Efficacy Trials of a Micronutrient Dietary Supplement in Schoolchildren and Pregnant Women in Tanzania

Abstract

Traditionally, the main strategies used to control micronutrient deficiencies have been food diversification, consumption of medicinal supplements, and food fortification. In Tanzania, we conducted efficacy trials using a dietary supplement as a fourth approach. These were randomized, double-blind, placebo-controlled efficacy trials conducted separately first in children and later in pregnant women. The dietary supplement was a powder used to prepare an orange-flavored beverage. In the school trial, children consumed 25 g per school day attended. In the pregnancy trial, women consumed the contents of two 25-g sachets per day with meals. This dietary supplement, unlike most medicinal supplements, provided 11 micronutrients, including iron and vitamin A, in physiologic amounts. In both trials we compared changes in subjects consuming either the fortified or the nonfortified supplement. Measures of iron and vitamin A status were similar in the groups at the baseline examination, but significantly different at follow-up, always in favor of the fortified groups. Children receiving the fortified supplement had significantly improved anthropometric measures when compared with controls. At four weeks postpartum, the breast milk of a supplemented group of women had significantly higher mean retinol content than did the milk of mothers consuming the nonfortified supplement. The advantages of using a fortified dietary supplement, compared with other approaches, include its ability to control several micronutrient deficiencies simultaneously; the use of physiologic amounts of nutrients, rather than megadoses that require medical supervision; and the likelihood of better compliance than with the use of pills because subjects liked the beverage used in these trials.

Preventive Treatments of Iron Deficiency Anaemia in Pregnancy: A Review of Their Effectiveness and Implications for Health System Strengthening

“…Furthermore, two Vietnamese studies showed similar improvements in iron stores following ingestion of ironfortified fish sauce for six to 12 months [42, 43]. Comparable results were documented with dietary supplements containing iron and ironfortified milk [30, 31]. …”

Decreased Parasite Load and Improved Cognitive Outcomes Caused by Deworming and Consumption of Multi-Micronutrient Fortified Biscuits in Rural Vietnamese Schoolchildren

“…[21][22][23] A meta-analysis of multiple micronutrient supplementation showed a positive effect on child growth with effect sizes of 0.28 (95% confidence interval = 0.16-0.41) for height and 0.28 (95% confidence interval = -0.07 to 0.63) for weight. 24 Multiple micronutrient fortification showed a positive effect on growth in some studies 25,26 but not in other studies such as in school children in Thailand 27 and South Africa. 28 The present study investigated the impact of multi-micronutrient fortification in combination with de-worming in a school-based approach on growth, cognitive function, and parasite load among rural Vietnamese schoolchildren and whether combining the two interventions was more beneficial than either intervention alone.…”

Maternal nutrition: how is Eastern and Southern Africa faring and what needs to be done?

“…Agricultural interventions by promoting production and use of vitamin A rich sweet potatoes significantly increased vitamin A intake from orange sweet potato sources and serum retinol levels 50,51 . Multiple micronutrient supplementation (MMN) among pregnant and lactating women significantly improved hemoglobin, serum ferritin, birth weight, small-for-gestational age (SGA), anemia in children with non-significant impact on serum retinol levels and preterm birth [52][53][54][55][56][57][58][59][60][61] . Malaria prevention in pregnancy showed that the use of ITNs in pregnancy sig- nificantly reduced the risk of peripheral parasitemia [62][63][64][65][66][67] .…”