Effect of Daily versus Once-Weekly Home Fortification with Micronutrient Sprinkles on Hemoglobin and Iron Status among Young Children in Rural Bangladesh

Hyder, S.M. Ziauddin; Haseen, Farhana; Rahman, Md. Saydur; Tondeur, Mélody; Zlotkin, Stanley

doi:10.1177/156482650702800204

Cited by 42 publications

(51 citation statements)

References 30 publications

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“…Al respecto, se ha evaluado diferentes estrategias para lograr una mayor adherencia, como incrementar el tiempo de exposición pero con dosis flexibles para asegurar cubrir la deficiencia de hierro (23) o tener solo una toma semanal pero a altas dosis (24,25) , situaciones que podrían ser evaluadas en nuestro contexto.…”

Section: Discussionunclassified

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

Huamán-Espino¹,

Aparco²,

Nuñez-Robles³

et al. 2012

Rev Peru Med Exp Salud Publica

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RESUMENObjetivos. Evaluar la implementación del programa de suplementación universal con multimicronutrientes "Chispitas ® " en la región Apurímac a través de la cantidad y calidad de sobres consumidos y su relación con la anemia, en niños de 6 a 35 meses. Materiales y métodos. Se realizó un estudio transversal usando un muestreo multietápico en el 2010. Se consideró como anemia a los valores de hemoglobina ajustados por altitud menores de 110 g/L. El consumo de multimicronutrientes se categorizó en: menor de 30; de 30 a 59, y 60 o más sobres. La calidad del consumo fue adecuada cuando la madre refería que el niño consumía toda la comida con el suplemento. Se calculó las razones de prevalencia (RPa) ajustadas por regresión de Poisson. Resultados. Se incluyó 714 participantes, 25,3% vivía en hogares pobres y 59,2% en extrema pobreza; 52,6% residía a más de 3000 m de altitud. La prevalencia de anemia fue de 51,3% (IC95%: 47,1-55,4%), 5,4% no recibió la intervención; 60,3% consumió 60 o más sobres y 49,0% los consumió en forma adecuada. No se encontró asociación entre la cantidad de sobres recibidos o consumidos y la anemia (p<0,05). Aquellos niños que consumieron el suplemento en forma adecuada tuvieron menor prevalencia de anemia que aquellos que no lo hicieron (RPa: 0,81; IC95%: 0,68-0,96) Conclusiones. No basta con entregar o consumir la cantidad necesaria de los multimicronutrientes, sino asegurar que el proceso de consumo sea adecuado para lograr una reducción de la prevalencia de anemia, aspecto que debe ser trabajado para mejorar esta intervención. CONSUMPTION OF CHISPITAS ® MULTIMICRONUTRIENT SUPPLEMENTS AND ANEMIA IN 6 -35-MONTH-OLD CHILDREN: CROSS-CUT STUDY IN THE CONTEXT OF A POPULATIONAL HEALTH INTERVENTION IN APURIMAC, PERU ABSTRACT Objectives.To assess the implementation of the Universal "Chispitas®" Multimicronutrient Supplement Program in Apurimac by determining the quantity and quality of sachets consumed and their connection with anemia, in 6 -35-monthold children. Materials and methods. A crosscut study was conducted by using a multistage sample in 2010. Anemia was considered to be related to altitude-adjusted hemoglobin values below 110 g/L. The consumption of multimicronutrients was classified as follows: less than 30; 30 to 59, and 60 or more sachets. The quality of consumption was considered to be adequate when the mother indicated that the child ate all his food with the supplement. The rationale for prevalence (RPa) adjusted by Poisson regression was calculated. Results. 714 participants were included, 25.3% of which lived in poor houses and 59.2% in extreme poverty; 52.6% lived at over 3000 m of altitude. The prevalence of anemia was 51.3% (CI95%: 47.1-55.4%), 5.4% did not receive intervention; 60.3% consumed 60 or more sachets and 49.0% consumed them adequately. No association between the number of sachets received or consumed and anemia (p<0.05) was found. Children who consumed the supplement adequately showed lower prevalence of anemia than those who did not (RPa: 0.81; CI95%: 0.68-0....

