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. 2020 Feb 28;2020(2):CD008959. doi: 10.1002/14651858.CD008959.pub3
Study Reason for exclusion
Avula 2011 Quasi‐experimental longitudinal design with randomisation at centre level. 1128 children aged 6 to 30 months living in Rajasthan, India, were selected from 30 Anganwadi centres (AWCs) and received the enhanced programme or the usual programme for 6 months. Enhancements to the Supplemental Nutrition Program (SNP) were provided through a network of AWCs delivered by Anganwadi workers (AWWs). AWCs were randomly selected and delivered the enhanced programme or the usual SNP programme

  1. Enhanced group (n = 680 children, 15 AWCs) received 3 enhancements to the usual SNP programme

    1. Ready‐to‐eat‐supplement prepared within the village instead of procuring it centrally

    2. Multiple micronutrient supplement (5 sachets per week; per sachet: 12 mg of iron, 50 μg of folic acid, 300 μg of vitamin A as retinol acetate, 40 mg of vitamin C, and 5 mg of zinc, topped up to 500 mg of dextrose to make it more palatable)

    3. Increased monitoring of programme delivery

  2. Usual group (n = 448 children, 15 AWCs) received centrally produced ready‐to‐eat supplementary food


Outcomes were height‐for‐age, weight‐for‐age, and weight‐for‐height z scores. We excluded the study because there was no appropriate comparison arm (comparison vs placebo or other type of supplement)
Bagni 2009 Randomised controlled trial with children between 12 and 60 months of age attending public childcare centres in Rio de Janeiro, Brazil. Participants were randomly assigned to receive a daily meal prepared with iron‐fortified rice or to receive non‐fortified placebo rice. The rice was fortified once a week. We excluded the study because the type of intervention provided (fortification) is outside the scope of this review
Barth‐Jaeggi 2015 Randomised controlled, double‐blinded trial. 287 infants aged 6 months living in the catchment area of Kikoneni Health Center in rural coastal Kenya were selected if they had a haemoglobin level of at least 70 g/L and no acute or chronic illness. Infants were enrolled and randomised to 2 groups

  1. Group 1 = daily maize porridge fortified with MNP containing 2.5 mg of iron as NaFeEDTA iron, 100 µg of vitamin A, 2.5 mg of zinc, 60 mg of vitamin C, and 12 other micronutrients; or

  2. Group 2 = same MNP composition without iron


Haemoglobin, serum ferritin, sTfR, body iron stores, C‐reactive protein, weight, height, and illness recall were assessed at baseline, 6 months, and 12 months. We excluded the study because both intervention and control groups received MNP and they differed only in iron supplementation. There was no appropriate comparison arm (comparison vs placebo or other type of supplement)
Bilenko 2014 Open‐label, cluster‐randomised, controlled clinical trial with a 2‐arm design. Randomisation at cluster level (mother and child health (MCH) clinics). Stratification by ethnic population group (Bedouin and Jewish). 621 infants (328 Bedouin and 293 Jewish), aged 6 months old, living in Negev, Israel, who belonged to families attending MCH clinics during 2005 to 2007. Excluded infants with Hb < 10 g/dL; chronic haematological, immunological, metabolic, or malabsorption disorders; or major congenital malformations; or participating in another study Infants from 12 clusters were randomised to 2 groups

  1. Group 1 (MNP arm) = daily sachet containing 12.5 mg of elemental iron as microencapsulated ferrous fumarate, 5 mg of zinc, 300 μg of vitamin A, 7.5 μg of vitamin D, 150 μg of folic acid, and 50 mg of ascorbic acid; or

  2. Group 2 (standard treatment) = 12 mg of iron, 300 μg of vitamin A, 10 μg of vitamin D as water‐based formula


Length of intervention was 2 months. Outcomes included haemoglobin, hematocrit, mean cell volume, red blood cell distribution, serum ferritin, transferrin saturation, and nutritional evaluation at 6 and 12 months. We excluded the study because there was no appropriate comparison arm (comparison vs placebo or other type of supplement)
Cardoso 2016 Multi‐centre, pragmatic, controlled trial among young Brazliian children, carried out in primary health centres, with data collected at baseline and at end‐line. Control group (CG) included children aged 10 to 14 months (n = 521) who were assessed at baseline only. CG participants were recruited during routine healthcare visits, where measurements of anaemia, anthropometry, and micronutrient status were collected. Intervention group (IG) children were 6 to 8 months of age at baseline (n = 462) and were given 60 micronutrient powder sachets to consume ‐ 1 daily over 60 days. Data were collected for IG children when they reached the age of CG children. Data were collected during different seasons and with no blinding. We excluded the study because children were not randomised
Chen 2008 Randomised trial with 226 apparently healthy preschool children (2 to 6 years old) from 15 nurseries or kindergartens in the Banan District of Chongqing, China, who were randomly assigned to 1 of 3 groups for 6 months

