Open AccessEffect of Providing Multiple Micronutrients in Powder through Primary Healthcare on Anemia in Young Brazilian Children: A Multicentre Pragmatic Controlled Trial
Author(s) -
Marly Augusto Cardoso,
Rosângela Aparecida Augusto,
Gisele Ane Bortolini,
Cristieli S. M. Oliveira,
Daniela C. Tietzman,
Leopoldina Augusta Souza Sequeira,
Maria Claret Costa Monteiro Hadler,
Maria do Rosário Gondim Peixoto,
Pascoal Torres Muniz,
Márcia Regina Vítolo,
Pedro Israel Cabral de Lira,
Patrícia Constante Jaime
Publication year - 2016
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0151097
Subject(s) - medicine , micronutrient , anemia , anthropometry , pediatrics , vitamin a deficiency , hemoglobin , micronutrient deficiency , iron deficiency , randomized controlled trial , iron deficiency anemia , vitamin , retinol , pathology
Background Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. Methods A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months ( n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months ( n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. Results In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children. Conclusions MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children. Trial Registration Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b