Effect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial

Abstract

BackgroundMultiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce.MethodsA multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment.ResultsIn CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children.ConclusionsMNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children.Trial RegistrationRegistro Brasileiro de Ensaios Clinicos RBR-5ktv6b

Correlation between maternal and childhood VitB12, folic acid and ferritin levels

“…Another study in UK showed 40 percent of women (19-34years) have low iron levels. A study in India showed increased ferritin threshold for children with increased C reactive protein 3. Insufficient iron can affect brain myelination 7.…”

Iron Deficiency Anaemia

“…The choice of processed food vehicles varies widely by region and context, depending on the subpopulation targeted, food consumption and acceptability, food availability and sustainability, as well as the financial and technical concerns. The staple food is the most commonly used as vehicle of fortification, in addition, milk powder, beverages, biscuits, the most commonly used sauce, such as soy sauce, drink and water, can also be used as fortified foods [92][93][94][95][96][97][98][99][100][101][102][103][104].…”

The impact of home fortification with multiple micronutrient powder on vitamin A status in young children: A multicenter pragmatic controlled trial in Brazil

“…Study design details have been previously reported (Cardoso et al, 2016). Study design details have been previously reported (Cardoso et al, 2016).…”

“…The Estudo Nacional de Fortificação caseira da Alimentação Complementar (ENFAC), a pragmatic, controlled clinical trial, was conducted between June 2012 and June 2013 in Brazil. Study design details have been previously reported (Cardoso et al, 2016). Briefly, the ENFAC study was primarily designed to assess the impact of MNP among infants who attended to 24 large primary health centers in four cities (Rio Branco, Olinda, Goiânia, and Porto Alegre) from different regions in Brazil.…”