Multi‐micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial

Abstract

Home-fortification of complementary foods with micronutrients (including iron) as Sprinkles is a new strategy to control iron deficiency and anaemia in developing countries. However, the most effective dose and form of iron is not known. The purpose of this study was to compare the efficacy of various doses (12.5, 20 or 30 mg) and treatment methods (multi-micronutrient Sprinkles vs. ferrous sulphate drops) on haemoglobin (Hb) concentration after 8 weeks of treatment in anaemic children. In total, 133 anaemic Ghanaian children (Hb 70-99 g L(-1)) aged 6-18 months were randomly assigned to one of five daily interventions for 8 weeks. Out of the five interventions, four used Sprinkles, and one used iron drops. Of the four Sprinkles groups, three included 12.5, 20 or 30 mg of iron as ferrous fumarate, and one included 20 mg of iron as ferric pyrophosphate. The iron drops group included 12.5 mg of iron as liquid ferrous sulphate. Hb concentrations were measured at baseline, week 3 and week 8. The primary outcome measure was Hb concentration at 8 weeks after treatment. We compared differences in Hb and ferritin concentrations and prevalence of iron deficiency anaemia (Hb < 100 g L(-1) and soluble transferrin receptor concentrations >8.5 mg L(-1)) from baseline to 8 weeks within and between groups. Adherence and reporting of side effects (staining of the teeth, ease of use, diarrhoea and darkening of stools) were compared between groups. Mean change in Hb was 1.4 g L(-1) (SD = 1.8) (P = 0.0001). Change in Hb concentrations from baseline to 8 weeks was significant in all groups (P = 0.0001-0.0007), with no differences across groups. Geometric means of serum ferritin varied from 18.6 to 44.0 microg L(-1) at baseline. At week 8, these means were in the interval of 48.0-78.3 microg L(-1), with no group differences. Prevalence of iron deficiency anaemia decreased significantly from baseline to 8 weeks in all groups with the exception of the iron drops group, with no group differences. Adherence was lower in the drops group (64%) as compared with Sprinkles groups (84%). Greater staining of the teeth and less ease of use were reported in the drops group as compared with Sprinkles groups. A dose as low as 12.5 mg of iron as ferrous fumarate when provided as Sprinkles may be effective in anaemic children.

Consumo de suplementos con multimicronutrientes Chispitas® y anemia en niños de 6 a 35 meses: estudio transversal en el contexto de una intervención poblacional en Apurímac, Perú

“…Para evaluar esta situación hay que considerar varios aspectos, en primer lugar tener en cuenta que a pesar de que los suplementos tipo multimicronutrientes tienen una mejor adherencia que el tratamiento con sulfato ferroso (19) , esta es muy variable en programas de uso masivo, donde es relevante monitorear la aceptabilidad y uso, conocer los motivos de no uso para mitigarlo y supervisarlo en forma continua, como se ha demostrado en estudios realizados en Kenya (20)(21)(22) .…”

Anemia and Helicobacter pylori Seroreactivity in a Rural Haitian Population

“…14,[35][36][37][38][39] Given the high prevalence of anemia and malnutrition in this population, it is obviously appropriate to study the effects of public health interventions such as micronutrient fortification powders, 37 AK-1000 (Akamil) fortified home supplement, 40 deworming, 41 and maternal education on infant nutrition. 20 Finally, the devastating January 2010 earthquake and the subsequent cholera epidemic have likely exacerbated the situation and increased the prevalence of anemia and malnutrition in this rural Haitian population.…”

Randomised comparison of the effects of Sprinkles and Foodlets with the currently recommended supplement (Drops) on micronutrient status and growth in Iranian children

“…Using the one-way analysis of variance multiple comparisons test with 80% power and 5% significance level, detecting a 4 g/l difference in mean Hb between groups at the end of intervention (Hop and Berger, 2005;Smuts et al, 2005a;Christofides et al, 2006) requires a sample size of 360 children (120 in each group), based on the standard (MOHME, 2001). Similarly this provides sufficient power to detect mean group differences of 5.5 mg/dl in serum zinc, using s ¼ 13.5 mg/dl.…”

“…The potential effectiveness of CFS in Iran is uncertain as the majority of Sprinkles and Foodlets efficacy trials have recruited anaemic children as participants in areas with a higher prevalence of anaemia than in Iranian children (Zlotkin et al, 2001(Zlotkin et al, , 2003Smuts et al, 2005b;Christofides et al, 2006). In addition, other micronutrient deficiencies coexist with anaemia, which may reduce the effectiveness of CFS.…”