Effect of Sprinkles on reducing anemia in young children in Cambodia: a cluster‐randomized effectiveness trial

Abstract

Whether anemia can be significantly reduced by delivery of micronutrient powders (Sprinkles) through government health services is uncertain. We evaluated the effectiveness of daily Sprinkles mixed with complementary foods in infants from aged 6 to 11 months (mo) with infant and young child feeding education (IYCFE). We followed 1350 randomly selected children at 6 mo intervals to aged 24 mo via biomarkers and anthropometry to establish whether any observed effects on anemia, deficiencies of Fe, vitamin A, Zn, and growth were sustained. Sprinkles plus IYCFE vs. IYCFE alone reduced any anemia at 12 mo by 24% (hemoglobin (Hb)<110g/L, Incidence Rate Ratio (IRR) 0·76, 95% CI 0·64 to 0·89, P=0·001) and moderate anemia (Hb<100g/L) by 57% (IRR 0·43, 95% CI 0·33 to 0·56, P<0.001). At later follow ups there were no significant differences in any anemia between groups. Iron deficiency was reduced by 57% (IRR 0·43, 95% CI 0·32 to 0·58, P<0.001) and iron deficiency anemia (IDA) and non‐IDA were reduced for moderate anemia at 12 mo. We found a significant increase in mean serum zinc (0·44 μmol/L, 95% CI 0·04 to 0·83, P = 0·028) but no difference in zinc and vitamin A deficiency, or growth at any time. Sprinkles reduced anemia, and increased mean serum zinc in Cambodian infants. These effects were in addition to IYCFE alone, but did not persist beyond the intervention. A2Z, USAID; Cambodia Health Sector Support Projects I & II; WHO Cambodia; GAIN.Grant Funding Source : A2Z, USAID; Cambodia Health Sector Support Projects I & II; WHO Cambodia; GAIN