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

Abstract

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.

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

“…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.…”

Anemia y adherencia a la suplementación oral con hierro en una muestra de niños usuarios de la red de salud pública de Rosario, Santa Fe

“…[16][17][18] Una revisión publicada por Lutter y cols. 19 mostró la eficacia de controlar la adherencia a la suplementación con hierro para disminuir la prevalencia de la anemia infantil, mientras que otros estudios 20,21 sobre estrategias alternativas comunicaron resultados contradictorios.…”

Acceptance and Effect of Ferrous Fumarate Containing Micronutrient Sprinkles on Anemia, Iron Deficiency and Anthropometrics in Honduran Children

“…In a study conducted by Adu-Afarwuah et al (2008), 96.9% of mothers thought it was easy to give the sprinkles supplement, 89.6% said that the child accepted the food well, 95.9% did not have any major problems feeding the sprinkles to the child and 100% had a good impression of the sprinkles supplement. Allowing flexible administration vs. daily administration of micronutrient sprinkles improved adherence and was more acceptable (Ip et al, 2009). In an evaluation of iron drops vs. sprinkles, both groups had generally pour adherence and overall, there was no significant difference between groups (Geltman et al, 2009).…”

“…An analysis of studies that used dispersion of micronutrients in sachets completed by Horton et al (2010) resulted in an increase in Hb concentration of 0.057 g/dL and IDA was reduced as compared to controls. When allowing flexible administration of micronutrient sprinkles compared to daily administration Hb was significantly higher in the group allowed flexible administration and resulted in an anemia prevalence decrease by 65% vs. 51% (Ip et al, 2009). In comparison with other studies (Adu-Afarwuah et al, 2008;Giovannini et al, 2006;Zlotkin et al, 2003a), this study attempted to determine the utility of sprinkles to prevent anemia in non-anemic children.…”