1. Introduction
intellectual impairments, wasting, undernutrition, micronutrient deficiencies, Micronutrient deficiencies
WASTING, UNDERNUTRITION, UNDERNUTRITION, MALNUTRITION, IRON DEFICIENCY ANEMIA, ZINC DEFICIENCY
Cost-effective interventions are needed to address undernutrition, particularly micronutrient deficiencies, which are common in children under the age of five in low- and middle-income countries. A community-based, non-randomized clinical trial was undertaken in the Kurram district of Khyber Pakhtunkhwa from January 2018 to June 2019, to evaluate the effect of locally produced micronutrient powder (local name: Vita-Mixe) on plasma micronutrient status, hemoglobin level, and anthropometric outcomes. Children aged 24–48 months old were recruited and allocated to the intervention and control arm of the study. The enrolled children in the intervention arm received one micronutrient powder (MNP) sachet for consumption on alternate days for 12 months. To assess the impact of the intervention on plasma levels of zinc, vitamin D, vitamin A, and hemoglobin level, blood samples were taken at baseline and after one year following the intervention. The analysis was conducted using Enzyme-Linked Immunosorbent Assay (ELISA), atomic absorption spectrometry, and an automated hematology analyzer. For the impact on growth parameters, the anthropometric assessment was performed using WHO standard guidelines. A 24 h dietary recall interview was used to assess the nutrient intake adequacy. Results showed that in the intervention arm, children had on average a 7.52 ng/mL (95% CI 5.11–9.92, Undernutrition, especially micronutrient malnutrition, in pre-school children is a major concern of public health in low- and middle-income countries [According to the National Nutrition Survey of Pakistan (NNS-2018), the burden of undernutrition among 6–59-month-old children is very high, i.e., stunting 40%, wasting 17.7%, and underweight 28.9%. Similarly, the prevalence of micronutrient deficiencies among these children is also very high, i.e., vitamin A 51.5%, vitamin D 62.7%, and zinc 18.6%. Moreover, iron deficiency anemia was estimated at 28.6%. The Khyber Pakhtunkhwa Newly Merged District (KP-NMD) presents the worst situation of undernutrition in the country. Micronutrient deficiencies are above the national average, i.e., vitamin A 54.9% and vitamin D 81.5%. Only zinc deficiency is comparatively less than the national average, i.e., 16.6% [Children and pregnant women require minerals and vitamins for growth and normal physiological function, which are frequently unmet by dietary intake [Micronutrient deficiencies also contribute to other health problems, such as iron deficiency anemia and intellectual impairments [In light of the current prevalence and consequences of micronutrient deficiencies, the provision of micronutrient supplementation to children under the age of five is critical for reducing the burden of micronutrient deficiencies. Multiple micronutrient supplementation with vitamins and minerals is found to be a cost-effective strategy for reducing micronutrient deficiencies in children [