Effect of micronutrient sprinkles on reducing anemia: a cluster-randomized effectiveness trial. Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA but not amaranth grain flour reduces anemia and iron deficiency in Kenyan preschool children. Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. Combined intensive nutrition education and micronutrient powder supplementation improved nutritional status of mildly wasted children on Nias Island, Indonesia. Effect of zinc supplementation on growth and body composition of Ugandan preschool children: a randomized, controlled, intervention trial. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. A multimicronutrient-fortified seasoning powder enhances the hemoglobin, zinc, and iodine status of primary school children in North East Thailand: a randomized controlled trial of efficacy. Effect of daily or weekly multiple-micronutrient and iron foodlike tablets on body iron stores of Indonesian infants aged 6-12 mo: a double-blind, randomized, placebo-controlled trial. A micronutrient-fortified seasoning powder reduces morbidity and improves short-term cognitive function, but has no effect on anthropometric measures in primary school children in northeast Thailand: a randomized controlled trial. Effect of a 12-mo micronutrient intervention on learning and memory in well-nourished and marginally nourished school-aged children: 2 parallel, randomized, placebo-controlled studies in Australia and Indonesia. Micronutrient Sprinkles reduce anemia among 9- to 24-mo-old children when delivered through an integrated health and nutrition program in rural Haiti. Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as sprinkles to complementary (weaning) foods. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. Plasma beta-carotene and retinol concentrations of children increase after a 30-d supplementation with the fruit Momordica cochinchinensis (gac). Effect of iron fortification on malaria incidence in infants and young children in Ghana: a randomized trial. Zinc and other micronutrients supplementation through the use of sprinkles: impact on the occurrence of diarrhea and respiratory infections in institutionalized children. Use of microencapsulated iron(II) fumarate sprinkles to prevent recurrence of anaemia in infants and young children at high risk. Effectiveness of a community-based responsive feeding programme in rural Bangladesh: a cluster randomized field trial. Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial Impacts on Breastfeeding Practices of At-Scale Strategies That Combine Intensive Interpersonal Counseling, Mass Media, and Community Mobilization: Results of Cluster-Randomized Program Evaluations in Bangladesh and Viet Nam Effect of Daily versus Once-Weekly Home Fortification with Micronutrient Sprinkles on Hemoglobin and Iron Status among Young Children in Rural Bangladesh Effects of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on preschool children in a suburb of Chongqing, China. A micronutrient powder with low doses of highly absorbable iron and zinc reduces iron and zinc deficiency and improves weight-for-age Z-scores in South African children. Effect of iron fortification of nursery complementary food on iron status of infants in the DPRKorea. Bioavailability of Iron from Micro-Encapsulated Iron Sprinkle Supplement Combining Intensive Counseling by Frontline Workers with a Nationwide Mass Media Campaign Has Large Differential Impacts on Complementary Feeding Practices but Not on Child Growth: Results of a Cluster-Randomized Program Evaluation in Bangladesh123 Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa Short-term daily or weekly administration of micronutrient Sprinkles has high compliance and does not cause iron overload in Chinese schoolchildren: a cluster-randomised trial. Sustainability of market-based community distribution of Sprinkles in western Kenya. Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control Randomised comparison of the effects of Sprinkles and Foodlets with the currently recommended supplement (Drops) on micronutrient status and growth in Iranian children Comparison of response between food supplemented with powdered iron and iron in syrup form for iron deficiency anemia. GRADE guidelines: 3. Rating the quality of evidence. Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial Multi-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial. Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops. Delivering Sprinkles Plus through the Integrated Child Development Services (ICDS) to Reduce Anemia in Pre-school Children in India Low dose 'Sprinkles'-- an innovative approach to treat iron deficiency anemia in infants and young children. Daily Use of Sprinkles Micronutrient Powder for 2 Months Reduces Anemia among Children 6 to 36 Months of Age in the Kyrgyz Republic: A Cluster-Randomized Trial Selling Sprinkles micronutrient powder reduces anemia, iron deficiency, and vitamin A deficiency in young children in Western Kenya: a cluster-randomized controlled trial. [Effect of weekly rice fortification with iron on anemia prevalence and hemoglobin concentration among children attending public daycare centers in Rio de Janeiro, Brazil]. Efficacy of Fortification of School Meals with Ferrous Glycine Phosphate and Riboflavin against Anemia and Angular Stomatitis in Schoolchildren Micronutrients (including zinc) reduce diarrhoea in children: The Pakistan Sprinkles Diarrhoea Study A Cluster-Randomized Evaluation of a Responsive Stimulation and Feeding Intervention in Bangladesh Formative Research Exploring Acceptability, Utilization, and Promotion in Order to Develop a Micronutrient Powder (Sprinkles) Intervention among Luo Families in Western Kenya Acceptability of micronutrient fortified school meals by schoolchildren in rural Himalayan villages of India. A responsive feeding intervention increases children's self-feeding and maternal responsiveness but not weight gain. Iron fortification adversely affects the gut microbiome, increases pathogen abundance and induces intestinal inflammation in Kenyan infants Effect of vitamin A, vitamin A plus iron and multiple micronutrient-fortified seasoning powder on infectious morbidity of preschool children. Large-Scale Behavior-Change Initiative for Infant and Young Child Feeding Advanced Language and Motor Development in a Cluster-Randomized Program Evaluation in Bangladesh. Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India.
OBJECTIVE To evaluate the effectiveness of Sprinkles alongside infant and young child feeding ( IYCF ) education compared with IYCF education alone on anemia , deficiencies in iron , vitamin A , and zinc , and growth  in Cambodian infants . DESIGN Cluster-r and omized effectiveness study . SETTING Cambodian rural health district . PARTICIPANTS Among 3112 infants aged 6 months , a r and om sub sample ( n = 1350 ) was surveyed at baseline and 6-month intervals to age 24 months . INTERVENTION Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months . MAIN OUTCOME MEASURES Prevalence of anemia ; iron , vitamin A , and zinc deficiencies ; and growth via biomarkers and anthropometry . RESULTS Anemia prevalence ( hemoglobin level < 11.0 g/dL [ to convert to grams per liter , multiply by 10.0 ] ) was reduced in the intervention arm compared with the control arm by 20.6 % at 12 months ( 95 % CI , 9.4 - 30.2 ; P = .001 ) , and the prevalence of moderate anemia ( hemoglobin level < 10.0 g/dL ) was reduced by 27.1 % ( 95 % CI , 21.0 - 31.8 ; P < .001 ) . At 12 and 18 months , iron deficiency prevalence was reduced by 23.5 % ( 95 % CI , 15.6 - 29.1 ; P < .001 ) and 11.6 % ( 95 % CI , 2.6 - 17.9 ; P = .02 ) , respectively . The mean serum zinc concentration was increased at 12 months ( 2.88 μg/dL [ to convert to micromoles per liter , multiply by 0.153 ] ; 95 % CI , 0.26 - 5.42 ; P = .03 ) . There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time . CONCLUSIONS Sprinkles reduced anemia and iron deficiency and increased the  mean serum zinc concentration in Cambodian infants . Anemia and zinc effects did not persist beyond the intervention period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12608000069358 Objective : To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude . Design : Double blind iron supplementation trial including a placebo control group . Setting : A socioeconomically disadvantaged district of La Paz , Bolivia ( altitude of 4000 m ) . Subjects : Anemic ( hemoglobin concentration≤144 g/L ) , 3.3–8.3 y old children of both sexes . Intervention : Children received a placebo ( n=57 ) or a dose of 3–4 mg of elemental iron per kg body weight ( FeSO4 tablets ) 1 d per week ( n=58 ) or 5 d per week ( n=58 ) for 16 weeks . Results : Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group . Changes in hemoglobin during the study were not significantly different between supplemented groups ( weekly group : 15.2±6.9 g/L and daily group : 18.6±11.1 g/L ) but were different from the placebo group ( 0.5±7.1 g/L , P<0.001 ) . At the end of the supplementation period , the hemoglobin distribution was Gaussian , and similar in both supplemented groups . Adjusting for the initial hemoglobin concentration , final hemoglobin and its changes were similar in both supplemented groups . Conclusion : Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude . Sponsorship : Program supported in part by ORSTROM , the French Ministry of Foreign Affairs and the National Secretary 's Office of Health , Bolivia Few studies have evaluated the impact of fortification with iron-rich foods such as amaranth grain and multi-micronutrient powder ( MNP ) containing low doses of highly bioavailable iron to control iron deficiency anemia ( IDA ) in children . We assessed the efficacy of maize porridge enriched with amaranth grain or MNP to reduce IDA in Kenyan preschool children . In a 16-wk intervention trial , children ( n = 279 ; 12 - 59 mo ) were r and omly assigned to : unrefined maize porridge ( control ; 4.1 mg of iron/meal ; phytate : iron molar ratio 5:1 ) ; unrefined maize ( 30 % ) and amaranth grain ( 70 % ) porridge ( amaranth group ; 23 mg of iron/meal ; phytate : iron molar ratio 3:1 ) ; or unrefined maize porridge with MNP ( MNP group ; 6.6 mg iron/meal ; phytate : iron molar ratio 2.6:1 ; 2.5 mg iron as NaFeEDTA ) . Primary outcomes were anemia and iron status with treatment effects estimated relative to control . At baseline , 38 % were anemic and 30 % iron deficient . Consumption of MNP reduced the prevalence of anemia [ -46 % ( 95 % CI : -67 , -12 ) ] , iron deficiency [ -70 % ( 95 % CI : -89 , -16 ) ] , and IDA [ -75 % ( 95 % CI : -92 , -20 ) ] . The soluble transferrin receptor [ -10 % ( 95 % CI : -16 , -4 ) ] concentration was lower , whereas the hemoglobin ( Hb ) [ 2.7 g/L ( 95 % CI : 0.4 , 5.1 ) ] and plasma ferritin [ 40 % ( 95 % CI : 10 , 95 ) ] concentrations increased in the MNP group . There was no significant change in Hb or iron status in the amaranth group . Consumption of maize porridge fortified with low-dose , highly bioavailable iron MNP can reduce the prevalence of IDA in preschool children . In contrast , fortification with amaranth grain did not improve iron status despite a large increase in iron intake , likely due to high ratio of phytic acid : iron in the meal BACKGROUND Children participating in the Integrated Child Development Service ( ICDS ) in India have high rates of iron and vitamin A deficiency . OBJECTIVE The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi , a rice and dal mixture , in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency , anemia , and vitamin A deficiency . DESIGN This cluster , r and omized , double-blind , controlled trial was initiated in 30 Anganwadi centers ( daycare centers ) in West Bengal state , India . Children aged 36 - 66 mo ( n = 516 ) attending village-based ICDS centers were r and omly assigned to receive either a fortified or a nonfortified premix for 24 wk . Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin , serum ferritin , and serum retinol . RESULTS The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups ( P < 0.001 ) . Prevalence rates of anemia , iron deficiency , and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group ( P < 0.001 ) . There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups . CONCLUSION A premix fortified with iron , vitamin A , and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia To assess the impact of intensive nutrition education ( INE ) with or without the provision of micronutrient powder ( MNP ) on the nutritional status of mildly wasted children in Nias , Indonesia , two groups of mildly wasted ( > = -1.5 to < -1.0 WHZ ) children aged > = 6 to < 60 months in the Church World Service ( CWS ) project areas were assigned by village r and omization to receive INE ( n=64 ) or INE+MNP ( n=51 ) in a weekly program . Another two groups of mildly wasted children who were living at a clear distance from INE and INE+MNP villages were selected to receive a monthly non-intensive nutrition education program ( NNE ) with or without MNP ( n=50 both respectively ) . WHZ , weight , height , haemoglobin ( Hb ) level , and morbidity data were assessed at admission , during the study , and at individual discharge .  Children 's weight gain ( g/kg body weight/day ) was highest in INE+MNP group ( 2.2±2.1 ) , followed by INE ( 1.1±0.9 ) , NNE+MNP ( 0.3±0.5 ) and NNE ( 0.3±0.4 ) group . In both MNP intervention groups ( INE+MNP , NNE+MNP ) , supplements significantly increased Hb value ( g/L ) of respective children ( 10.0±10.0 ; p<0.001 and 3.0±8.0 ; p<0.05 respectively ) . Proportion of children who reached discharge criterion was highest among the INE+MNP ( 70.6 % ; n=36 ) , followed by INE ( 64.1 % ; n=41 ) , NNE+MNP ( 26.0 % ; n=13 ) , and NNE ( 20.0 % ; n=10 ) groups ( p<0.001 ) . Shortest length of stay until recovery was observed among children in the INE+MNP group ( 29.9 days ) , followed by INE ( 40.0 days ) , NNE+MNP ( 80.6 days ) , and NNE ( 86.2 days ) respectively ( p<0.001 ) . Weekly intensive nutrition education supported by MNP supplementation produced the best results regarding weight gain and haemoglobin status of mildly wasted children BACKGROUND Despite ample food supplies , the incidence of childhood underweight and stunting remains high in Ug and a. Many factors contribute to this situation , but the role of low zinc intakes has not been adequately explored . OBJECTIVE Our objective was to study the effect of zinc supplementation on growth and body composition of preschool children by using the outcome measures of weight , height , and midupper arm circumference ( MUAC ) . DESIGN The study was r and omized , double-blind , placebo-controlled , parallel , and 8 mo long , and incorporated 6 mo of zinc supplementation .  Children ( n = 153 ) aged 55.8 + /- 11.2 mo from 3 r and omly selected nursery schools of medium , low , and very low socioeconomic status in a suburb of Kampala took part . The intervention comprised 10 mg Zn ( as ZnSO4 ) or placebo daily in freshly prepared fruit juice , Monday to Friday inclusive . RESULTS Zinc supplementation increased MUAC by the end of the study ( P = 0.029 ) and led to greater weight gain in children from the school of medium socioeconomic status at 3 and 8 mo ( P = 0.019 and P = 0.038 , respectively ) . There was no effect on weight gain of the children from the other schools . Zinc supplementation had no influence on height . Infection rates ( of which 82 % were recorded as malaria ) were lower in the zinc-supplemented group than in control subjects ( P = 0.063 ) . CONCLUSIONS Zinc supplementation may counter the age-related decrease in MUAC often observed in preschool children in developing countries . The study provides evidence that zinc may not be the most limiting nutrient for weight gain in children of poor nutritional status , but may become so as nutritional status improves Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with anemia ( hemoglobin < 110 g/L ) , 16 % vitamin A deficiency ( plasma retinol < 0.7 micromol/L ) , 47 % zinc deficiency ( plasma zinc < 10.7 micromol/L ) , 2 % underweight , and 11 % stunting . There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study . The DMM was the most effective intervention tested , not only for improving anemia but also for improving iron , zinc , riboflavin , and tocopherol status Anemia and co-existing deficiencies of zinc , iron , iodine , and vitamin A occur among children in many developing countries including NE Thail and , probably contributing to impairments in growth , immune competence , and cognition . Sustainable strategies are urgently required to combat these deficiencies . We assessed the efficacy of a micronutrient-fortified seasoning powder served with a school lunch on reducing anemia and improving the micronutrient status of rural NE Thai children . Children ( n = 569 ) aged 5.5 - 13.4y from 10 schools were r and omly assigned to receive a seasoning powder either unfortified or fortified with zinc ( 5 mg ) , iron ( 5 mg ) , vitamin A ( 270 microg ) , and iodine ( 50 microg ) ( per serving ) and incorporated into a school lunch prepared central ly and delivered 5 d/wk for 31 wk . Teachers monitored school lunch consumption . Baseline and final micronutrient status , hemoglobinopathies , and infection or inflammation were assessed from blood and urine sample s. For the primary outcome , anemia ( based on hemoglobin ) , no intervention effect was apparent ( odds ratio : 1.02 95 % CI : 0.69 , 1.51 ) after adjustment for design strata . The odds of zinc ( based on serum zinc ) and urinary iodine deficiency in the fortified group were 0.63 ( 0.42 , 0.94 ) and 0.52 ( 0.38 , 0.71 ) times those in the unfortified group , respectively . Fortification had no effect on serum retinol ( 0.61 : 0.25,1.51 ) , ferritin ( 1.12 : 0.43 , 2.96 ) , or mean red cell volume ( 1.16 : 0.82 , 1.64 ) . Therefore , a micronutrient-fortified seasoning powder is a promising vehicle for improving zinc , iodine , and hemoglobin status , and its potential for incorporation into lunch programs in day care centers and schools in NE Thail and warrants investigation BACKGROUND There is still uncertainty about the best procedure to alleviate iron deficiency . Additionally more reliable methods are needed to assess the effect of iron intervention . OBJECTIVE We examined the efficacy of daily iron ( 10 mg ) , daily and weekly multiple-micronutrient supplementation ( 10 and 20 mg Fe , respectively ) in improving body iron stores of Indonesian infants . DESIGN Infants aged 6 - 12 mo were r and omly allocated to 1 of 4 groups : daily multiple-micronutrients ( DMM ) foodlike tablets ( foodLETs ) , weekly multiple-micronutrient ( WMM ) foodLETs , daily iron ( DI ) foodLETs , or daily placebo .  Hemoglobin , ferritin , transferrin receptors , and C-reactive protein data were obtained at baseline and 23 wk . RESULTS Body iron estimated from the ratio of transferrin receptors to ferritin was analyzed for 244 infants . At baseline , mean iron stores ( 0.5 + /- 4.1 mg/kg ) did not differ among the groups , and 45.5 % infants had deficits in tissue iron ( body iron < 0 ) . At week 23 , the group DI had the highest increment in mean body iron ( 4.0 mg/kg ) , followed by the DMM group ( 2.3 mg/kg ; P < 0.001 for both ) . The iron stores in the WMM group did not change , whereas the mean body iron declined in the daily placebo group ( -2.2 mg/kg ; P < 0.001 ) . Compared with the daily placebo group , the DMM group gained 4.55 mg Fe/kg , the DI group gained 6.23 mg Fe/kg ( both P < 0.001 ) , and the WMM group gained 2.54 mg Fe/kg ( P = 0.001 ) . CONCLUSIONS When compliance can be ensured , DI and DMM foodLETs are efficacious in improving and WMM is efficacious in maintaining iron stores among Indonesian infants BACKGROUND Reductions in iodine and zinc deficiencies and improvements in hemoglobin were achieved from a micronutrient-fortified seasoning powder consumed in school lunches by children in northeast Thail and . OBJECTIVE The objective was to determine whether fortification with 4 micronutrients in a school lunch results in changes in children 's growth , morbidity , and cognitive function compared with no fortification . DESIGN In a r and omized controlled trial of 569 children aged 5.5 - 13.4 y from 10 schools , we compared the efficacy of a seasoning powder fortified with or without 5 mg Fe , 5 mg Zn , 50 mug I , and 270 mug vitamin A per serving consumed with a school lunch 5 d/wk . Here we report on results of the secondary functional outcomes . RESULTS The groups were comparable concerning compliance and loss to follow-up . The intervention had no statistically significant effect on anthropometric measures over 31 wk , but reduced the incidence of respiratory-related illnesses [ rate ratio ( RR ) : 0.83 ; 95 % CI : 0.73 , 0.94 ] , symptoms of runny nose ( RR : 0.80 ; 95 % CI : 0.70 , 0.92 ) , cough ( RR : 0.80 ; 95 % CI : 0.66 , 0.96 ) , and diarrhea ( RR : 0.38 ; 95 % CI : 0.16 , 0.90 ) . For the visual recall test , those in the fortified group recalled 0.5 more items ( 95 % CI : 0.1 , 0.9 ) than did the controls . There were no statistically significant differences between groups in the results of the digits forward and backward tests or in school grade s at the conclusion of the 2 semesters . CONCLUSION The beneficial effects on morbidity and visual recall over a short period , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a school lunch . This trial was registered at clinical trials.gov as ACTRN12605000341628 BACKGROUND Little is known about the combined effect of micronutrients and essential fatty acids on cognitive function in school-aged children . OBJECTIVE We assessed the effect of micronutrients , long-chain n-3 fatty acids , or both on indicators of cognitive performance in well-nourished and marginally nourished school-aged children . DESIGN Two 2-by-2 factorial r and omized controlled double-blind trials were performed home-based in Adelaide , South Australia , and at 6 primary schools in Jakarta , Indonesia . A total of 396 children ( aged 6 - 10 y ) in Australia and 384 children in Indonesia were r and omly allocated to receive a drink with a micronutrient mix ( iron , zinc , folate , and vitamins A , B-6 , B-12 , and C ) , with docosahexanoic acid ( DHA , 88 mg/d ) and eicosapentaenoic acid ( EPA , 22 mg/d ) , or with both or placebo 6 d/wk for 12 mo .  