Abstract
Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana's malaria endemic area.
Highlights
Anaemia prevalence in children under 5 years old was estimated to be 43% globally in 2011 and was higher (71%) in central and western Africa [1]
We present a secondary analysis of the double-blind, cluster randomized trial data [25], and successfully show the impact of long-term prophylactic iron-micronutrient powder (MNP) on the risk of iron deficiency and anaemia among pre-school children living in malaria endemic areas in Ghana
The trial was overseen by an independent Data and Safety Monitoring Board (DSMB), which was constituted in October 2009 and held three meetings during the trial
Summary
Anaemia prevalence in children under 5 years old was estimated to be 43% globally in 2011 and was higher (71%) in central and western Africa [1]. In Ghana, the prevalence of anaemia, iron deficiency and iron deficiency anaemia among pre-school children in 2017 were 35.6%, 21.5% and 12.2% respectively [2]. Zinc deficiency is thought to be as prevalent as iron deficiency affecting about 293 million children below the age of five years [5]. Despite the significant physiological roles of micronutrient in human health, their deficiencies are a universal health burden, among young children in developing countries [6]. As an intervention to curb the universal health burden of micronutrient deficiencies, vitamin A and zinc supplementation for children, and fortification of foods with iron and iodine, have been considered the most cost-effective approach [8]. MNP with iron (iron-MNP) given to pre-school children improved their motor and cognitive performance and mitigated severe anaemia [9,10]
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