducing Anemia

Cited by 63 publications

References 27 publications

Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

Effects of a large-scale micronutrient powder and young child feeding education program on the micronutrient status of children 6–24 months of age in the Kyrgyz Republic

Association of Early Interventions With Birth Outcomes and Child Linear Growth in Low-Income and Middle-Income Countries

Effect of a Community Health Worker–Delivered Parental Education and Counseling Intervention on Anemia Cure Rates in Rural Indian Children

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