Biochemical indicators were determined at baseline and 12 mo . Cognitive performance was measured at baseline , 6 mo , and 12 mo . RESULTS The micronutrient treatment significantly improved plasma micronutrient concentrations in Australian and Indonesian children . DHA+EPA treatment increased plasma DHA and total plasma n-3 fatty acids in both countries . The micronutrient treatment result ed in significant increases in scores on tests representing verbal learning and memory in Australia ( estimated effect size : 0.23 ; 95 % CI : 0.01 , 0.46 ) . A similar effect was observed among Indonesian girls ( estimated effect size : 0.32 ; 95 % CI : -0.01 , 0.64 ) . No effects were found on tests measuring general intelligence or attention . No effects of DHA+EPA on the factors of cognitive tests were observed . CONCLUSION In well-nourished school-aged children , fortification with multiple micronutrients can result in improvements in verbal learning and memory We evaluated the effectiveness of a 2-mo treatment of Sprinkles containing 12.5 mg iron , 5 mg zinc , 400 microg vitamin A , 160 microg folic acid , and 30 mg vitamin C in reducing  anemia among children 9- to 24 mo old in Haiti . Ten food distribution points ( FDP ) where children received take-home rations of fortified wheat-soy blend ( WSB ) were r and omly allocated into 2 groups : 1 ) Sprinkles-WSB ( S-WSB ) ( 6 FDP ; n = 254 ) , receiving 30 sachets of Sprinkles monthly for 2 mo ; and 2 ) WSB only ( WSB ) ( 4 FDP ; n = 161 ) , not receiving Sprinkles . At baseline , anemia prevalence [ hemoglobin ( Hb ) < 100 g/L ] , adjusted for age and sex , was 54 and 39 % in S-WSB and WSB groups , respectively . After the 2-mo intervention ( 1st follow-up ) , anemia , adjusted for baseline prevalence , age , and sex dropped to 24 % in S-WSB ( P < 0.001 ) and increased to 43 % in WSB ( P = 0.07 ) . At 7 mo postintervention , anemia in S-WSB declined to 14 % ; 92 % of children who were nonanemic at 1st follow-up remained so without further Sprinkles consumption . From baseline to 1st follow-up , mean Hb increased by 5.5 g/L and dropped by 1.0 g/L in the S-WSB and WSB groups , respectively ( P < 0.001 ) . From baseline to 2nd follow-up , mean Hb increased by 10.9 g/L in S-WSB ( P < 0.001 ) . Changes in mean Hb were greater for younger children ( < 21 mo at onset of intervention ) ( P < 0.05 ) and for children who were anemic at baseline ( P < 0.001 ) . In population s with a high prevalence of anemia , such as rural Haiti , 2 mo of Sprinkles are effective in reducing anemia among 9- to 24-mo-old children BACKGROUND St and ard therapy for anemia in infants is ferrous sulfate drops administered 3 times/d . Adherence to treatment , however , is often poor . One likely reason for poor adherence is the unpleasant side effects associated with drops . OBJECTIVE The objective was to evaluate the use of a new form of iron and a delivery system to treat anemia in infants that is likely to produce better adherence to treatment . DESIGN Using a prospect i ve , r and omized , controlled design , we studied 557 anemic children aged 6 - 18 mo ( hemoglobin : 70 - 99 g/L ) in rural Ghana . One group received a daily sachet of microencapsulated ferrous fumarate ( 80 mg elemental Fe ) in powder form plus ascorbic acid to be sprinkled onto any complementary food eaten ( sprinkles group ) ; a control group received ferrous sulfate drops 3 times/d for 2 mo ( total dose : 40 mg elemental Fe ) . Hemoglobin and serum ferritin concentrations were measured at baseline and at the end of treatment . RESULTS Successful treatment of anemia ( hemoglobin > 100 g/L ) occurred in 58 % of the sprinkles group and in 56 % of the drops group , with minimal side effects in both groups . Geometric mean ferritin concentrations increased significantly in each group from baseline to the end of treatment ( P < 0.001 ) . CONCLUSION Use of ferrous sulfate drops or a single daily dose of microencapsulated ferrous fumarate sprinkles plus ascorbic acid result ed in a similar rate of successful treatment of anemia without side effects . To our knowledge , this is the first demonstration of the use of microencapsulated iron sprinkles to treat anemia . Improved ease of use may favor the use of sprinkles to deliver iron Although iron deficiency is the most common single-nutrient deficiency in infants and children , other deficiencies may develop concurrently , including zinc deficiency . In previous studies , we used home-fortification with " Sprinkles , " single-serve sachets containing microencapsulated ferrous fumarate added to weaning foods , to successfully treat anemia . This mode of micronutrient delivery is amenable to the delivery of other micronutrients . However , the relative efficacy of multiple micronutrient supplements for the treatment of anemia requires evaluation due to possible nutrient interactions . Thus , we evaluated the relative efficacy of Sprinkles formulated with iron and zinc in anemic infants , compared with Sprinkles formulated with iron alone . We studied 304 anemic infants ( mean age 10.3 + /- 2.5 mo ; hemoglobin 87.4 + /- 8.4 g/L ) in rural Ghana . A combined supplementation group ( FeZn ) received daily Sprinkles containing 80 mg iron and 10 mg zinc ; a comparison group ( Fe ) received Sprinkles ( 80 mg iron ) without zinc for 2 mo . The rate of recovery from anemia was higher in the Fe group compared with the FeZn group ( 74.8 vs. 62.9 % ; P = 0.048 ) . The plasma zinc concentration decreased significantly in both groups ( P < 0.05 ) . A significant decline in the height for age Z-score was observed in the FeZn group ( P = 0.0011 ) , but there was no change in the Fe group . These results suggest that in a controlled setting , home-fortification using micronutrient Sprinkles with iron , or iron and zinc , was very successful in treating anemia ; however , this intervention alone was insufficient to improve zinc status or promote catch-up growth in this stunted and wasted population BACKGROUND In rural Vietnam , vitamin A deficiency is a concern . Among the indigenous fruit and vegetables , Momordica cochinchinensis ( gac ) fruit has been identified as having the highest beta-carotene concentration . Locally , it is mixed with rice in a preparation called xoi gac . OBJECTIVE The purpose of this study was to assess this beta-carotene- rich rice preparation as a source of provitamin A for children in rural Vietnam . DESIGN Preschoolers ( n = 185 ) participated in a 30-d controlled supplementation trial . Children with low hemoglobin concentrations were assigned to 1 of 3 groups : a fruit group , who received xoi gac that contained 3.5 mg beta-carotene per serving ; a powder group , who received rice mixed with 5.0 mg synthetic beta-carotene powder ; and a control group , who received rice without fortification . RESULTS The mean increase in plasma beta-carotene concentrations in the fruit and powder groups was significantly greater than that in the control group ( P < 0.0001 ) . After supplementation , the mean plasma retinol concentration in the fruit group was significantly higher than that in the control ( P = 0.006 ) and powder ( P = 0.0053 ) groups . Among the children with initial hemoglobin concentrations < or=110 g/L , the mean increase in hemoglobin concentrations in the fruit group was marginally higher than that in the control group ( P = 0.017 ) but was not significantly different from that in the powder group . CONCLUSIONS beta-Carotene from xoi gac is a good source of provitamin A carotenoids . Severely anemic children might particularly benefit from routine xoi gac IMPORTANCE In sub-Saharan Africa , malaria is a leading cause of childhood morbidity and iron deficiency is among the most prevalent nutritional deficiencies . In 2006 , the World Health Organization and the United Nations Children 's Fund released a joint statement that recommended limiting use of iron supplements ( tablets or liquids ) among children in malaria-endemic areas because of concern about increased malaria risk . As a result , anemia control programs were either not initiated or stopped in these areas . OBJECTIVE To determine the effect of providing a micronutrient powder ( MNP ) with or without iron on the incidence of malaria among children living in a high malaria-burden area . DESIGN , SETTING , AND PARTICIPANTS Double-blind , cluster r and omized trial of children aged 6 to 35 months ( n = 1958 living in 1552 clusters ) conducted over 6 months in 2010 in a rural community setting in central Ghana , West Africa . A cluster was defined as a compound including 1 or more households . Children were excluded if iron supplement use occurred within the past 6 months , they had severe anemia ( hemoglobin level < 7 g/dL ) , or severe wasting ( weight-for-length z score < -3 ) . INTERVENTIONS Children were r and omized by cluster to receive a MNP with iron ( iron group ; 12.5 mg/d of iron ) or without iron ( no iron group ) . The MNP with and without iron were added to semiliquid home-prepared foods daily for 5 months followed by 1-month of further monitoring . Insecticide-treated bed nets were provided at enrollment , as well as malaria treatment when indicated . MAIN OUTCOMES AND MEASURES Malaria episodes in the iron  group compared with the no iron group during the 5-month intervention period . RESULTS In intention-to-treat analyses , malaria incidence overall was significantly lower in the iron group compared with the no iron group ( 76.1 and 86.1 episodes/100 child-years , respectively ; risk ratio ( RR ) , 0.87 [ 95 % CI , 0.79 - 0.97 ] ) , and during the intervention period ( 79.4 and 90.7 episodes/100 child-years , respectively ; RR , 0.87 [ 95 % CI , 0.78 - 0.96 ] ) . In secondary analyses , these differences were no longer statistically significant after adjusting for baseline iron deficiency and anemia status overall ( adjusted RR , 0.87 ; 95 % CI , 0.75 - 1.01 ) and during the intervention period ( adjusted RR , 0.86 ; 95 % CI , 0.74 - 1.00 ) . CONCLUSION AND RELEVANCE In a malaria-endemic setting in which insecticide-treated bed nets were provided and appropriate malaria treatment was available , daily use of a MNP with iron did not result in an increased incidence of malaria among young children . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01001871 OBJECTIVE To evaluate the incidence of diarrheal disease ( DD ) and acute respiratory infection ( ARI ) in children undergoing supplementation of zinc and other micronutrients through the use of sprinkles , as well as their acceptance by these patients . METHOD This was a r and omized double-blinded clinical trial of 143 healthy institutionalized children , aged 6 to 48 months . They were r and omized into two groups and received daily zinc and micronutrients - test group ( sprinkles ) , or micronutrients without zinc - control group . Children were supplemented for 90 days and followed regarding the outcomes of DD and ARI . RESULTS Of the r and omized children , 52.45 % belonged to the test and 47.55 % to the control group . The incidence of DD in the test group was 14.7 % and was 19.1 % in the control group . The test group showed a lower risk of developing DD when compared to controls , but this finding was not statistically significant ( RR=0.77 [ 0.37 to 1.6 ] , p=0.5088 ) . ARI had high incidence in both groups , 60 % in the test group and 48.5 % in the control group , with an increased risk of developing the disease in the test group , but with no statistical significance ( RR=1.24 [ 0.91 to 1.68 ] , p=0.1825 ) . Regarding acceptance , the mean percentage of consumption , in days , of the entire content of the sachets containing sprinkles was 95.72 % ( SD=4.9 ) and 96.4 % ( SD=6.2 ) for the test and control groups , respectively . CONCLUSIONS Zinc supplementation through the use of sprinkles did not reduce the incidence of DD or ARI among the evaluated children . The sprinkles were well accepted by all study participants OBJECTIVE To compare the effectiveness of microencapsulated iron(II ) fumarate sprinkles ( with and without vitamin A ) , iron(II ) sulfate drops , and placebo sprinkles in preventing recurrence of anaemia and to determine the long-term haematological outcomes in children at high risk of recurrence of anaemia 12 months after the end of supplementation . METHODS A prospect i ve , r and omized , placebo-controlled design was used to study 437 Ghanaian children aged 8 - 20 months who were not anaemic ( haemoglobin > or = 100 g/l ) . Four groups were given microencapsulated iron(II ) fumarate sprinkles , microencapsulated iron(II ) fumarate sprinkles with vitamin A , iron(II ) sulfate drops or placebo sprinkles daily for six months . Primary outcome measures were change in haemoglobin and anaemic status at baseline and study end . Non-anaemic children at the end of the supplementation period were reassessed 12 months after supplementation ended . FINDINGS Overall , 324 children completed the supplementation period . Among the four groups , no significant changes were seen in mean haemoglobin , ferritin or serum retinol values from baseline to the end of the supplementation period . During the trial , 82.4 % ( 267/324 ) of children maintained their non-anaemic status . Sprinkles were well accepted without complications . At 12 months post-supplementation , 77.1 % ( 162/210 ) of children with no intervention remained non-anaemic . This proportion was similar for children among the four groups . CONCLUSION In most children previously treated for anaemia , further supplementation was not needed to maintain their non-anaemic status . These results may have important implication s for community intervention programmes in which initial high-dose treatment is needed because of a high prevalence of anaemia Responsive