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Randomized Controlled Trial
. 2017 Sep 25;17(1):738.
doi: 10.1186/s12889-017-4755-0.

The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial

Renfu Luo  1 , Ai Yue  2 , Huan Zhou  3 , Yaojiang Shi  4 , Linxiu Zhang  5 , Reynaldo Martorell  6 , Alexis Medina  7 , Scott Rozelle  7 , Sean Sylvia  8
Affiliations
Randomized Controlled Trial

The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial

Renfu Luo et al. BMC Public Health. .

Abstract

Background: Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.

Methods: We conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6-11 months in target villages. Following a baseline survey, investigators randomly assigned each village/cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development.

Results: One thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017-3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061-4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed.

Conclusions: Providing caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline.

Trial registration: ISRCTN44149146 ; prospectively registered on 15th April 2013.

Keywords: Anemia; Cognition; Early childhood; Micronutrient supplementation.

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Conflict of interest statement

Ethics approval and consent to participate

The protocol was approved by the institutional review boards of Stanford University (No. 25734) and Sichuan University (No. 2013005–01). All participating caregivers gave their oral consent for their own and their child’s involvement in the program.

Consent for publication

My manuscript does not contain data from any individual person.

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trial profile. MNP = Micronutrient Powder
Fig. 2
Fig. 2
Hemoglobin concentration (g/L), anemia prevalence (%), mental and psychomotor Development of sample children by experimental arm and age/survey wave. MNP = Multiple Micronutrient Powders, MDI = Bayley Mental Development Index, PDI = Bayley Psychomotor Development Index
See this image and copyright information in PMC

References

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