  1. Group 1 = fortified powder containing 500 μg of vitamin A (as acetate)

  2. Group 2 = fortified powder containing 500 μg of vitamin A (as acetate) and 12 mg of elemental iron (as ferric sodium edentate); or

  3. Group 3 = fortified powder containing 500 μg of vitamin A (as acetate) and 12 mg of elemental iron (as ferric sodium edentate), 12 mg of zinc (as zinc oxide), 0.7 mg of thiamin (as thiamin mononitrate), 0.7 mg of riboflavin, 200 μg (0.2 mg) of folic acid, 7 mg of niacinamide, and 800 mg of calcium (as calcium carbonate)


Powders were to be sprinkled over porridge, soy milk, soup, or noodles after cooking, and were indistinguishable in taste, colour, and packaging. Food prepared with the powders was delivered to each child at lunchtime or afternoon snack time, 5 days a week, during the study period. We excluded the study because participants are outside of the age range for inclusion in this review
Geltman 2009 Randomised clinical trial with 150 healthy 6‐month‐old infants. Each infant received a daily packet of MNPs, or multiple micronutrient drops. Follow‐up included alternating telephone and home visits biweekly for 3 months. Adherence was the primary outcome, whereas side effects and caregiver attitude about supplements were secondary outcomes. We excluded the study because the micronutrient powder formulation contained iron and vitamins A, C, and D, but not zinc, which was 1 of 3 main nutrients evaluated in this review
Goyena 2019 Randomised community trial of children 6 to 23 months of age in the Phillippines receiving 2 different formulations of MNP. Primary outcomes were compliance and acceptability. We excluded the study because there was no comparison arm. Also, no data were presented on any of our primary or secondary outcomes
Ip 2009 Cluster‐randomised trial with 362 Bangladeshi children (haemoglobin ≥ 70 g/L) aged 6 to 24 months who received 60 sachets of MNP daily over 2 months; flexibly over 3 months; or flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use MNP without exceeding 1 sachet per day. Post‐intervention outcomes included adherence, acceptability, and haematological status, which also was evaluated at 6 months post intervention. We excluded the study because it compared different schemes for providing MNP but did not compare them versus placebo or another type of supplement
Jaeggi 2015 A double‐blind, randomised controlled trial in 6‐month‐old Kenyan infants (n = 115). Participants were randomly assigned to receive MNP with or without 2.5 mg of iron as sodium iron EDTA. Researchers dispensed 7 MNP sachets and 2 kg of maize flour directly to participating mothers each week for 4 months. We excluded the study because both intervention and control groups received MNP, differing only in iron supplementation
Jyoti 2014 In India, from the records of registered children at respective Anganwadi centres, all children into the 6‐ to 36‐month age group were enrolled in the study through house‐to‐house visits. The experimental group (n = 790) received 75 g of the new supplementary baby mix (6 times a week) with micronutrient sprinkles (5 sachets per week). Micronutrient sprinkles were not administered to the control group (n = 540)
 The study was a quasi‐experimental longitudinal study. In the Tonk district, 2 blocks (namely, Tonk (rural) and Malpurawere) were selected randomly, and from the list of total Anganwadi centres in each block, a total of 15 Anganwadi centres were selected randomly. Tonk (rural) and Malpura were considered as experimental and control groups, respectively. We excluded the study because it was not an RCT
Khan 2014 A double‐blind, randomised controlled (2‐month) trial in Bangladesh. Infants aged 6 to 11 months (n = 100) were randomised to 1 of 2 intervention groups given MNP (Sprinkles) containing Fe and other micronutrients, with or without Ca. We excluded the study because both intervention and control groups received MNP, differing only in Ca supplementation
Lemaire 2011 A randomised, double‐blind, placebo‐controlled, non‐inferiority safety trial conducted in 268 Bangladeshi children used a 2‐month course of daily iron‐containing micronutrient powder (iron MNP) or placebo powder. This trial evaluated the effects of iron MNP on infectious morbidities when provided to children aged 12 to 24 months with moderate to severe malnutrition and anaemia. Primary outcomes included diarrhoea, dysentery, and lower respiratory tract infection episodes. Secondary outcomes included haemoglobin and anthropometric changes at 2 and 6 months. We excluded the study because MNP targeted to high‐risk populations is outside the scope of this review
Munayco 2013 Randomised controlled trial with Peruvian infants (n = 400) aged 6 to 11 months. Participants were randomly assigned to 6 months daily, 6 months intermittent (every other day), 12 months daily, or 12 months intermittent MNP supplementation. MNPs were provided monthly, and field staff conducted home visits twice monthly. Unused MNP sachets were collected throughout, and at end‐line (12 months) all caregivers were asked about their experiences using MNP. The study was conducted between 2009 and 2011. We excluded the study because there was no comparison arm
Neufeld 2008 A cluster‐randomised trial, implemented in the context of the Oportunidades programme, which is a conditional cash transfer programme implemented in rural areas in 1997 and urban areas in 2002 with authorisation from Oportunidades officials at federal, state, and local levels, at the National Institute of Public Health Ethics Commission, in Mexico. The study was designed to guide decisions within the programme to compare the effects of 3 nutritional supplements vs identical multiple micronutrient content (syrup, Nutrisano, MNP Sprinkles) on child growth and development and micronutrient status among Mexican children aged 6 to 12 months at baseline. 927 children were randomly assigned to:

