Assessment of the effectiveness of a small quantity lipid-based nutrient supplement on reducing anaemia and stunting in refugee populations in the Horn of Africa: Secondary data analysis.

Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and its partner organisations implement blanket supplementary feeding programmes using a range of special nutritional products as one approach to address these issues. The evidence base for the efficacy and effectiveness of a small quantity lipid-based nutrient supplement, Nutributter®, in reducing stunting and anaemia is limited. Secondary data analysis was used to assess the effectiveness of Nutributter® distribution on anaemia and stunting in children aged 6-23 months (programme target group) and 6-59 months (the standard age group sampled in routine nutrition surveys). Analysis was conducted using routine pre and post-intervention cross-sectional nutrition survey data collected between 2008-2011 in five refugee camps in Kenya and Djibouti. Changes in total anaemia (Haemoglobin<110g/L), anaemia categories (mild, moderate and severe), and stunting (height-for-age z-score <-2) were explored using available data on the Nutributter® programme and contextual factors. A significant reduction in the prevalence of anaemia in children aged 6-23 months and 6-59 months was seen in four of five, and in all five camps, respectively (p<0.05). Reductions ranged from 12.4 to 23.0, and 18.3 to 29.3 percentage points in each age group. Improvements were largely due to reductions in moderate and severe anaemia and occurred where the prevalence of acute malnutrition was stable or increasing. No change in stunting was observed in four of five camps. The replicability of findings across five sites strongly suggests that Nutributter® distribution was associated with a reduction in anaemia, but not stunting, among refugee children in the Horn of Africa. Benefits were not restricted to the 6-23 month target group targeted by the nutrition programme. However, even following this intervention anaemia remained a serious public health problem and additional work to define and evaluate an effective intervention package is warranted

Effect of daily versus once-weekly home fortification with micronutrient Sprinkles on hemoglobin and iron status among young children in rural Bangladesh

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 differences in the effects of the two regimens.Methods. In this cluster- randomized, 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 randomly allocated 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 &lt;.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 mu g/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 &lt;.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.</p

Regression analysis of mean height for age and stunting prevalence (HAZ<-2) in children aged 6–23 months.

<p>Regression analysis of mean height for age and stunting prevalence (HAZ<-2) in children aged 6–23 months.</p

Mean haemoglobin concentration in children aged 6–23 and 24–59 months between 2008 and 2011.

<p>Mean haemoglobin concentration in children aged 6–23 and 24–59 months between 2008 and 2011.</p

Regression analysis of mean height for age and stunting prevalence (HAZ<-2) in children aged 6–59 months.

<p>Regression analysis of mean height for age and stunting prevalence (HAZ<-2) in children aged 6–59 months.</p

Anaemia, stunting, and global acute malnutrition (GAM) prevalence in children aged 6–59 months between 2008 and 2011.

<p>Anaemia, stunting, and global acute malnutrition (GAM) prevalence in children aged 6–59 months between 2008 and 2011.</p

Nutributter^® distribution protocols and surveys used for assessing the intervention in Dadaab, Kakuma, and Ali Addeh refugee camps.

<p>Nutributter^® distribution protocols and surveys used for assessing the intervention in Dadaab, Kakuma, and Ali Addeh refugee camps.</p

Regression analysis of mean haemoglobin and the prevalence of anaemia at baseline and end-line in children aged 6–59 months.

<p>Regression analysis of mean haemoglobin and the prevalence of anaemia at baseline and end-line in children aged 6–59 months.</p

Regression analysis of mean haemoglobin and the prevalence of anaemia at baseline and end-line in children aged 6–23 months.

<p>Regression analysis of mean haemoglobin and the prevalence of anaemia at baseline and end-line in children aged 6–23 months.</p

Demonstrating zinc and iron bioavailability from intrinsically labeled microencapsulated ferrous fumarate and zinc gluconate Sprinkles in young children.

Nutrient-nutrient interactions are an important consideration for any multiple-micronutrient formulation, including Sprinkles, a home-fortification strategy to control anemia. The objectives of this randomized controlled trial were as follows: 1) to compare the absorption of zinc at 2 doses given as Sprinkles; and 2) to examine the effect of zinc and ascorbic acid (AA) on iron absorption from Sprinkles. Seventy-five children aged 12-24 mo were randomly assigned to the following groups: 1) 5 mg of labeled zinc (67Zn) with 50 mg AA (LoZn group); b) 10 mg of labeled zinc (67Zn) with 50 mg AA (HiZn group); or 3) 5 mg zinc with no AA (control). All groups contained 30 mg of labeled iron (57Fe). Intravenous infusions labeled with 70Zn (LoZn and HiZn groups) and 58Fe (control) were administered. Blood was drawn at baseline, 48 h and 14 d later. The percentage of zinc absorbed did not differ between LoZn (geometric mean = 6.4%; min-max: 1.7-14.6) and HiZn (geometric mean = 7.5%; min-max: 3.3-18.0) groups. However, total zinc absorbed was significantly different between the LoZn (geometric mean = 0.31 mg; min-max: 0.08-0.73) and HiZn (geometric mean = 0.82 mg; min-max: 0.33-1.82) groups (P = 0.0004). Geometric mean percentage iron absorption values did not differ between the LoZn (5.9%; min-max: 0.8-21) and HiZn (4.4%; min-max: 0.6-12.3) groups and between the LoZn and control groups (5.0%; min-max: 1.4-24). We conclude that zinc in the form of Sprinkles has a low bioavailability, yet provides adequate amounts of absorbed zinc in young children, and that there is no effect of zinc or AA on iron absorption from the given formulations of Sprinkles