Table 1.
Clinical trials assessing adherence to and acceptability of home fortification with multiple micronutrients in powder (MNP) in complementary feeding
| Source study (n = 14) | Setting | Prevalence of nutritional disorders | Study aim | Study design | Sample at baseline | Intervention |
|---|---|---|---|---|---|---|
| Soofi et al. (2013) [20] | Sindh, Pakistan (urban and rural areas) | Stunting = 23.3 %, 30.1 %, and 26.9 %; anaemia = 17.1 %, 26.6 %, and 24.9 %, in control, MNP with zinc, and MNP without zinc groups, respectively. | To assess the effects of provision of two MNP formulations, with or without zinc, on children’s growth, micronutrient status, and morbidity. | Cluster-randomized trial. Three groups: non-supplemented control, MNP without zinc, and MNP with 10 mg of zinc. |
n = 2746 children, aged 6 months. | Frequency of MNP: daily Intervention duration: 1 year Total sachets prescribed: 360 Iron dosage in MNP: no data given |
| Jack et al. (2012) [17] | Cambodia | Stunting = 11.3 % and 13.3 %; anaemia = 83.7 % and 84.4 %, in control and intervention groups, respectively. | To evaluate the effect of MNP alongside infant and young child feeding education program compared with feeding education alone on anaemia, iron deficiency, vitamin A, zinc, and growth in Cambodian infants. | Cluster-randomized effectiveness trial. Two groups: non-supplemented control received infant and young child feeding education alone; supplemented group received MNP alongside education. |
n = 1350 children, aged 6 months. | Frequency: daily Intervention duration: 6 months Total sachets prescribed: 180 Iron dosage in MNP: 12.5 mg |
| Inayati et al. (2012) [15] | Nias Island, Indonesia | Stunting = 34.1 %; anaemia = 51.7 %. | To assess the impact of intensive nutrition education with or without the provision of MNP on the nutritional status of mildly wasted children. | Cluster-randomized trial. Four groups: MNP plus intensive education; intensive nutritional education alone; supplemented MNP plus monthly non-intensive nutrition education program; non-intensive education program alone. |
n = 215 children, aged 6 to 60 months. | Frequency: daily Intervention duration: 1 year (or until child reached a weight-for-height z score ≥ -1) Total sachets prescribed: 360 Iron dosage in MNP: 10 mg |
| Sampaio et al. (2012) [7] | Bahia, Brazil | Stunting = 5.3 % and 7.4 %, respectively, in intervention and control groups. | To evaluate the incidence of diarrheal disease and acute respiratory infection in children undergoing supplementation with zinc and other micronutrients through the use of MNP. | Randomized clinical trial, double blind. Two groups: supplemented control with MNP without zinc; intervention group supplemented with MNP with zinc. |
n = 143 children, aged 6 to 48 months. | Frequency: daily Intervention duration: 90 days Total sachets prescribed: 90 Iron dosage in MNP: 12.5 mg |
| Avula et al. (2011) [13] | Rajasthan, India | Stunting = 48.0 % in India. | To assess the impact of the existing Supplemental Nutrition Program with local production of supplemental food, home fortification with MNP, and monitoring. | Quasi-experimental. Two groups: control group received the usual Supplementation Nutrition Program; intervention group received the enhanced program. |
n = 1128 children, aged 6 to 30 months. | Frequency: five times weekly Intervention duration: 6 months Total sachets prescribed: ≈ 120 Iron dosage in MNP: 12 mg |
| Kounnavong et al. (2011) [18] | Rural community in Lao People’s Democratic Republic | Stunting = 44.5 %, 42.3 %, and 40.4 % in control, twice weekly, and daily groups, respectively. Anaemia = 63.5 %. | To compare the effect of twice weekly versus daily supplementation with MNP on anaemia prevalence, haemoglobin concentration, and growth in infants and young children. | Randomized trial. Three groups: non-supplemented control, twice weekly supplementation, and daily supplementation. |
n = 336 children, aged 6 to 52 months. | Frequency: daily or twice weekly. Intervention duration: 24 weeks Total sachets prescribed: 168 (daily group) or 48 (twice weekly) Iron dosage in MNP: 10 mg |