complementary feeding , whereby the mother feeds her child in response to child cues of hunger state and psychomotor abilities , is a problem in some countries , and likely contributes to malnutrition . Interventions are needed to evaluate whether promoting responsive feeding would add any benefit . Using a cluster r and omized field trial , we evaluated a six-session educational programme that emphasized practice of two key behaviours , namely child self-feeding and maternal responsiveness . One hundred mothers and their 12- to 24-month-olds attended the sessions as part of village clusters r and omly assigned to the intervention group . A similar number of controls received sessions on foods to feed and nutritional disorders . Outcomes assessed at pre-test , 2-week post-intervention and again 5-months post-intervention included weight , mouthfuls of food taken , self-feeding and maternal responsiveness . Research assistants , blind to group assignment , observed and coded mother and child behaviours during the midday meal . Secondary measures included foods fed and feeding messages recalled . Analysis was based on intention to treat and accounted for clustering . Only 10 % of each group was lost to follow-up . Weight ( d = 0.28 ) , weight gain ( d = 0.48 ) and child self-feeding ( d = 0.30 ) were significantly higher in the responsive feeding group . Mouthfuls of food eaten and maternal responsiveness were not significantly increased by the intervention . Mothers in the intervention gave their children more vegetables , and spontaneously recalled more feeding messages at the 5-month follow-up . These results provide evidence that self-feeding and weight gain can improve by targeting specific behaviours , while maternal responsiveness may require more intensive strategies Background Multiple micronutrient deficiencies , in particular iron deficiency anaemia ( IDA ) is a severe public health problem in Lao People 's Democratic Republic ( Lao PDR ) . Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children , recently , home-fortification with multivitamins and minerals sprinkles was recommended . This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder ( MMP ) on anaemia prevalence , haemoglobin concentration , and growth in infants and young children in a rural community in Lao PDR . Methods A r and omized trial was conducted in six rural communities . Children aged 6 to 52 months ( n = 336 ) were r and omly assigned to a control group ( n = 110 ) or to one of two intervention groups receiving either two sachets per week ( n = 115 ) or a daily sachet ( n = 111 ) of MMP for 24 weeks ; 331 children completed the study . A finger prick of blood was taken at baseline , at week 12 , and again at week 24 to determine haemoglobin concentration . Anthropometric measurements were taken every 4 weeks . The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups . Results MMP supplementation result ed in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group ( p < 0.001 ) . The severely to moderately anaemic children ( Hb < 100 g/L ) on daily supplementation recovered faster than those on twice weekly supplementation . MMP was well accepted and compliance was high in both treatment groups . Overall , the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups . Conclusions MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration . For severely to moderately anaemic children , daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence . A longer intervention period is probably needed to have a positive effect on growth Background Despite recommendations supporting optimal breastfeeding , the number of women practicing exclusive breastfeeding ( EBF ) remains low , and few interventions have demonstrated implementation and impact at scale . Alive & Thrive was implemented over a period of 6 y ( 2009–2014 ) and aim ed to improve breastfeeding practice s through intensified interpersonal counseling ( IPC ) , mass media ( MM ) , and community mobilization ( CM ) intervention components delivered at scale in the context of policy advocacy ( PA ) in Bangladesh and Viet Nam . In Bangladesh , IPC was delivered through a large non-governmental health program ; in Viet Nam , it was integrated into government health facilities . This study evaluated the population -level impact of intensified IPC , MM , CM , and PA ( intensive ) compared to st and ard nutrition counseling and less intensive MM , CM , and PA ( non-intensive ) on breastfeeding practice s in these two countries . Methods and Findings A cluster-r and omized evaluation design was employed in each country . For the evaluation sample , 20 sub-districts in Bangladesh and 40 communes in Viet Nam were r and omized to either the intensive or the non-intensive group . Cross-sectional surveys ( n ~ 500 children 0–5.9 mo old per group per country ) were implemented at baseline ( June 7–August 29 , 2010 , in Viet Nam ; April 28–June 26 , 2010 , in Bangladesh ) and endline ( June 16–August 30 , 2014 , in Viet Nam ; April 20–June 23 , 2014 , in Bangladesh ) . Difference-in-differences estimates ( DDEs ) of impact were calculated , adjusting for clustering . In Bangladesh , improvements were significantly greater in the intensive compared to the non-intensive group for the proportion of women who reported practicing EBF in the previous 24 h ( DDE 36.2 percentage points [ pp ] , 95 % CI 21.0–51.5 , p < 0.001 ; prevalence in intensive group rose from 48.5 % to 87.6 % ) and engaging in early initiation of breastfeeding ( EIBF ) ( 16.7 pp , 95 % CI 2.8–30.6 , p = 0.021 ; 63.7 % to 94.2 % ) . In Viet Nam , EBF increases were greater in the intensive group ( 27.9 pp , 95 % CI 17.7–38.1 , p < 0.001 ; 18.9 % to 57.8 % ) ; EIBF declined ( 60.0 % to 53.2 % ) in the intensive group , but less than in the non-intensive group ( 57.4 % to 40.6 % ; DDE 10.0 pp , 95 % CI −1.3 to 21.4 , p = 0.072 ) . Our impact estimates may underestimate the full potential of such a multipronged intervention because the evaluation lacked a “ pure control ” area with no MM or national/provincial PA . Conclusions At-scale interventions combining intensive IPC with MM , CM , and PA had greater positive impacts on breastfeeding practice s in Bangladesh and Viet Nam than st and ard counseling with less intensive MM , CM , and PA . To our knowledge , this study is the first to document implementation and impacts of breastfeeding promotion at scale using rigorous evaluation design s. Strategies to design and deliver similar programs could improve breastfeeding practice s in other context s. Trial registration Clinical Trials.gov NCT01678716 ( Bangladesh ) and NCT01676623 ( Viet Nam Background The effectiveness of commonly suggested public health interventions to control  childhood iron- deficiency anemia  has been low . Objective To determine whether iron provided in Sprinkles daily or in a higher dose once weekly affected hemoglobin , serum ferritin levels , and serum transferrin receptor levels , and to determine whether there were dif- ferences in the effects of the two regimens . Methods In this cluster-r and omized , community- based trial conducted in rural areas of Bangladesh , 136 children aged 12 to 24 months with mild to moderate anemia ( hemoglobin 70–109 g/L ) were r and omly allo- cated to receive Sprinkles daily ( 12.5 mg of elemental iron , n = 79 ) or once weekly ( 30 mg of elemental iron , n = 73 ) for 8 weeks . Hemoglobin , serum ferritin , and serum transferrin receptor were assessed at the start and end of the intervention . Results In both groups , there were significant increases in hemoglobin and serum ferritin and a significant decrease in serum transferrin receptor ( p < .01 ) . There were no significant differences between the groups in the increases in hemoglobin ( 16.1 ± 13.2 g/L for the group receiving Sprinkles daily and 12.3 ± 13.3 g/L for the group receiving Sprinkles once weekly ) and serum ferritin ( 10.6 and 5.7 μg/L , respectively ) . The decrease in serum transferrin receptor also did not significantly differ between the groups ( median , −2.5 and −1 . 8 mg/L , respectively ) . The prevalence rates of iron-deficiency anemia , depleted iron stores , and tissue iron deficiency decreased significantly within each group ( p < .01 ) , with no significant differences between the groups . Conclusions Home fortification of complementary foods with Sprinkles given either daily or once weekly improved iron-deficiency anemia and iron status among young children Preschool children in developing countries are likely to have multiple , concurrent micronutrient deficiencies . This study was design ed to evaluate the effectiveness of different combinations of nutritional fortified diet to improve the blood levels of iron , vitamin A and other essential micronutrients in the preschool population of Banan District of Chongqing , China . From December 2005 to June 2006 , a total of 226 2 - 6 y old preschool children were recruited from three nurseries in the area , and they were r and omly assigned to three different fortified diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc and calcium , respectively . Subjects ' weight and height were measured for assessing the children 's growth and development . Blood sample s were taken at the beginning and the end of the 6-mo study period for measuring serum levels of micronutrients . Group III with the multiple micronutrient fortified diet was the most effective to improve the serum level of retinol from [ media ( P25 , P75 ) : 1.06 ( 0.89 , 1.32 ) ] micromol/L to 1.29 ( 1.04 , 1.39 ) micromol/L ( p<0.05 ) and retinol binding protein from 17.0 ( 12.6 , 25.6 ) mg/L to 31.6 ( 24.4 , 44.0 ) mg/L ( p<0.05 ) and to mobilize the stored iron in the liver ( p<0.05 ) . In addition , the three groups ' hemoglobin levels were elevated from 117.0 ( 109.0 , 124.1 ) g/L , 114.0 ( 109.2 , 119.7 ) g/L and 115.0 ( 109.5 , 122.7 ) g/L to 125.7 ( 119.2 , 133.1 ) g/L , 126.5 ( 122.2 , 135.9 ) g/L and 125.1 ( 119.8 , 131.6 ) g/L over the 6 mo of intervention period , but there were no difference among the three groups ( p>0.05 ) . Nevertheless , unexpected results were obtained when comparing the effects on growth status among the different supplement groups . Our study has demonstrated that a multiple micronutrient fortified diet for 6 mo is more effective to improve the levels of hemoglobin , serum retinol , and RBP as well as to facilitate the mobilization of iron storage in preschool children Micronutrient powders ( MNP ) are often added to complementary foods high in inhibitors of iron and zinc absorption . Most MNP therefore include high amounts of iron and zinc , but it is no longer recommended in malarial areas to use untargeted MNP that contain the Reference Nutrient Intake for iron in a single serving . The aim was to test the efficacy of a low-iron and -zinc ( each 2.5 mg ) MNP containing iron as NaFeEDTA , ascorbic acid ( AA ) , and an exogenous phytase active at gut pH. In a double-blind controlled trial , South African school children with low iron status ( n = 200 ) were r and omized to receive either the MNP or the unfortified carrier added just before consumption to a high-phytate maize porridge 5 d/wk for 23 wk ; primary outcomes were iron and zinc status and a secondary outcome was somatic growth . Compared with the control , the MNP increased serum ferritin ( P < 0.05 ) , body iron stores ( P < 0.01 ) and weight-for-age Z-scores ( P < 0.05 ) and decreased transferrin receptor ( P < 0.05 ) . The prevalence of iron deficiency fell by 30.6 % ( P < 0.01 ) and the prevalence of zinc deficiency decreased by 11.8 % ( P < 0.05 ) . Absorption of iron from the MNP was estimated to be 7 - 8 % . Inclusion of an exogenous phytase combined with NaFeEDTA and AA may allow a substantial reduction in the iron dose from existing MNP while still delivering adequate iron and zinc . In addition , the MNP is likely to enhance absorption of the high native iron content of complementary foods based on cereals and /or legumes The aim of this study was to determine the iron status of infants who consumed porridge cooked in water with added ferrous sulphate .  