  1. Group 1 (n = 265 infants): 44 g of daily supplement, Nutrisano (fortified food), containing 10 mg of elemental iron (as ferrous gluconate), 400 μg of vitamin A, 10 mg of zinc, 50 mg of vitamin C, 50 μg (0.05 mg) of folic acid, 6 mg of vitamin E, 0.8 mg of vitamin B2, and 0.7 μg of vitamin B12, and providing energy, protein, lipids, carbohydrates, and sodium

  2. Group 2 (n = 323 infants): 5 mL of a syrup daily containing 10 mg of elemental iron (as ferrous gluconate), 400 μg of vitamin A, 10 mg of zinc, 50 mg of vitamin C, 50 μg (0.05 mg) of folic acid, 6 mg of vitamin E, 0.8 mg of vitamin B2, and 0.7 μg of vitamin B12

  3. Group 3 (n = 339 infants): 1 g of micronutrient powder (Sprinkles) containing 10 mg of elemental iron (as ferous fumarate), 400 μg of vitamin A, 10 mg of zinc, 50 mg of vitamin C, 50 μg (0.05 mg) of folic acid, 6 mg of vitamin E, 0.8 mg of vitamin B2, and 0.7 μg of vitamin B12


We excluded the study because there was no comparison arm
Rawat 2015 A cluster‐randomised, controlled trial was conducted with children aged 6 to 11 months in Bangladesh, to assess the impact of (1) sale of MNPs by BRAC (Bangladesh Rural Advancement Committee) front‐line workers (MNP intervention); or (2) enhanced nutrition interpersonal counselling (EIPC intervention), or both, on anaemia and iron deficiency. We excluded the study because it focused on the sale of MNP, which is outside the scope of this review
Samadpour 2011 Randomised trial, conducted from May to September 2007 in an urban area of Iran, to compare the efficacy of daily MNP provided as foodlets (food‐like tablets), sprinkles, and drops on micronutrient status and growth in children aged 6 to 18 months. 362 children were allocated to receive a 4‐month daily dosage of:

  1. Foodlet tablets (n = 120)

  2. Sprinkles (n = 121) or

  3. Drops (n = 121)


Foodlets and sprinkles had the same 14 nutrients, whereas drops included only 9 of the 14 nutrients and did not contain zinc, vitamin B12, folic acid, copper, or iodine. Haemoglobin, serum ferritin, serum retinol, serum zinc, 25(OH)D concentration, and anthropometry were assessed at baseline and at 4 months. We excluded the study because it compared different schemes for providing MNP but did not compare them vs placebo or another type of supplement, or the same MNPs as supplements
Shafique 2014 Community‐based, cluster‐randomised trial with 244 full‐term, low‐birthweight infants aged 6 to 12 months in rural Bangladesh (24 clusters). Participants were randomly assigned to 2 groups:

  1. NHHE (nutrition, health, and hygiene education) plus MNP or

  2. NHHE only


We excluded the study because this type of participant (low‐birthweight infants) is outside the scope of this review
Sharieff 2006b 16 classes of 3‐ to 6‐year‐old children (n = 415) attending kindergarten in northern China were randomly assigned to 1 of 3 groups

  1. Group 1 = daily provision of a single‐dose sprinkles sachet containing 30 mg of elemental iron (as encapsulated ferrous fumarate), 5 mg of zinc (as gluconate), 300 μg of vitamin A, 50 mg of vitamin C, 7.5 μg of vitamin D3, and 150 μg (0.15 mg) of folic acid for 5 days a week

  2. Group 2 = once‐a‐week provision of a single‐dose sprinkles sachet containing 30 mg of elemental iron (as encapsulated ferrous fumarate), 5 mg of zinc (as gluconate), 300 μg of vitamin A, 50 mg of vitamin C, 7.5 μg of vitamin D3, and 150 μg (0.15 mg) of folic acid or

  3. Group 3 = no supplements (control group)


The intervention lasted for 1 school term (13 weeks). Consumption of sachets was monitored for each child, and SF concentrations were measured at the end of the study. We excluded the study because this type of participant is outside the scope of this review
Singla 2014 A cluster‐randomised trial to assess the effects of a 22‐element MNP on linear growth and mental development in full‐term, low‐birthweight children in rural Bangladesh. Children from 24 clusters were randomly allocated to receive:

  1. MNP intervention (a 22‐element MNP plus nutrition, health, and hygiene education) from 6 to 12 months of age (n = 117, 12 clusters) or

  2. No MNP (nutrition, health, and hygiene education only) (n = 114, 12 clusters)


Children at 16 to 22 months of age were assessed on subtests of the Bayley Scales of Infant and Toddler Development III, to measure cognitive and receptive and expressive language development. We excluded the study because this type of participant (full‐term, low‐birthweight children) is outside the scope of this review
Smuts 2005 290 term infants, aged 6 to 12 months, were recruited through the health posts of Valley of a Thousand Hills, Durban, KwaZulu‐Natal Province, South Africa; they were enrolled in the study and were randomly assigned to 1 of 4 groups:

  1. Group 1 = daily supplement containing 1 daily allowance of MNP for young children

  2. Group 2 = daily placebo supplement containing no micronutrients

  3. Group 3 = weekly supplement containing 2 daily allowances of MNP for young children and a placebo supplement on the other days of the week or

  4. Group 4 = daily supplement containing 10 mg of elemental iron


The MNPs provided were large, chewable tablets or foodlets (food‐like tablets). We excluded the study because this type of intervention is outside the scope of this review
Suchdev 2012 A cluster‐randomised trial with children aged 6 to 35 months in Western Kenya, from March 2007 to March 2009, to investigate (1) the effectiveness of the distribution of sprinkles MNP through an integrated health promotion and income‐generating programme; and (2) the impact of sales of sprinkles MNP on anaemia, iron deficiency, and vitamin A deficiency. Children from 60 villages were enrolled into the study and were randomly allocated to receive:

  1. Sprinkles MNP with 12.5 mg of iron; 375 μg of vitamin A; 5 mg of zinc; 150 μg of folic acid; 35 mg of vitamin C; 5 μg of vitamin D3; 6 mg of vitamin E; 6 mg of niacin; 0.6 mg of copper; 50 μg of iodine; 0.5 mg of thiamin, riboflavin, and vitamin B6; and 0.9 mg of vitamin B12 (n = 561) or

