Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in Western Kenya

Abstract

Background Although the use of micronutrient powders (MNPs) is considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials have challenged programmatic scale-up. Objective We aimed to measure the effects of community-based sales of MNPs on diarrhea-, fever-, cough-, and malaria-morbidity episodes in children 6–35 mo of age. Design We conducted a cluster-randomized trial in rural Western Kenya where 60 villages were randomly assigned to either intervention or control groups. MNPs (containing iron, vitamin A, zinc, and 11 other micronutrients) and other health products (e.g., insecticide-treated bednets, soap, and water disinfectant) were marketed in 30 intervention villages from June 2007 to March 2008. Household visits every 2 wk were used to monitor self-reported MNP use and morbidity (illness episodes in the previous 24 h and hospitalizations in the previous 2 wk) in both groups. Iron, vitamin A, anemia, malaria, and anthropometric measures were assessed at baseline and at 12 mo of follow-up. Data were analyzed by intent-to-treat analyses. Results Of 1062 children enrolled in the study, 1038 children (97.7%) were followed (a total of 14,204 surveillance visits). Mean MNP intake in intervention villages was 0.9 sachets/wk. Children in intervention villages, compared with children in control villages, had ~60% fewer hospitalizations for diarrhea (0.9% compared with 2.4%, respectively; P = 0.03) and 70% fewer hospitalizations for fever (1.8% compared with 5.3%, respectively; P = 0.003) but no significant differences in hospitalizations for respiratory illness (1.1% compared with 2.2%, respectively; P = 0.11) or malaria (3.1% compared with 2.9%, respectively; P = 0.82). There were no differences between groups in the numbers of episodes of diarrhea, cough, or fever. Conclusions MNP use in Western Kenya through market-based community sales was not associated with increased infectious morbidity in young children and was associated with decreased hospitalizations for diarrhea and fever. An integrated distribution of MNPs with other health interventions should be explored further in settings with a high child malnutrition and infection burden. This trial was registered at clinicaltrials.gov as NCT01088958.

Micronutrient powder supplements combined with nutrition education marginally improve growth amongst children aged 6–23 months in rural Burkina Faso: A cluster randomized controlled trial

“…This result contrasts with the findings of a large trial in Pakistan, which found an increased incidence of diarrhoea and chest indrawing morbidity in MNP-supplemented children (Soofi et al, 2013) but supports the results of other trials that evaluated the impact of MNP on morbidity outcomes (Lemaire et al, 2011;Osei et al, 2015;Sharieff, Bhutta, Schauer, Tomlinson, & Zlotkin, 2006;Suchdev et al, 2016). Most of the latter studies even reported lower risk of diarrhoea (Lemaire et al, 2011;Osei et al, 2015;Suchdev et al, 2016). In our study, the increase in diarrhoea prevalence may be an indication of side-effects of the supplements, which seemed to be mitigated due to the intensive counselling on the use of MNP and appropriate complementary feeding.…”

Anaemia, iron deficiency and susceptibility to infection in children in sub‐Saharan Africa, guideline dilemmas

“…Their predictive value is often limited by infection, as most iron biomarkers act as acute‐phase‐proteins. To bypass this confounding effect, some studies adjust their cut‐off values using inflammatory markers (C‐reactive protein or alpha ‐1‐acid glycoprotein) as correcting factors (Esan et al , ; Le Nguyen Bao et al , ; Suchdev et al , ), whereas others have made use of iron biomarkers that are less affected by inflammation (e.g. serum transferrin receptor, zinc protoporphyrin) (Wander et al , ).…”

Impact of the Integration of Water Treatment, Hygiene, Nutrition, and Clean Delivery Interventions on Maternal Health Service Use

“…8 Alternatively, because of a saturation of water treatment marketing in the population, its use may have plateaued. 8,[40][41][42] Finally, it is possible that lack of product acceptability might have influenced uptake by mothers. We did not collect data on acceptability of WaterGuard, but it is possible that issues of taste, product cost, or beliefs that water did not need to be treated may have limited use; similar barriers have been noted in other studies.…”