A total of 234 infants , aged 6 - 12 months , were recruited from 36 nurseries in the Democratic Peoples Republic of Korea ( DPRK North Korea ) and r and omly divided into iron ( Fe ) and placebo groups . At baseline , almost half the children had Hb<110 g/L and no significant differences between the two groups were found with regard to hemoglobin concentration and anemia prevalence . The Fe group received rice porridge fortified with 10 mg of iron ( as ferrous sulfate ) per day , added to the water in which the rice was cooked and the placebo group non-fortified cereal for 6 months . After which , the hemoglobin ( Hb ) , serum ferritin ( SF ) and packed cell volume ( PCV ) were measured and it was found that the proportion of children with anemia ( Hb<110 g/L ) was lower ( 24.3 % v 48.1 % p<0.01 ) , the Hb levels ( 117.6 g/L v 109.8 g/L p<0.001 ) and serum ferritin were higher ( 40.7 v 26.8 mcg/L p<0.001 ) ; and iron deficiency anemia ( Hb<110 g/L , SF<12 mcg/L ) was lower in the Fe group ( 3 % v 22 % p<0.001 ) when compared to the placebo group . Ferrous sulphate , added to the water in which rice was cooked , lowered the prevalence of iron deficiency anemia of infants in the DPRK with no adverse reactions . This simple fortification would be suitable as a nationwide program in the DPRK and other countries with large infant nurseries To improve the  iron status of infants an effort was made to increase the iron content of complementary foods by adding 12.5 mg of elemental iron to the meal in the form of micro-encapsulated ferrous fumarate coated with a lipid . The contents of the packet were sprinkled directly on to infant foods . Relative absorption of iron from this supplement was determined in a prospect i ve r and omized study with 39 infants ( mean age 33.6 ± 5.2 weeks ) with initial hemoglobin values greater than 100 g/L. They were fed two complementary foods ( rice-based and wheat-based ) in which the supplement labeled with stable isotopes of iron 57Fe and 58 Fe was incorporated . The erythrocyte iron incorporation was measured in the blood by inductively coupled plasma mass spectrophotometry . The incorporation of iron was significantly higher 11.9 % p < .001 and 13.3 % p < .001 and no difference was observed with the type of cereal in complementary foods . The use of ferrous fumarate sprinkles has proved to be efficacious in increasing the available iron intake of the infants Background : Complementary feeding ( CF ) contributes to child growth and development , but few CF programs are delivered at scale . Alive & Thrive addressed this in Bangladesh through intensified interpersonal counseling ( IPC ) , mass media ( MM ) , and community mobilization ( CM ) . Objective : The objective was to evaluate the impact of providing IPC + MM + CM ( intensive ) compared with st and ard nutrition counseling + less intensive MM + CM ( nonintensive ) on CF practice s and anthropometric measurements . Methods : We used a cluster-r and omized , nonblinded evaluation with cross-sectional surveys [ n = ∼600 and 1090 children 6–23.9 mo and 24–47.9 mo/group , respectively , at baseline ( 2010 ) and n = ∼500 and 1100 children of the same age , respectively , at endline ( 2014 ) ] . We derived difference-in-difference impact estimates ( DDEs ) , adjusting for geographic clustering , infant age , sex , differences in baseline characteristics , and differential change in characteristics over time . Results : Groups were similar at baseline . CF improvements were significantly greater in the intensive than in the nonintensive group [ DDEs : 16.3 , 14.7 , 22.0 , and 24.6 percentage points ( pp ) for minimum dietary diversity , minimum meal frequency , minimum acceptable diet , and consumption of iron-rich foods , respectively ] . In the intensive group , CF practice s were high : 50.4 % for minimum acceptable diet , 63.8 % for minimum diet diversity , 75.1 % for minimum meal frequency , and 78.5 % for consumption of iron-rich foods . Timely introduction of foods improved . Significant , nondifferential stunting declines occurred in intensive ( 6.2 pp ) and nonintensive ( 5.2 pp ) groups in children 24–47.9 mo . Conclusions : The intensive program substantially improved CF practice s compared with the nonintensive program . Large-scale program delivery was feasible and , with the use of multiple platforms , reached 1.7 million households . Nondifferential impacts on stunting were likely due to rapid positive secular trends in Bangladesh . Accelerating linear growth further could require accompanying interventions . This study establishes proof of concept for large-scale behavior change interventions to improve child feeding . This trial was registered at clinical trials.gov as NCT01678716 This current pilot trial assessed the feasibility of implementing a point-of-use ( PoU ) micronutrient fortification in preschool setting s. Preschool children ( n = 151 ) aged 36–79 months were r and omized into intervention ( n = 76 ) and control ( n = 75 ) groups , both receiving breakfast maize-porridge with added micronutrient or placebo powder for 52 school days . Process evaluation and early childhood development indicators were used to assess trial feasibility . Process evaluation results showed that the implementation components were feasible and could be delivered with high fidelity . The improvement in hemoglobin concentration in intervention and control groups were not significantly different ( P = 0.250 ) . There was medium likelihood for practical significance for the two global cognitive scores assessed : non-verbal index ( intervention effects : 7.20 ; 95 % confidence interval : 2.60 , 11.81 ; P = 0.002 , effect size : 0.55 ) and mental processing index ( intervention effects : 2.73 ; 95 % confidence interval : 0.25 , 5.70 ; P = 0.072 , effect size : 0.36 ) on the Kaufman Assessment Battery for Children , Second Edition . The lessons from this trial could help in planning/implementing future PoU micronutrient fortification trial among South African preschool children OBJECTIVES To examine consumption rates and serum ferritin ( SF ) concentrations ( as a marker of safety ) among schoolchildren ( 3 - 6 years ) provided with daily and weekly micronutrients . DESIGN AND METHODS Micronutrients were provided for one school term ( 13 weeks ) to a kindergarten in northern China as single-dose Sprinkles sachets containing 30 mg of iron as encapsulated ferrous fumarate , 5 mg zinc gluconate , 50 mg vitamin C , 300 microg vitamin A , 7.5 microg vitamin D3 and 150 microg folic acid .  Sixteen classrooms were r and omly assigned to : ( 1 ) daily supplements for 5 days a week ( daily group ) ; ( 2 ) weekly supplements ( weekly group ) ; or ( 3 ) no supplements ( control group ) . Consumption of sachets was monitored for each child and SF concentrations were measured at the end of study . R and om effects general linear models and graphs were used to compare the groups . RESULTS A total of 415 children from 16 classrooms entered the study . At the end of the study , mean consumption rates per child were 86 % ( daily group ; st and ard deviation ( SD ) 12 % ) and 87 % ( weekly group ; SD 16 % ) . Median SF concentrations were 71 microg l(-1 ) ( range 27 - 292 microg l(-1 ) ; daily group ) , 55 microg l(-1 ) ( range 11 - 299 microg l(-1 ) ; weekly group ) and 54 microg l(-1 ) ( range 7 - 327 microg l(-1 ) ; control group ) ; the overall difference was not significant ( P=0.06 ) . However , the daily group was significantly different from the control ( P=0.02 ) ; daily and weekly groups had higher SF at lower percentiles and similar SF at higher percentiles compared with the control group . CONCLUSION The high consumption rates and appropriate SF concentrations in the supplemented groups suggest that a short-term school programme with Sprinkles is an efficient and safe way to provide micronutrients ( including iron ) To evaluate the sustainability of market-based community distribution of micronutrient powders ( Sprinkles ( ® ) , Hexagon Nutrition , Mumbai , India . ) among pre-school children in Kenya , we conducted in August 2010 a follow-up survey , 18 months after study -related marketing and household monitoring ended . We surveyed 849 children aged 6 - 35 months r and omly selected from 60 study villages .  Nutritional biomarkers were measured by fingerstick ; demographic characteristics , Sprinkles purchases and use were assessed through household question naires . We compared Sprinkles use , marketing efforts and biomarker levels with the data from surveys conducted in March 2007 , March 2008 and March 2009 . We used logistic regression to evaluate associations between marketing activities and Sprinkles use in the 2010 survey . At the 2010 follow-up , 21.9 % of children used Sprinkles  in the previous 7 days , compared with 64.9 % in 2008 ( P < 0.001 ) . Average intake was 3.2 sachets week(-1 ) in 2008 , 1.6 sachets week(-1 ) in 2009 and 1.1 sachets week(-1 ) in 2010 ( P < 0.001 ) . Factors associated with recent Sprinkles use in 2010 included young age [ 6 - 23 months vs. 24 - 35 months , adjusted odds ratio ( aOR ) = 1.5 , P = 0.02 ] , lowest 2 quintiles of socio-economic status ( aOR = 1.7 , P = 0.004 ) , household attendance at trainings or launches ( aOR = 2.8 , P < 0.001 ) and ever receiving promotional items including free Sprinkles , calendars , cups and t-shirts ( aOR = 1.7 , P = 0.04 ) . In 2010 , there was increased prevalence of anaemia and malaria ( P < 0.001 ) , but not iron deficiency ( P = 0.44 ) , compared with that in 2008 . Sprinkles use in 2010 was associated with decreased iron deficiency ( P = 0.03 ) . Sprinkles coverage reduced after stopping household monitoring and reducing marketing activities . Continued promotion and monitoring of Sprinkles usage may be important components to sustain the programme 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)⩾70 g l−1 ) aged 6–24 months were cluster-r and omized 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 discussion s. 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 ( P<0.01 ) . 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=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 ( P<0.05 ) . Conclusions : The adherence , acceptability and haematological response to flexible administration over 4 months were found preferable to daily Background / Objectives : Multiple micronutrient supplementation with Sprinkles powder and crushable Foodlets tablets may be effective means of controlling micronutrient deficiencies in infants . Their efficacy has not been tested in countries like Iran where wheat as the staple food may affect nutrient bioavailability . This study aim ed to compare the efficacy of Sprinkles , Foodlets and the current supplement ( Drops ) for improving micronutrient status and growth among Iranian infants . Subjects/ Methods : Infants of 6–18 months of age , living in an urban district of Iran were r and omised to receive daily Sprinkles ( n=120 ) , Foodlets ( n=121 ) or Drops ( n=121 ) for 4 months . Haemoglobin ( Hb ) , serum ferritin , serum retinol , serum zinc , 25(OH ) D concentration and anthropometry were assessed at baseline and at 4 months . Results : Iron status improved with all treatments . Drops showed significantly greater changes in Hb and serum ferritin , though changes in anaemia prevalence were not different across groups . Infants having Foodlets and Sprinkles had significantly greater reductions in proportion of children with zinc deficiency compared with Drops . No significant differences in treatment effects were observed for mean serum 25(OH ) D and retinol , or for growth of infants across groups . Conclusion : The study was the first efficacy trial with Sprinkles and Foodlets in the Middle East where wheat or rice is the principal complementary foods . Differences across treatment groups were largely consistent with supplement micronutrient composition for iron and zinc , with no benefit in this population for serum retinol , 25(OH ) D , growth or anthropometric status . The trial identified trade-offs in combining multiple micronutrients in a single delivery mechanism OBJECTIVE To evaluate and compare the response between food supplemented with iron in powdered and iron in syrup forms for the treatment of iron deficiency anemia in children aged 1 - 5 years . DESIGN Quasi-experimental study . PLACE AND DURATION OF STUDY This study was conducted at Combined Military Hospital , Multan , from January 2000 to December 2000 . PATIENTS AND METHODS Consecutive 200 cases of iron deficiency anemia , aged 1 - 5 years , were included in the study . Diagnosis was based on history , physical examination , complete blood counts ( CBC ) and serum ferritin levels . The patients were r and omized to receive either iron in syrup form ( Group A ) or equivalent doses of iron powder sprinkled over food ( Group B ) . The patients were followed up with  hemoglobin estimation ( Hb ) and reticulocyte response at 2 weeks , 4 weeks and 6 weeks .  