  2. No intervention (control; n = 502)


Sprinkles MNP was marketed and distributed in the intervention villages, but vendors were not prevented from selling sprinkles MNP in control villages. Outcomes included haemoglobin, ferritin, retinol binding protein, malaria, and anthropometric measurements at baseline and 12 months of follow‐up, along with sprinkles MNP sales and usage. We excluded the study because it was focused on marketing of MNP, which is outside the scope of this review
Teshome 2017 Randomised, double‐blind, non‐inferiority trial with children aged 12 to 36 months in Western Kenya that included 3 arms: (1) experimental treatment (n = 112), given MNP containing 3 mg of iron as NaFeEDTA plus 13 other micronutrients taken daily for 30 days; (2) active control treatment (n = 114), given MNP containing 12.5 mg of iron as encapsulated ferrous fumarate plus 13 other micronutrients taken daily for 30 days; and (3) placebo (n = 112), given MNP containing no iron but 13 other micronutrients taken daily for 30 days. Outcomes included haemoglobin concentration, iron status, anaemia, and malaria (microscopy and dipstick test). We excluded the study because all 3 arms were given MNP with and without iron
Troesch 2009 101 apparently healthy, non‐pregnant, non‐lactating young women studying or working at the Institute of Food Science and Nutrition, Swiss Federal Institute of Technology, Zurich, and the University of Zurich, between January and April 2008, were randomly assigned to 1 of 6 groups receiving a maize porridge fortified with a micronutrient powder containing stable, isotope‐labelled elemental iron as ferrous sulphate or NaFeEDTA, along with different combinations of inhibitors and enhancers (ascorbic acid, calcium, phytase, l‐alpha‐glycerophosphocholine). Each woman consumed 2 meals in a cross‐over design for determination of iron absorption. We excluded this study because this type of participant and this type of intervention are not within the scope of this review  
Troesch 2011 200 apparently healthy South African schoolchildren aged between 5 and 11 years from 2 primary schools in low socioeconomic areas of Kimberley, Northern Cape, South Africa, with low iron status, with haemoglobin higher than 90 g/L, and not taking nutritional supplements containing iron were randomly assigned to 1 of 2 groups:

  1. Group 1 = MNP containing 2.5 mg of elemental iron (as NaFeEDTA), 2.5 mg of zinc (as zinc oxide), and 60 mg of vitamin C, as well as a phytase and 14 other micronutrients or

  2. Group 2 = unfortified carrier added just before consumption to a bowl of 250 g of sweetened, high‐phytate maize porridge, given daily for 5 days a week for a period of 23 weeks


Primary outcomes were iron and zinc status. Secondary outcome was somatic growth. We excluded the study because participants were school‐aged children, between 5 and 11 years of age, and thus they were outside the scope of this review
Van der Kam 2016a 3‐Armed, partially blinded, randomised controlled trial; randomisation at individual level. 2213 children aged 6 to 59 months living in Goronyo, rural Nigeria, diagnosed with 1 or more of the 3 study diseases (malaria, diarrhoea, lower respiratory tract infection) were included in the study. Children were randomised in a 1:1:1 ratio to 1 of 3 intervention groups:

  1. Control group = no supplementation

  2. MNP group = 2 doses per day for 14 days whenever children were diagnosed with at least 1 of the 3 study diseases (2 sachets of MNP contained 8.2 mg of zinc, 1.1 mg of copper, 20 mg of iron, 180 μg of iodine, 34 μg of selenium, 800 μg of vitamin A, 10 μg of vitamin D, 10 μg of vitamin E, 60 mg of vitamin C, 1 mg of thiamin, 1 mg of riboflavin, 12 mg of niacin, 1 mg of pyridoxine, 1.8 μg of cobalamin, and 300 μg of folic acid) or

  3. RUFT group = 1 sachet of RUFT for 14 days whenever children were diagnosed with at least 1 of the 3 study diseases (1 sachet of RUFT contained 11.6 g of protein, 29.5 g of lipid, 276 mg of calcium, 276 mg of phosphorus, 1022 mg of potassium, 84.6 of magnesium, 12.9 mg of zinc, 1.6 mg of copper, 10.6 mg of iron, 96 μg of iodine, 27.6 μg of selenium, < 267 μg of sodium, 840 μg of vitamin A, 15 μg of vitamin D, 18.4 μg of vitamin E, 49 mg of vitamin C, 0.55 mg of thiamin, 1.66 mg of riboflavin, 4.88 mg of niacin, 0.55 mg of pyridoxine, 1.7 μg of cobalamin, 193 μg of folic acid, 19.3 μg of vitamin K, 60 μg of biotin, and 2.85 mg of pantothenic acid)


