Effectiveness of a Program Intervention with Reduced-Iron Multiple Micronutrient Powders on Iron Status, Morbidity and Growth in Young Children in Ethiopia

Abstract

Despite the potential for improving iron status and child growth in low- and middle-income settings, concerns on the safety of high iron dosages of Micronutrient Powders (MNP currently limit their applicability in programs. We examined the effectiveness and risks of an integrated complementary feeding program with low iron dose (6 mg/serving) MNP among 6–23-month-old Ethiopian children using a quasi-experimental study design comparing children from five intervention districts (n = 1172) to those from four matched non-intervention districts (n = 1137). Haemoglobin concentrations increased in intervention and decreased in non-intervention children (group-difference +3.17 g/L), but without improvement in iron stores. Intervention children were 2.31 times more likely to have diarrhoea and 2.08 times more likely to have common cold and flu, but these differences decreased towards the end of the intervention. At end line, intervention children had higher mean Height-for-Age Zscore (HAZ) and a 51% reduced odds of being stunted compared to non-intervention children. MNP with low iron dose, when provided combined with other Infant and Young Child Feeding (IYCF) interventions, marginally improved haemoglobin status and resulted in a remarkable improvement in linear growth in 6–23-month-old children. These benefits likely outweigh the relatively small increase in the risk of diarrhoea.

Micronutrient Supplementation and Fortification Interventions on Health and Development Outcomes among Children Under-Five in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

“…Of these studies, 121 studies were randomized controlled trials , 57 were cluster randomized controlled trials , 11 were non-randomized controlled trials [218][219][220][221][222][223][224][225][226][227][228], 2 were natural experiments [229,230], 4 were controlled before-after studies [231][232][233][234], 1 was an interrupted time-series study [235], and 1 was a propensity score matched retrospective cohort study [236]. 86 studies were conducted in Asia [43,48,49,54,55,57,[59][60][61][62]69,[72][73][74][75][76][78][79][80]83,86,87,92,97,98,107,110,117,[119]…”

Bottlenecks and predictors of coverage and adherence outcomes for a micronutrient powder program in Ethiopia

“…A recent national micronutrient survey found that 34% of children under 5 years of age experience anaemia, 18% are iron deficient, 14% vitamin A deficient and 35% zinc deficient (Ethiopian Public Health Institute, ). Point‐of‐use fortification of complementary foods with MNP has been demonstrated to improve growth and haemoglobin status among Ethiopian children 6–23 months of age (Samuel et al, ).…”

“…A recent national micronutrient survey found that 34% of children under 5 years of age experience anaemia, 18% are iron deficient, 14% vitamin A deficient and 35% zinc deficient (Ethiopian Public Health Institute, 2016). Point-of-use fortification of complementary foods with MNP has been demonstrated to improve growth and haemoglobin status among Ethiopian children 6-23 months of age (Samuel et al, 2018). A theory-driven, mixed-method, formative process evaluation was conducted to elucidate how the intervention worked, with the goal of determining what aspects of program delivery and adherence went well, identifying where problems occurred and understanding the magnitude and causes of problems.…”

Penatalaksanaan Efektif dalam Rangka Peningkatan Pertumbuhan Anak pada Kasus Stunting

“…Empat studi memberikan intervensi mikronutrien dalam bentuk bubuk/tablet dengan berbagai model atau jenis. Intervensi yang diberikan berisi mikronutrien antara lain energi, protein, lemak, karbohidrat, kalsium, fosfat, sodium, potassium, magnesium, iron, zinc, iodine, manganese, copper, niacin, thiamin, riboflavin, taurine, pantothenic acid, folat, choline, biotin, selenium, chloride, retinol, phosphorus, vitamin (A,B,C,D,E,K) (Christian et al, 2015;Hess et al, 2015;Phuka et al, 2009;Samuel et al, 2018 (A,C,D) dan membandingkan dengan kelompok kontrol yang diberikan formula rendah kalori dan rendah protein (Lebenthal et al, 2014;Yackobovitch-Gavan et al, 2016). Pemberian mikronutrien pada kelompok intervensi meningkatkan tinggi badan (p<0.001) dan berat badan (p = 0.005) pada anak yang termasuk dalam kategori "good consumer" atau mengkonsumsi >50% formula yang diberikan.…”

“…Terdapat juga peningkatan konsentrasi Hb (+2.4 ± 1.2 g/L) pada kelompok intervensi sedangkan pada kelompok kontrol mengalami penurunan konsentrasi Hb (Samuel et al, 2018). Peningkatan TB dan BB secara signifikan menurunkan prevalensi stunting, wasting, dan underweight (Hess et al, 2015).…”