CBC and serum ferritin were repeated at 6 weeks . RESULTS Over half ( 51 % ) of the patients were between 1 - 2 years of age . One hundred thirty-two were males and 68 females . Most of the patients belonged to poor socioeconomic class . The iron in powder form was better tolerated than iron syrup as this group witnessed fewer episodes of gastrointestinal disturbances . The rise in mean Hb level after 6 weeks of treatment in group A and B was 1.6 g/dl and 1.9 g/dl respectively . Hemoglobin rise in group B was more than group A but this was statistically non-significant ( p > 0.05 ) . There was small but significant ( p < 0.05 ) rise in serum ferritin in both the groups . There was no significant difference between the two groups for response to the two forms of iron administration . CONCLUSION The powdered form of iron is a cost-effective and better tolerated method of iron administration in children and can be considered as an alternate option for the treatment of iron deficiency anemia in children This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence BACKGROUND Powders containing iron and other micronutrients are recommended as a strategy to prevent nutritional anaemia and other micronutrient deficiencies in children . We assessed the effects of provision of two micronutrient powder formulations , with or without zinc , to children in Pakistan . METHODS We did a cluster r and omised trial in urban and rural sites in Sindh , Pakistan . A baseline survey identified 256 clusters , which were r and omly assigned ( within urban and rural strata , by computer-generated r and om numbers ) to one of three groups : non-supplemented control ( group A ) , micronutrient powder without zinc ( group B ) , or micronutrient powder with 10 mg zinc ( group C ) . Children in the clusters aged 6 months were eligible for inclusion in the study . Powders were to be given daily between 6 and 18 months of age ; follow-up was to age 2 years . Micronutrient powder sachets for groups B and C were identical except for colour ; investigators and field and supervisory staff were masked to composition of the micronutrient powders until trial completion . Parents knew whether their child was receiving supplementation , but did not know whether the powder contained zinc . Primary outcomes were growth , episodes of diarrhoea , acute lower respiratory tract infection , fever , and incidence of admission to hospital . This trial is registered with Clinical Trials.gov , number NCT00705445 . RESULTS The trial was done between Nov 1 , 2008 , and Dec 31 , 2011 . 947 children were enrolled in group A clusters , 910 in group B clusters , and 889 in group C clusters . Micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group ( odds ratio [ OR ] for micronutrient powder without zinc=0·20 , 95 % CI 0·11 - 0·36 ; OR for micronutrient powder with zinc=0·25 , 95 % CI 0·14 - 0·44 ) . Compared with the control group , children in the group receiving micronutrient powder without zinc gained an extra 0·31 cm ( 95 % CI 0·03 - 0·59 ) between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm ( 0·29 - 0·84 ) . We recorded strong evidence of an increased proportion of days with diarrhoea ( p=0·001 ) and increased incidence of bloody diarrhoea ( p=0·003 ) between 6 and 18 months in the two micronutrient powder groups , and reported chest indrawing ( p=0·03 ) . Incidence of febrile episodes or admission to hospital for diarrhoea , respiratory problems , or febrile episodes did not differ between the three groups . INTERPRETATION Use of micronutrient powders reduces iron-deficiency anaemia in young children . However , the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in population s with malnourished children and high diarrhoea burdens . FUNDING Bill & Melinda Gates Foundation Home-fortification of complementary foods with micronutrients ( including iron ) as Sprinkles is a new strategy to control iron deficiency and anaemia in developing countries . However , the most effective dose and form of iron is not known . The purpose of this study was to compare the efficacy of various doses ( 12.5 , 20 or 30 mg ) and treatment methods ( multi-micronutrient Sprinkles vs. ferrous sulphate drops ) on haemoglobin ( Hb ) concentration after 8 weeks of treatment in anaemic children . In total , 133 anaemic Ghanaian children ( Hb 70 - 99 g L(-1 ) ) aged 6 - 18 months were r and omly assigned to one of five daily interventions for 8 weeks . Out of the five interventions , four used Sprinkles , and one used iron drops . Of the four Sprinkles groups , three included 12.5 , 20 or 30 mg of iron as ferrous fumarate , and one included 20 mg of iron as ferric pyrophosphate . The iron drops group included 12.5 mg of iron as liquid ferrous sulphate .  Hb concentrations were measured at baseline , week 3 and week 8 . The primary outcome measure was Hb concentration at 8 weeks after treatment . We compared differences in Hb and ferritin concentrations and prevalence of iron deficiency anaemia ( Hb < 100 g L(-1 ) and soluble transferrin receptor concentrations > 8.5 mg L(-1 ) ) from baseline to 8 weeks within and between groups . Adherence and reporting of side effects ( staining of the teeth , ease of use , diarrhoea and darkening of stools ) were compared between groups . Mean change in Hb was 1.4 g L(-1 ) ( SD = 1.8 ) ( P = 0.0001 ) . Change in Hb concentrations from baseline to 8 weeks was significant in all groups ( P = 0.0001 - 0.0007 ) , with no differences across groups . Geometric means of serum ferritin varied from 18.6 to 44.0 microg L(-1 ) at baseline . At week 8 , these means were in the interval of 48.0 - 78.3 microg L(-1 ) , with no group differences . Prevalence of iron deficiency anaemia decreased significantly from baseline to 8 weeks in all groups with the exception of the iron drops group , with no group differences . Adherence was lower in the drops group ( 64 % ) as compared with Sprinkles groups ( 84 % ) . Greater staining of the teeth and less ease of use were reported in the drops group as compared with Sprinkles groups . A dose as low as 12.5 mg of iron as ferrous fumarate when provided as Sprinkles may be effective in anaemic children OBJECTIVE To determine whether low-income infants ' adherence to nutritional supplementation with ferrous fumarate sprinkles was better than that with ferrous sulfate drops . STUDY DESIGN The study was a r and omized clinical trial of healthy 6-month-old infants . Each infant received either a daily packet of sprinkles or a dropperful of liquid . Follow-up included alternating telephone and home visits biweekly for 3 months . Adherence was defined as high if the infant 's caregiver reported supplement use on 5 to 7 days during the week before assessment . Side effects and caregiver attitude about supplements were secondary outcomes . Analyses were conducted using generalized estimating equations and chi(2 ) and Wilcoxon rank-sum tests . RESULTS A total of 150 of 225 eligible infants were enrolled .  Adherence to supplementation was generally poor . High adherence ranged from 32 % to 63 % at any assessment in the subjects receiving drops , compared with 30 % to 46 % in those receiving sprinkles . The drops group was more likely to have at least four assessment s with high adherence ( 22 % vs 9.5 % ; P = .03 ) . Caregivers of the drops infants were more likely to report greater than usual fussiness ( P < .01 ) ; however , fussiness had no consistent impact on adherence . CONCLUSIONS The use of ferrous fumarate sprinkles rather than traditional ferrous sulfate drops did not improve adherence with daily iron supplementation in low-income infants Objective To assess the effectiveness of micronutrient powder ( MNP ) supplementation in reducing  anemia levels in children aged 6 mo to 6 y in India . Methods Sixty sachets of MNP ( Sprinkles Plus ) were administered flexibly over a 4 mo period to 17,124 children at anganwadi centers or at home through Integrated Child Development Services ( ICDS ) . Compliance was monitored using compliance cards and an assessment of mother ’s recall at post-intervention survey . Hemoglobin was measured in separate r and om sample s of 1,786 children before and 1,782 children after MNP  supplementation . Results Mean compliance rate was estimated at 56.4 % ( based on mother ’s recall ) and 91.7 % ( based on compliance cards ) for children who received MNP at home . Mean compliance was 96.9 % ( based on compliance cards ) for children who received MNP  at anganwadis . A significant reduction in anemia ( 50 % to 33 % in boys ; p-value < .000 ; 47.4 % to 34.2 % in girls ) was seen following MNP supplementation . Conclusions Integration of a flexibly administered MNP supplementation into the ICDS is effective in reducing and treating anemia in children 6 mo to 6 y age UNLABELLED Iron supplementation programs using pediatric tablets or drops have not been successful in the control of anemia amongst infants and children in India .  Sprinkles is an innovative multi-micronutrient home fortification strategy to control iron deficiency and anemia . OBJECTIVE We aim ed to determine the hematologic response to different doses and forms of iron in Sprinkles and iron drops . SETTING Twenty two villages of Vadu Rural Health Program , KEM Hospital , Pune . DESIGN Double blind clustered r and omized community-based trial . SUBJECTS Children ( n=432 ) aged 6 to 18 mo age with Hb between 70 to 100 g/L were enrolled . METHODS Selected villages were r and omized into 5 groups : Sprinkles 12.5 , 20 or 30 mg ferrous fumarate , Sprinkles 20 mg micronized ferric pyrophosphate or drops 20 mg ferrous glycine sulphate ( DROPS ) for 8 weeks . Household socio-demographic information was collected at baseline . Side effects and compliance were monitored through weekly visits . Hemoglobin was estimated at baseline , 3 and 8 weeks . Ferritin was assessed at baseline and 8 weeks . RESULTS Baseline characteristics were similar across all groups . Hemoglobin increased significantly ( P<0.0001 ) in all groups at 8 weeks with no difference between groups . Ferritin increased ( P<0.0001 ) significantly in all groups with no difference across the groups . Compliance ( overall range : 42 to 62 % ) was lowest for DROPS . Side effects were significantly higher among DROPS compared to Sprinkles ( p>0.05 ) . CONCLUSIONS Sprinkles 12.5 mg FF dose is as efficacious as higher doses of iron in Sprinkles or DROPS in increasing hemoglobin . Sprinkles FF 12.5 mg is recommended as it has fewer reported side effects and better compliance compared to DROPS Background Iron-deficiency anemia is widespread among young children in the Kyrgyz Republic , and there is an urgent need to identify an effective intervention to address this significant public health problem . Objective To test the effectiveness of a 2-month intervention with daily home fortification of complementary food using micronutrient powder ( Sprinkles ) in reducing anemia  among children 6 to 36 months of age in the Kyrgyz Republic . Methods In this cluster-r and omized , community-based effectiveness trial conducted in three regions of the Kyrgyz Republic , 24 clusters of children aged 6 to 36 months were r and omly assigned to two groups . The intervention group ( 12 clusters , n = 1,103 ) received 60 sachets of micronutrient powder ( 12.5 mg elemental iron ) , which were taken as one sachet daily for 2 months . The control group ( 12 clusters , n = 1,090 ) did not receive micronutrient powder until after the study period . Blood hemoglobin concentration was assessed at the start and end of the intervention . Results From baseline to follow-up , the mean hemoglobin concentration in the intervention group increased by 7 g/L , whereas it decreased by 2 g/L in the control group ( p < .001 ) . The prevalence of anemia ( hemoglobin < 110 g/L ) in the intervention group decreased from 72 % at baseline to 52 % at follow-up , whereas it increased from 72 % to 75 % in the control group ( p < .001 ) . Compliance with the intervention was high , with children consuming on average 45 of the 60 sachets given . Conclusions A course of 60 Sprinkles micronutrient powder sachets taken daily for 2 months is effective in improving hemoglobin levels and reducing the prevalence of anemia among young children in the Kyrgyz Republic BACKGROUND Although the efficacy of micronutrient powders [ MNPs ; eg , Sprinkles MNP ( Sprinkles Global Health Initiative ) ] in the reduction of anemia has been established , the effectiveness of these powders in real-world programs has seldom been assessed . OBJECTIVE In this study , we evaluated the effect of community-based marketing and distribution of Sprinkles MNP on  childhood rates of anemia and iron and vitamin A deficiency .  