Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control

• Published in: European journal of clinical nutrition Vol. 63; no. 2; pp. 165 - 172
• Main Authors: Ip, H, Hyder, S.M.Z, Haseen, F, Rahman, M, Zlotkin, S.H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2009; Nature Publishing Group
• Subjects: Acceptability; Anemia; anemia (disease); Anemia, Iron-Deficiency - drug therapy; Anemia, Iron-Deficiency - epidemiology; Anemias. Hemoglobinopathies; Bangladesh - epidemiology; Biological and medical sciences; Care and treatment; child nutrition; Child, Preschool; Children; Clinical Nutrition; compliance; cure rates; Demographic aspects; Developing countries; Dietary minerals; Dietary Supplements; disease control; Disease prevention; Diseases of red blood cells; Dosage and administration; Epidemiology; Feeding. Feeding behavior; Female; food fortification; Fundamental and applied biological sciences. Psychology; Health aspects; Hematologic and hematopoietic diseases; Hematology; Hemoglobin; Hemoglobins - analysis; Humans; Infant; Internal Medicine; Intervention; Iron; Iron - administration & dosage; LDCs; Male; Measurement; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Metals (hemochromatosis...); Nutrients; nutrition assessment; nutritional intervention; nutritional status; original-article; Other metabolic disorders; Patient Compliance; Prevalence; Public Health; Sprinkles (micronutrient supplement); Trace Elements - administration & dosage; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin deficiency; Bangladesh; Asia; Canada; Bangladesh; flexible administration; anaemia; iron deficiency; children; Sprinkles; Human; Iron deficiency anemia; Rate; Metabolic diseases; Hemopathy; Iron; Adhesion; Inorganic element; Micronutrient; Sideropenia; Child; Public health
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/sj.ejcn.1602917

Background/Objectives: Despite repeated public commitments and availability of various forms of iron supplements, rates of anaemia in developing countries remain high. A major reason for this lack of success has been poor adherence. The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence, acceptability and haematological status among young children in rural Bangladesh. Subjects/Methods: A sample of 362 children (haemoglobin (Hb) > or = 70 g l-1) aged 6-24 months were cluster-randomized to receive 60 sachets of Sprinkles either (i) daily over 2 months; (ii) flexibly over 3 months; or (iii) flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day. Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussions. Haemoglobin was measured at baseline, at the end of each intervention period and 6 months post-intervention. Results: Mean percent adherence was significantly higher in the flexible-4-month group (98%) compared to the flexible-3-month (93%) and daily-2-month (88%) groups (P<0.01). Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use. Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group (P=0.03). Anaemia prevalence decreased by 65% in the flexible-4-month group compared to 54% in the flexible-3-month and 51% in the daily-2-month groups. Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month (82%) and flexible-3-month (80%) groups than the daily-2-month (53%) group (P<0.05). Conclusions: The adherence, acceptability and haematological response to flexible administration over 4 months were found preferable to daily.