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Section: Discussionunclassified

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

Huamán-Espino¹,

Aparco²,

Nuñez-Robles³

et al. 2012

Rev Peru Med Exp Salud Publica

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“…However, all mothers were instructed not to give more than one sachet a day. The content of Sprinkles sachets was identical for all groups and included 12.5 mg elemental iron as microencapsulated ferrous fumarate, 5 mg zinc as zinc gluconate, 300 mg retinol equivalents as retinol acetate, 160 mg folic acid and 50 mg vitamin C. The rationale for delivering 60 sachets to all children was based on the demonstrated efficacy of a twomonth daily supply of Sprinkles (Zlotkin et al, 2001(Zlotkin et al, , 2003Hirve et al, 2007;Hyder et al, 2007).…”

Section: Methodsmentioning

confidence: 99%

“…For example, a recent field trial in India showed that a daily iron dose of 12.5 mg given as Sprinkles over a two-month period significantly increased haemoglobin concentrations and successfully treated anaemia (Hirve et al, 2007). In a recent study in Bangladesh, focus group discussions revealed that mothers preferred a less structured regimen than daily use (Hyder et al, 2007). Mothers reported that a prescribed dosing regimen, whether daily or onceweekly was rigid and imposed psychological stress if a scheduled dose was inadvertently missed.…”

Section: Introductionmentioning

confidence: 99%

Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control

Hyder

Haseen

et al. 2007

Eur J Clin Nutr

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Background/Objectives: Despite repeated public commitments and availability of various forms of iron supplements, rates of anaemia in developing countries remain high. A major reason for this lack of success has been poor adherence. The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence, acceptability and haematological status among young children in rural Bangladesh. Subjects/Methods: A sample of 362 children (haemoglobin (Hb)X70 g l À1 ) aged 6-24 months were cluster-randomized to receive 60 sachets of Sprinkles either (i) daily over 2 months; (ii) flexibly over 3 months; or (iii) flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day. Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussions. Haemoglobin was measured at baseline, at the end of each intervention period and 6 months post-intervention. Results: Mean percent adherence was significantly higher in the flexible-4-month group (98%) compared to the flexible-3-month (93%) and daily-2-month (88%) groups (Po0.01). Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use. Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group (P ¼ 0.03). Anaemia prevalence decreased by 65% in the flexible-4-month group compared to 54% in the flexible-3-month and 51% in the daily-2-month groups. Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month (82%) and flexible-3-month (80%) groups than the daily-2-month (53%) group (Po0.05). Conclusions: The adherence, acceptability and haematological response to flexible administration over 4 months were found preferable to daily.

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“…Kaliganj is a fair representation of rural Bangladesh with its high population density, fertile agricultural land, susceptibility to seasonal flooding, and limited access to health-care and education services. Similar to other rural settings of Bangladesh, the study area is known to have widespread malnutrition and poverty, with women and children bearing most of the burden (29,30) . Kaliganj is not an area with endemic malaria or hookworm (hookworms affect fewer than 2 % of children under the age of 2 years), but it does have a high prevalence of IDA (approximately 87 %) among children 6 to 24 months of age (29)(30)(31) .…”

Section: Study Area and Participantsmentioning

confidence: 99%

“…However, the original Sprinkles MNP formulation did not contain Ca because of the postulated negative effect on Fe absorption (29) . In the current study, we used a new Sprinkles MNP formulation which included Ca in addition to Fe, Zn, folic acid, ascorbic acid and vitamin A.…”

mentioning

confidence: 99%

Home fortification with calcium reduces Hb response to iron among anaemic Bangladeshi infants consuming a new multi-micronutrient powder formulation

Khan

Shafique

Shikder

et al. 2013

Public Health Nutr.

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Objective: To investigate whether the recommended dietary intake of Ca in anaemic infants compromises the expected Hb response, via home fortification with a new Ca-and Fe-containing Sprinkles TM micronutrient powder (MNP). Design: A double-blind, randomized controlled, 2-month trial was conducted in Bangladesh. Infants were randomized to one of two MNP intervention groups containing Fe and other micronutrients, with or without Ca. Hb, anthropometrics and dietary intake were measured pre-and post-intervention while family demographics were collected at baseline. Setting: Twenty-six rural villages in the Kaliganj sub-district of Gazipur, Bangladesh.

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Effect of Daily versus Once-Weekly Home Fortification with Micronutrient Sprinkles on Hemoglobin and Iron Status among Young Children in Rural Bangladesh

Abstract: Background.

Cited by 42 publications

References 30 publications

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

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

Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control

Home fortification with calcium reduces Hb response to iron among anaemic Bangladeshi infants consuming a new multi-micronutrient powder formulation

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