Open Access Research

Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial

Sengchanh Kounnavong12*, Toshihiko Sunahara2, C G Nicholas Mascie-Taylor3, Masahiro Hashizume2, Junko Okumura2, Kazuhiko Moji4, Boungnong Boupha1 and Taro Yamamoto2

Author Affiliations

1 National Institute of Public Health, Ministry of Health, Vientiane, Lao People's Democratic Republic

2 Department of International Health, Institute of Tropical Medicine (NEKKEN) and the Global Centre of Excellence Program (GCOE), Nagasaki University, Japan

3 Division of Biological Anthropology, Department of Archaeology and Anthropology, University of Cambridge, United Kingdom

4 Research Institute for Humanity and Nature, Kyoto, Japan

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Nutrition Journal 2011, 10:129  doi:10.1186/1475-2891-10-129

Published: 24 November 2011

Abstract

Background

Multiple micronutrient deficiencies, in particular iron deficiency anaemia (IDA) is a severe public health problem in Lao People's Democratic Republic (Lao PDR). Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children, recently, home-fortification with multivitamins and minerals sprinkles was recommended. This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder (MMP) on anaemia prevalence, haemoglobin concentration, and growth in infants and young children in a rural community in Lao PDR.

Methods

A randomized trial was conducted in six rural communities. Children aged 6 to 52 months (n = 336) were randomly assigned to a control group (n = 110) or to one of two intervention groups receiving either two sachets per week (n = 115) or a daily sachet (n = 111) of MMP for 24 weeks; 331 children completed the study. A finger prick of blood was taken at baseline, at week 12, and again at week 24 to determine haemoglobin concentration. Anthropometric measurements were taken every 4 weeks. The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups.

Results

MMP supplementation resulted in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group (p <0.001). The severely to moderately anaemic children (Hb <100 g/L) on daily supplementation recovered faster than those on twice weekly supplementation. MMP was well accepted and compliance was high in both treatment groups. Overall, the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups.

Conclusions

MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration. For severely to moderately anaemic children, daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence. A longer intervention period is probably needed to have a positive effect on growth.

Keywords:
Anaemia; multiple micronutrient powder; supplementation; home fortified food; Lao PDR