Use of ferrous sulfate drops or a single daily dose of microencapsulated ferrous fumarate sprinkles plus ascorbic acid resulted in a similar rate of successful treatment of anemia without side effects. To our knowledge, this is the first demonstration of the use of microencapsulated iron sprinkles to treat anemia. Improved ease of use may favor the use of sprinkles to deliver iron.

Although iron deficiency is the most common single-nutrient deficiency in infants and children, other deficiencies may develop concurrently, including zinc deficiency. In previous studies, we used home-fortification with "Sprinkles," single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods, to successfully treat anemia. This mode of micronutrient delivery is amenable to the delivery of other micronutrients. However, the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions. Thus, we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants, compared with Sprinkles formulated with iron alone. We studied 304 anemic infants (mean age 10.3 +/- 2.5 mo; hemoglobin 87.4 +/- 8.4 g/L) in rural Ghana. A combined supplementation group (FeZn) received daily Sprinkles containing 80 mg iron and 10 mg zinc; a comparison group (Fe) received Sprinkles (80 mg iron) without zinc for 2 mo. The rate of recovery from anemia was higher in the Fe group compared with the FeZn group (74.8 vs. 62.9%; P = 0.048). The plasma zinc concentration decreased significantly in both groups (P < 0.05). A significant decline in the height for age Z-score was observed in the FeZn group (P = 0.0011), but there was no change in the Fe group. These results suggest that in a controlled setting, home-fortification using micronutrient Sprinkles with iron, or iron and zinc, was very successful in treating anemia; however, this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population.

A single versus a 3-times-daily dose of ferrous sulfate drops over 2 months resulted in a similar rate of successful treatment of anemia, without side effects. To our knowledge, this is the first demonstration of the use of a single-dose daily regimen to treat anemia. Although not examined in the current study, use of a single-dose daily regimen may improve adherence to treatment of anemia in infants.

This study provides insight into physician preferences for eCME and hypotheses that can be used to guide further research.