DESIGN In a cluster-r and omized trial in children aged 6 - 35 mo in Western Kenya , 60 villages were r and omly assigned to either intervention or control groups . Community vendors marketed and sold sachets of Sprinkles MNP in intervention villages . Biweekly household visits monitored the use of Sprinkles MNP . Hemoglobin , ferritin , retinol binding protein , malaria , and anthropometric measures were assessed at baseline ( n = 1063 ) and 12 mo of follow-up ( n = 862 ) . Data were analyzed by using an intention-to-treat analysis and generalized linear mixed models . RESULTS On average , 33 % of households in intervention villages purchased Sprinkles MNP ;  the average weekly intake per child was 0.9 sachets ( ∼11.3 mg Fe and ∼328 μg vitamin A ) . Compared with control subjects , intervention children had greater improvements in hemoglobin concentrations ( increase of 0.9 compared with 0.6 g/dL , respectively ; P = 0.02 ) , iron deficiency ( decrease of 19.3 % compared with 5.3 % , respectively ; P = 0.001 ) , and vitamin A deficiency ( decrease of 7.5 % compared with an increase of 2.5 % , respectively ; P = 0.01 ) . Results adjusted for age , sex , socioeconomic status , and maternal education showed a significant association between the hemoglobin , iron , and vitamin A concentrations of children and the number of Sprinkles MNP sachets the children consumed . The prevalence of malaria , wasting , and stunting did not change significantly in either group . CONCLUSION Even with relatively low and infrequent use , Sprinkles MNP sales through community vendors were associated with decreased rates of anemia and iron and vitamin A deficiency in children in a re source -poor setting . This trial was registered at clinical trials.gov as NCT01088958 This was a double-blind , placebo-controlled , community-based trial . For 16 weeks , children in the intervention group ( n = 180 ) received iron-fortified rice , while children in the control group ( n = 174 ) received rice with placebo .  Anemia was defined as hemoglobin < 11.0g/dL. Student 's t-test was used to compare mean variation in hemoglobin between the groups . Hemoglobin concentration improved in both groups , with a mean increase of 0.42g/ dL in the intervention group ( 11.28+/-1.23g/dL to 11.75+/-1.16g/dL , p < 0.001 ) , and 0.49g/dL in controls ( 11.06+/-1.13g/dL to 11.51+/-1.16g/dL , p < 0.001 ) . Anemia decreased ( p < 0.01 ) in both groups ( 37.8 % to 23.3 % in the intervention group and 45.4 % to 33.3 % in controls ) , with no significant difference between the two . Hemoglobin increase was significantly higher in children that received total iron = 53.76 mg from fortified rice , compared to those who received less than this cut-off value ( 0.94g/dl vs. 0.39g/dl , p = 0.03 ) . The findings suggest that this type of intervention can be useful in anemia control as long as fortified food intake is adequate Objective Multiple micronutrient deficiencies exist in many developing countries . We conducted a study to test the efficacy of ferrous glycine phosphate in reducing anemia and of riboflavin in reducing angular stomatitis when these micronutrients were added to the noon meal for schoolchildren . Methods A pre- and post-test design was used to study children 5 to 9 years of age , with an experimental and a control group . Two schools in the same locality in Chennai were chosen for the study . The experimental school had 65 children and the control school had 71 children , all of whom consumed a noon meal at the school daily . The children in the experimental school received a powder containing ferrous glycine phosphate and riboflavin , which was added to the meal during cooking every day for 6 months . The dosage was 28 mg of elemental iron and 1 mg of riboflavin per child per day . The children attended school for 5 days each week from Monday to Friday , except for holidays ; they received the fortificants on 100 days during the 6-month period . There was no intervention in the control school . Children in the experimental and control groups were matched by socioeconomic status , age , and eating habits at baseline . All the children in the experimental and control schools were dewormed at baseline and at endline after 6 months . Hemoglobin was measured by the cynamethemoglobin method at baseline and endline . Results Binary logistic regression showed a significant ( p < .001 ) time x group interaction for anemia . The prevalence of anemia in the experimental school was 69.0 % at baseline and 32.8 % after 100 days of intervention over 6 months , a statistically significant change ( p < .001 ) . The prevalence of anemia in the control school was 91.5 % at baseline and increased to 97.2 % at endline ; the increase was not statistically significant . The prevalence of angular stomatitis was reduced from 21 % at baseline to 0 % at endline in the experimental school , whereas it was 23 % at baseline and 20 % at endline in the control school . Conclusions The added fortificants reduced the prevalence of the micronutrient deficiencies Aims : To examine the effect of the daily use of micronutrients ( including zinc ) or the same micronutrients plus heat inactivated lactic acid bacteria ( LAB ) , on  diarrhoea in children compared to placebo . Methods : A triple blind r and omised clinical trial in an urban slum of Karachi , Pakistan .  Micronutrients ( including zinc ) , micronutrients ( including zinc and LAB ) , or placebo , were provided daily for two months to 75 young children ( aged 6–12 months ) identified at high risk for diarrhoea related mortality on the basis of history of at least one episode of diarrhoea in the preceding two weeks . The longitudinal prevalence of diarrhoea was defined as the percentage of days a child had diarrhoea out of the days the child was observed . Results : Mean longitudinal prevalence of diarrhoea in the micronutrient – zinc group was 15 % ( SD = 10 % ) child-days compared to 26 % ( SD = 20 % ) child-days in the placebo group and 26 % ( SD = 19 % ) child-days in the micronutrient – zinc – LAB group . The difference between the micronutrient – zinc – LAB and placebo groups was not significant . Conclusion : The daily provision of micronutrients ( including zinc ) reduces the longitudinal prevalence of diarrhoea and thus may also reduce diarrhoea related mortality  in young children ; heat inactivated LAB has negative effects in these children OBJECTIVES : The goal of this study was to determine if a responsive stimulation and feeding intervention improved developmental and nutritional outcomes compared with a regular information-based parenting program . The hypothesis was that mothers in the intervention would exhibit better parenting skills and children would exhibit better developmental and nutritional outcomes than controls . METHODS : A cluster-r and omized field trial was conducted with 302 children aged 8 to 20 months and their mothers in rural Bangladesh who were r and omly assigned according to village to 1 of 3 groups . The control mothers received 12 informational sessions on health and nutrition . The intervention groups received an additional 6 sessions delivered by peer educators who included modeling and coached practice in self-feeding and verbal responsiveness with the child during play . A second intervention group received , along with the sessions , 6 months of a food powder fortified with minerals and vitamins . Developmental outcomes included the Home Observation for Measurement of the Environment ( HOME ) Inventory , mother-child responsive talk , and language development . Nutritional outcomes included weight , height , self-feeding , and mouthfuls eaten . We used analysis of covariance to compare the 3 groups at the posttest and at follow-up , covarying the pretest levels and confounders . RESULTS : At follow-up , responsive stimulation-feeding groups had better HOME inventory scores , responsive talking , language , mouthfuls eaten , and h and -washing . Micronutrient fortification result ed in more weight gain . CONCLUSIONS : A brief behavior-change program that focused on modeling and practice in stimulation and feeding was found to benefit children 's nutrition and language development . Micronutrients benefited children 's weight but not length Background There is a lack of peer- review ed literature describing in detail the formative research to develop Sprinkles interventions . Objective To describe community members ' reactions to and experiences using Sprinkles , with an emphasis on acceptability , utilization , and promotion . Methods Fourteen initial focus group discussion s on Sprinkles  and a 25-family home study were conducted . For the home study , each child 6 to 59 months of age in the household received 30 sachets ( 1 per day ) . The initial 14 focus group discussion s included mothers , gr and mothers , vendors , women who purchased from vendors , and adults in the general population . Home study families were recruited from participants in the initial 14 focus group discussion s who had at least one child 6 to 59 months of age . Results Sprinkles were highly acceptable to adults and most children ; some children thought Sprinkles were sugar . Most home study families prepared and used Sprinkles correctly . All families reported positive effects , particularly increased appetite , and recommended Sprinkles ; none experienced major problems . Potential barriers identified were lack of knowledge of and experience with Sprinkles , availability of Sprinkles , and cost . Promotional messages targeted to mothers , fathers , all child-care providers , and doctors focused on the positive health effects of Sprinkles . Conclusions Issues related to Sprinkles preparation , use , and barriers required attention before implementation . Locally appropriate visual and written instructions were developed for dissemination . Intervention training sessions and promotions were tailored to answer frequently asked questions , increase knowledge of Sprinkles , and provide tangible evidence of health benefits . Information needs and perceptions changed quickly after use of Sprinkles . Existing levels of Sprinkles awareness and knowledge should be considered when design ing interventions This cross-sectional r and omized controlled study assessed the social acceptability of micronutrient fortified cooked lunch meals by schoolchildren in rural Himalayan villages of India , in a program where the cooking and the micronutrient fortification were done at school . Subjects were r and omly assigned to treatment ( 91 ) and control ( 90 ) groups . The treatment group consumed a weighed amount of cooked lunch meals fortified with locally produced multi-micronutrient premix and the control group consumed a weighed amount of the same meals but without added micronutrient premix . After having eaten , subjects were asked to rate , on a 3-point Likert scale using " smiley " faces , the pleasantness of smell , taste , and overall satisfaction with the food .  