| Tripp et al. (2011) [23] | Niger | Stunting = 49.0 %; Anaemia = 91.0 %. | To assess the acceptability of an MNP and a lipid-based nutrient supplement (Nutributter), and to explore people’s willingness to pay for these products. | Qualitative study. Two groups: 1. Supplemented with MNP or Nutributter for 4 weeks; 2. Supplemented with MNP and Nutributter for 2 weeks each. |
n = 83 children, aged 6 to 23 months. | Frequency: daily Intervention duration: 4 weeks Total sachets prescribed: 28 or 14 Iron dosage in MNP: 6 mg |
| Lundeen et al. (2010) [19] | Kyrgyz Republic | Anaemia = 50.0 %. | To test the effectiveness of a 2-month intervention with daily home fortification of complementary food using MNP in reducing anaemia among children 6 to 36 months of age. | Cluster-randomized trial. Two groups: non-supplemented control and intervention supplemented with multiple micronutrients. |
n = 2193 children, 6 to 36 months. | Frequency: daily Intervention duration: 2 months Total sachets prescribed: 60 Iron dosage in MNP: 12.5 mg |
| Rosado et al. (2010) [12] | Querétaro, México | No data given. | To evaluate the efficacy and children’s acceptance of several recognized strategies to treat anaemia. | Randomized clinical trial. Five groups: 1. Iron supplement, 2. Iron + folic acid supplement, 3. MNP, 4. Micronutrient-fortified complementary food as porridge powder, and 5. Zinc + iron + ascorbic acid-fortified water. |
n = 266 children, aged 6 to 43 months. | Frequency: daily. Intervention duration: 4 months Total sachets prescribed: 120 Iron dosage in MNP: 10 mg |
| Geltman et al. (2009) [11] | United States | Iron deficiency = 15.0–35.0 %. | To determine whether low-income infants’ adherence to MNP was better than to ferrous sulfate drops. | Randomized clinical trial. Two groups: Supplemented with MNP, supplemented with iron syrup. |
n = 150 children, aged 6 months. | Frequency: daily Intervention duration: 3 months Total sachets prescribed: 90 Iron dosage in MNP: 12.5 mg Iron dosage in ferrous sulphate drops: 10 mg of elemental iron |
| Adu-Afarwuah et al. (2008) [21] | Ghana | Anaemia = 23.0–30.0 % in both groups. | To compare the efficacy and acceptability of MNP, Nutritabs, and fat-based Nutributter, which provide 6, 16, and 19 vitamins and minerals, respectively, when used for home fortification of complementary foods. | Randomized trial. Four groups: non-supplemented; supplemented with MNP; supplemented with Nutritabs; supplemented with Nutributter. |
n = 313 children, aged 6 months. | Frequency: daily Intervention duration: 6 months Total sachets prescribed: 180 Iron dosage in MNP: 12.5 mg |
| Ip et al. (2007) [16] | Bangladesh | Anaemia = 75.8 %, 81.7 %, and 73.0 %, in daily for 2 months, flexible for 3 months, and flexible for 4 months groups, respectively. | To compare the effects of daily versus flexible administration of MNP on adherence, acceptability, and haematological status among young children in rural Bangladesh. | Cluster-randomized trial Three groups: supplemented daily with MNP for 2 months; supplemented with MNP with a flexible regimen for 3 months; supplemented with MNP with a flexible regimen for 4 months. |
n = 362 children, aged 6 to 24 months. | Frequency: Depended on the treatment regimen. The children received 60 sachets each. Intervention duration: 2, 3, or 4 months. Total sachets prescribed: 60 Iron dosage in MNP: 12.5 mg |
| Menon et al. (2007) [9] | Haiti | Anaemia = 52.0 % and 37.0 % in groups 1 and 2, respectively. | To evaluate the effectiveness of 2-months treatment with MNP in reducing anaemia among children 9–24 months. | Cluster-randomized pre-post intervention trial. Two groups: group 1 supplemented with MNP plus fortified food; group 2 supplemented with fortified food alone. |
n = 41 children, aged 9 to 24 months. | Frequency: daily Intervention duration: 2 months Total sachets prescribed: 60 Iron dosage in MNP: 12.5 mg |
| Christofides et al. (2005) [10] |
Aboriginal communities in Canada | Anaemia = 36.0 %. | To determine the acceptability and safety of MNP as a strategy for delivering iron to infants and young children | Double-blinded randomized controlled trial. Two groups: control; supplemented with MNP. |
n = 102 children, aged 4 to 18 months. | Frequency: daily Intervention duration: 6 months Total sachets prescribed: 180 Iron dosage in MNP: 30 mg |