Abstract
BackgroundAnemia 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.MethodsWe 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.ResultsOne 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.ConclusionsProviding 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 registrationISRCTN44149146; prospectively registered on 15th April 2013.
Highlights
Anemia early in life has been associated with delayed cognitive and motor development
Given that there are more than 8 million children born each year in rural areas, this implies that roughly 3 million children under 2 years old in rural China are anemic [13]
We present the results of a large-scale effectiveness trial of home fortification using micronutrient powders (MNPs) in villages in rural western China
Summary
Anemia early in life has been associated with delayed cognitive and motor development. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China. As a result of this poverty and associated factors, under-nutrition remains stubbornly high, among children in China’s poor rural areas. Rates of stunting and wasting are low, a large fraction of children in poor regions suffer from micronutrient deficiencies [1,2,3]. According to data from China’s Food and Nutrition Surveillance System, anemia rates among young children under 2 years of age in 2005 were 30–40% in poor rural areas nationally [3, 7,8,9]. In China, it is postulated that 90% of anemia in infants and young children results from iron deficiency [14]
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