Abstract
IntroductionMore than 3.5 million women and children under five die each year in poor countries due to underlying undernutrition. Many of these are associated with concomitant micronutrient deficiencies. In the last decade point of use or home fortification has emerged to tackle the widespread micronutrient deficiencies. We in this review have estimated the effect of Micronutrient Powders (MNPs) on the health outcomes of women and children.MethodsWe systematically reviewed literature published up to November 2012 to identify studies describing the effectiveness of MNPs. We used a standardized abstraction and grading format to estimate the effect of MNPs by applying the standard Child Health Epidemiology Reference Group (CHERG) rules.ResultsWe included 17 studies in this review. MNPs significantly reduced the prevalence of anemia by 34% (RR: 0.66, 95% CI: 0.57-0.77), iron deficiency anemia by 57% (RR: 0.43, 95% CI: 0.35-0.52) and retinol deficiency by 21% (RR: 0.79, 95% CI: 0.64, 0.98). It also significantly improved the hemoglobin levels (SMD: 0.98, 95% CI: 0.55-1.40). While there were no statistically significant impacts observed for serum ferritin and zinc deficiency. Our analysis shows no impact of MNPs on various anthropometric outcomes including stunting (RR: 0.92, 95% CI: 0.81, 1.04), wasting (RR: 1.13, 95% CI: 0.91, 1.40), underweight (RR:0.96, 95% CI: 0.83, 1.10), HAZ (SMD: 0.04, 95% CI: -0.13, 0.22), WAZ (SMD: 0.05, 95% CI: -0.12, 0.23) and WHZ (SMD: 0.04, 95% CI: -0.13, 0.21), although showing favorable trends. MNPs were found to be associated with significant increase in diarrhea (RR: 1.04, 95% CI: 1.01, 1.06) with non-significant impacts on fever and URI.ConclusionOur analysis of the effect of MNPs in children suggests benefit in improving anemia and hemoglobin however the lack of impact on growth and evidence of increased diarrhea requires careful consideration before recommending the intervention for implementing at scale.
Highlights
More than 3.5 million women and children under five die each year in poor countries due to underlying undernutrition
Micronutrient Powders (MNPs) significantly reduced the prevalence of anemia by 34% (RR: 0.66, 95% confidence intervals (CI): 0.57-0.77), iron deficiency anemia by 57% (RR: 0.43, 95% CI: 0.35-0.52) and retinol deficiency by 21% (RR: 0.79, 95% CI: 0.64, 0.98)
Our analysis shows no impact of MNPs on various anthropometric outcomes including stunting (RR: 0.92, 95% CI: 0.81, 1.04), wasting (RR: 1.13, 95% CI: 0.91, 1.40), underweight (RR:0.96, 95% CI: 0.83, 1.10), height for age z- score (HAZ) (SMD: 0.04, 95% CI: -0.13, 0.22), weight for age z-score (WAZ) (SMD: 0.05, 95% CI: -0.12, 0.23) and weight for height z-score (WHZ) (SMD: 0.04, 95% CI: -0.13, 0.21), showing favorable trends
Summary
More than 3.5 million women and children under five die each year in poor countries due to underlying undernutrition Many of these are associated with concomitant micronutrient deficiencies. Iron deficiency is widespread and globally about 1.62 billion people are anemic with the highest prevalence among preschool children (47%) followed by pregnant women (42%) [6]. Iodine deficiency (IDD) is a public health problem in 130 countries and affects 13% of world’s population [7]. It is estimated that one-third of the world population live in countries with a high prevalence of zinc deficiency. Clinical Vitamin A Deficiency (VAD) affects at least 2.80 million preschool children in over 60 countries, and sub clinical VAD is considered a problem for at least 251 million that includes school-age children and pregnant women [8]
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