Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana

Abstract

Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana’s malaria endemic area.

Impact of IgG response to malaria-specific antigens and immunity against malaria in pre-school children in Ghana. A cluster randomized, placebo-controlled trial

“…The trial was registered at ClinicalTrials.gov-registered trial (https://clinicaltrials.gov/ct2/ show/record/NCT01001871) [21]. The study was explained in local dialect to parents and guardians and informed consent was obtained from respective guardians before the children were enrolled as previously described [21,22]. Qualifying children aged 6 to 35 months were enrolled and randomized (1:1) to receive either iron-MNP or without iron (MNP-Sprinkles1 Mumbai, India).…”

“…Qualifying children aged 6 to 35 months were enrolled and randomized (1:1) to receive either iron-MNP or without iron (MNP-Sprinkles1 Mumbai, India). A cluster consisted of one or more households in the same compound with at least one child enrolled, and a cluster randomization design was used to prevent cross contamination between the groups through food sharing, using (in-house written programme) a computer-generated model [22]. The detailed comprehensive randomization and recruitment process has previously been reported [22].…”

“…About 500 μl of finger or heel prick blood was collected from each participants into an ethylene diamine tetra-acetic acid (EDTA) tube at baseline (BL) and endline (EL) for haematological, malaria microscopy, acute protein process, and iron biomarker analyses as previously described [21,22]. Briefly, at the start of the study, a malaria rapid diagnostic test (RDT) (Paracheck Pf 1 Device, Orchid Biomedical Systems, Verna, Goa, India) was used to screen the children; those who tested positive were treated for malaria, after which they were enrolled.…”

“…A haematofluorometer was used to measure the zinc protoporphyrin (ZPP) in red blood cells (Model 206D, Aviv Biomedical Inc. Lakewood, NJ, USA). The remaining blood sample was centrifuged to obtained plasma and the following procedures used an indirect enzyme-linked immunosorbent assay (ELISA) to measure ferritin (Fn) (Spectro Ferritin S-22, Ramco Laboratories Inc. USA) and transferrin receptor (TfR) (TFC-94, Ramco Laboratories Inc. USA) levels as previously reported in details elsewhere [21,22].…”

“…Iron-deficient was defined as lack iron reserves to meet functional or metabolic needs, ironsufficient indicates excess iron reserves, iron-replete shows that enough iron reserves to meet functional or metabolic needs and finally, iron-deficiency anaemia is the final stage of iron deficiency characterized by a mean haemoglobin level below 10 g / L in preschool children [21,22]. At baseline, there was no significant difference in the prevalence of iron deficiency between the children in the iron and non-iron arm (44.11% versus.…”