The mean age of study children was 7.96 + /- 1.64 y and 48.6 % were males . The average amounts of food consumed by the treatment and control groups were 345 + /- 114 and 360 + /- 102.4 g , respectively . Addition of the multi-micronutrient premix to school meals did not significantly affect the mean amount of food consumed by the schoolchildren ( P > 0.05 ; independent sample t-test ) . No significant differences were seen between treatment and control groups in terms of ratings for taste , smell , and the general acceptance of the micronutrient fortified or the unfortified school meals . In conclusion , the addition of a multiple micronutrient premix to school meals was well liked by schoolchildren and did not adversely affect their food consumption Responsive complementary feeding , whereby the mother feeds her child in response to child cues and psychomotor abilities , is low in some countries and likely contributes to malnutrition . Interventions are needed to evaluate whether promoting responsive feeding would add any benefit . Using a cluster-r and omized field trial , we evaluated a 6-session educational program that emphasized the practice of child self-feeding and maternal responsiveness . A total of 108 mothers and their 8- to 20-mo-old children in 19 clusters were r and omly assigned to the intervention group and 95 in 18 clusters were assigned to the informational control group . Outcomes were assessed at pretest , postintervention , and follow-up . Research assistants , who were unaware of group assignment , observed and coded mother and child midday meal behaviors . At follow-up , the percent of self-fed mouthfuls was 47.8 + /- 42.4 ( mean + /- SD ) in the responsive feeding group children compared with 32.2 + /- 41.0 in the controls ( P = 0.01 ) ; likewise , the number of responsive verbalizations was 6.55 + /- 5.9 in the responsive feeding mothers and 4.62 + /- 4.5 in controls ( P = 0.01 ) . Intervention mothers recalled more messages . Mouthfuls of food eaten by children and weight were equivalent in the 2 groups . Lack of change in foods eaten and small quantities may explain the similarly low levels of weight gain . These results provide evidence that self-feeding and maternal verbal responsiveness , two developmentally important behaviors , can be increased by targeting specific behaviors with appropriate behavior change strategies of modeling and coached practice . Weight gain may require more nutritional input , especially in areas of high food insecurity Background In-home  iron fortification for infants in developing countries is recommended for control of anaemia , but low absorption typically results in > 80 % of the iron passing into the colon . Iron is essential for growth and virulence of many pathogenic enterobacteria . We determined the effect of high and low dose in-home iron fortification on the infant gut microbiome and intestinal inflammation . Methods We performed two double-blind r and omised controlled trials in 6-month-old Kenyan infants ( n=115 ) consuming home-fortified maize porridge daily for 4 months . In the first , infants received a micronutrient powder ( MNP ) containing 2.5 mg iron as NaFeEDTA or the MNP without iron . In the second , they received a different MNP containing 12.5 mg iron as ferrous fumarate or the MNP without the iron . The primary outcome was gut microbiome composition analysed by 16S pyrosequencing and targeted real-time PCR ( qPCR ) . Secondary outcomes included faecal calprotectin ( marker of intestinal inflammation ) and incidence of diarrhoea . We analysed the trials separately and combined . Results At baseline , 63 % of the total microbial 16S rRNA could be assigned to Bifidobacteriaceae but there were high prevalences of pathogens , including Salmonella Clostridium difficile , Clostridium perfringens , and pathogenic Escherichia coli . Using pyrosequencing , + FeMNPs increased enterobacteria , particularly Escherichia/Shigella ( p=0.048 ) , the enterobacteria/bifidobacteria ratio ( p=0.020 ) , and Clostridium ( p=0.030 ) . Most of these effects were confirmed using qPCR ; for example , + FeMNPs increased pathogenic E. coli strains ( p=0.029 ) . + FeMNPs also increased faecal calprotectin ( p=0.002 ) . During the trial , 27.3 % of infants in + 12.5 mgFeMNP required treatment for diarrhoea versus 8.3 % in −12.5 mgFeMNP ( p=0.092 ) . There were no study -related serious adverse events in either group . Conclusions In this setting , provision of iron-containing MNPs to weaning infants adversely affects the gut microbiome , increasing pathogen abundance and causing intestinal inflammation . Trial registration number NCT01111864 OBJECTIVE Improvement of hemoglobin and serum retinol and facilitation of the mobilization of iron storage were achieved with a multiple-micronutrient-fortified diet in preschoolers for 6 mo in a suburb of Chongqing , China . We investigated whether fortification with multiple micronutrients in a diet for preschool children results in changes in children 's infectious morbidity compared with diets fortified solely with vitamin A and with vitamin A plus iron . METHODS From December 2005 to June 2006 , 226 2- to 6-y-old preschool children were recruited from three nurseries r and omly assigned to three different fortified-diet groups for 6 mo . Group I was fortified with vitamin A ; groups II and III were fortified with vitamin A plus iron and vitamin A plus iron , thiamine , riboflavin , folic acid , niacinamide , zinc , and calcium , respectively . The secondary functional outcomes , morbidity of diarrhea and respiratory infection , were collected during supplementation . RESULTS The groups were comparable concerning compliance and loss to follow-up . There was evidence of a lower incidence rate of respiratory-related illnesses , diarrhea-related illness , fewer symptoms of runny nose , cough , and fever , and shorter duration of respiratory-related illnesses and cough for children in group III compared with children in groups I and II . However , there was no significantly or clinical ly important difference between children in groups I and II . CONCLUSION The beneficial effects on infectious morbidity over 6 mo , in addition to some biochemical improvements , highlight the potential of this micronutrient-fortified seasoning powder supplied in a diet for preschool children BACKGROUND Promoting adequate nutrition through interventions to improve infant and young child feeding ( IYCF ) has the potential to contribute to child development . OBJECTIVE We examined whether an intensive intervention package that was aim ed at improving IYCF at scale through the Alive & Thrive initiative in Bangladesh also advanced language and gross motor development , and whether advancements in language and gross motor development were explained through improved complementary feeding . METHODS A cluster-r and omized design compared 2 intervention packages : intensive interpersonal counseling on IYCF , mass media campaign , and community mobilization ( intensive ) compared with usual nutrition counseling and mass media campaign ( nonintensive ) . Twenty subdistricts were r and omly assigned to receive either the intensive or the nonintensive intervention . Household surveys were conducted at baseline ( 2010 ) and at endline ( 2014 ) in the same communities ( n = ∼4000 children aged 0 - 47.9 mo for each round ) . Child development was measured by asking mothers if their child had reached each of multiple milestones , with some observed . Linear regression accounting for clustering was used to derive difference-in-differences ( DID ) impact estimates , and path analysis was used to examine developmental advancement through indicators of improved IYCF and other factors . RESULTS The DID in language development between intensive and nonintensive groups was 1.05 milestones ( P = 0.001 ) among children aged 6 - 23.9 mo and 0.76 milestones ( P = 0.038 ) among children aged 24 - 47.9 mo . For gross motor development , the DID was 0.85 milestones ( P = 0.035 ) among children aged 6 - 23.9 mo . The differences observed corresponded to age- and sex-adjusted effect sizes of 0.35 for language and 0.23 for gross motor development . Developmental advancement at 6 - 23.9 mo was partially explained through improved minimum dietary diversity and the consumption of iron-rich food . CONCLUSIONS Intensive IYCF intervention differentially advanced language and gross motor development , which was partially explained through improved complementary feeding . Measuring a diverse set of child outcomes , including functional outcomes such as child development , is important when evaluating integrated nutrition programs . This trial was registered at clinical trials.gov as NCT01678716 Anemia and micronutrient deficiencies are common among Indian schoolchildren . We assessed the effectiveness of micronutrient fortification of meals cooked and fortified at school on anemia and micronutrient status of schoolchildren in Himalayan villages of India . In this placebo-controlled , cluster-r and omized study , 499 schoolchildren ( 6 - 10 y ) received either multiple micronutrients ( treatment group ) or placebo ( control group ) as part of school meals ( 6 d/wk ) for 8 mo . Both groups were dewormed at the beginning of the study . The micronutrient premix provided 10 mg iron , 375 microg vitamin A , 4.2 mg zinc , 225 microg folic acid , and 1.35 microg vitamin B-12 for each child per day ( approximately 75 % recommended dietary allowance ) . Blood sample s drawn before and after the intervention were analyzed for hemoglobin , ferritin , retinol , zinc , folate , and vitamin B-12 . Baseline prevalence of anemia ( 37 % ) , iron deficiency anemia ( 10 % ) , low serum ferritin ( 24 % ) , retinol ( 56 % ) , zinc ( 74 % ) , folate ( 68 % ) , and vitamin B-12 ( 17 % ) did not differ between groups . Postintervention , fewer in the treatment group had lower serum retinol [ odds ratio ( OR ) ( 95 % CI ) : 0.57 ( 0.33 - 0.97 ) ] and folate [ OR ( 95 % CI ) : 0.47 ( 0.26 - 0.84 ) ] than the control group . The serum vitamin B-12 concentration decreased in both groups , but the magnitude of change was less in the treatment than in the control group ( P < 0.05 ) . Total body iron ( TBI ) increased in both groups ; however , the change was greater in the treatment than in the control group ( P < 0.05 ) . Micronutrient fortification of school meals by trained school personnel was effective in improving vitamin A , folate , and TBI status while also reducing the magnitude of a decrease in vitamin B-12 status
BACKGROUND Approximately 600 million children of preschool and school age are anaemic worldwide .
It is estimated that at least half of the cases are due to iron deficiency .
Point-of-use fortification of foods with micronutrient powders ( MNP ) has been proposed as a feasible intervention to prevent and treat anaemia .
It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form , to energy-containing foods ( excluding beverages ) at home or in any other place where meals are to be consumed .
MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour .
OBJECTIVES To assess the effects of point-of-use fortification of foods with iron-containing MNP alone , or in combination with other vitamins and minerals on nutrition , health and development among children at preschool ( 24 to 59 months ) and school ( five to 12 years ) age , compared with no intervention , a placebo or iron-containing supplements .