The WHO recommendation of home fortification of foods with multiple-micronutrient powders in children under 2 years of age and its effectiveness on anaemia and weight: a pragmatic cluster-randomized controlled trial

Abstract

Objective: To assess under real community settings the effectiveness of the WHO strategy of home fortification of foods (HFF) with multiple-micronutrient powders on Hb change, anaemia and weight in children.

Design: A pragmatic cluster-randomized controlled trial.

Setting: Forty villages in the Nioro Circle in Mali and 722 children aged 6-23 months were randomized to the intervention or control group. The intervention consisted of a daily dose of multiple-micronutrient powder for 3 months; in the control group, no supplement was given. In both groups, mothers received group education on child complementary feeding. Changes in weight, Hb concentration and anaemia were assessed as primary outcomes at baseline and 3 months. The HFF effect was determined using regression analyses and quantile regression with standard errors taking account of the cluster design.

Subjects: Children aged 6-23 months.

Results: Overall prevalence of anaemia in the sample was high: 90 %. HFF provided a modest but statistically significant Hb change v. no intervention (0·50 v. 0·09 g/dl, P=0·023). Prevalence of anaemia changed little: 91·3-85·8 % (P=0·04) in the intervention group v. 88·1-87·5 % % (P=0·86) in the control group. Proportion of severe anaemia was reduced by 84 % (from 9·8 to 1·6 %) in the intervention group, but increased in the control group (from 8·5 to 10·8 %). No effect was observed on weight.

Conclusions: The WHO HFF strategy to fight anaemia showed a modest change on Hb concentration and significantly reduced the rate of severe anaemia.

Keywords: Anaemia; Children; Growth; Hb; Multiple micronutrients.

Fig. 1

Diagram of participants in the cluster-randomized controlled trial, Nioro Circle, Mali, January 2016

Fig. 2

Prevalence of anaemia at baseline among study children aged 6–23 months with Hb concentration measurement (n 440), Nioro Circle, Mali, January 2016.

Fig. 3

(colour online) Box-and-whisker plots showing gain in Hb concentration at endline (after 3 months), by study group, among children aged 6–23 months (n 359), Nioro Circle, Mali, January 2016. The bottom and top edge of the box represent the 25th and 75th percentile (interquartile range); the line within the box represents the median; the ends of the bottom and top whiskers represent the minimum and maximum values; and the dots represent outliers