All groups (including the control group) received health education, including the message that following an illness, a child should eat 1 extra healthy meal per day for 2 weeks. Primary outcomes were negative nutritional outcome, defined as moderate malnutrition (MAM) or severe acute malnutrition (SAM), or both. For non‐malnourished children, weight‐for‐height z score < −2, MUAC < 115 mm, or nutritional oedema, whichever occurred first. For MAM, weight loss > 10% from baseline, weight‐for‐height z score < −2. For SAM, weight‐for‐height z score < −3, MUAC < 115 mm, nutritional oedema. Secondary outcomes included changes in anthropometric indicators, morbidity, and mortality. We excluded the study because high‐risk populations are outside the scope of this review
Van der Kam 2016b 3‐Armed, partially blinded randomised controlled trial; randomisation at individual level. 2202 children aged 6 to 59 months living in Kaabong, Karamoja region, Uganda, diagnosed with 1 or more of the 3 study diseases (malaria, diarrhoea, lower respiratory tract infection) were included in the study. Children were randomised in a 1:1:1 ratio to 1 of 3 intervention groups:

  1. Control group = no supplementation

  2. MNP group = 2 doses per day for 14 days whenever children were diagnosed with at least 1 of the 3 study diseases (2 sachets of MNP contained 8.2 mg of zinc, 1.1 mg of copper, 20 mg of iron, 180 μg of iodine, 34 μg of selenium, 800 μg of vitamin A, 10 μg of vitamin D, 10 μg of vitamin E, 60 mg of vitamin C, 1 mg of thiamin, 1 mg of riboflavin, 12 mg of niacin, 1 mg of pyridoxine, 1.8 μg of cobalamin, and 300 μg of folic acid) or

  3. RUFT group = 1 sachet of RUFT for 14 days whenever children were diagnosed with at least 1 of the 3 study diseases (1 sachet of RUFT contained 11.6 g of protein, 29.5 g of lipid, 276 mg of calcium, 276 mg of phosphorus, 1022 mg of potassium, 84.6 of magnesium, 12.9 mg of zinc, 1.6 mg of copper, 10.6 mg of iron, 96 μg of iodine, 27.6 μg of selenium, < 267 μg of sodium, 840 μg of vitamin A, 15 μg of vitamin D, 18.4 μg of vitamin E, 49 mg of vitamin C, 0.55 mg of thiamin, 1.66 mg of riboflavin, 4.88 mg of niacin, 0.55 mg of pyridoxine, 1.7 μg of cobalamin, 193 μg of folic acid, 19.3 μg of vitamin K, 60 μg of biotin, and 2.85 mg of pantothenic acid)


All groups (including the control group) received health education, including the message that following an illness, a child should eat 1 extra healthy meal per day for 2 weeks. Primary outcomes were negative nutritional outcome, defined as weight‐for‐height z score < −2, MUAC < 115 mm, or nutritional oedema, whichever came first. Secondary outcomes included changes in anthropometric indicators, morbidity, and mortality. We excluded the study because high‐risk populations are outside the scope of this review
Wang 2017 A double‐blind, randomised, placebo‐controlled clinical trial with rural, Malawian children aged 12 to 35 months. Intervention was the combined usage of a dose of albendazole, a course of zinc, and a daily MNP. Outcomes were compared to those of a placebo group after 12 and 24 weeks of intervention. We excluded this study because the type of intervention (a combined package of MNP and albendazole dose) is outside the scope of this review
Wijaya‐Erhardt 2007 Randomised controlled trial conducted in children between 6 and 12 months of age in rural Indonesia, which assessed the efficacy and safety of 3 types of food‐like tablets (foodlets) given for 23 weeks, compared to placebo. The foodlets were given as daily iron (ferrous sulphate), daily multiple micronutrients (14 nutrients: vitamins A, D, E, K, and C, thiamin, riboflavin, vitamin B12, niacin, folate, iron, zinc, copper, iodine), and weekly multiple micronutrients (same 14 nutrients). Results showed an increase in iron stores in the daily iron and daily multiple micronutrients groups, but not in the weekly multiple micronutrients group. Observed side effects were vomiting and diarrhoea, with no significant differences between intervention groups. We excluded the study because foodlets are not an intervention within the scope of this review
Yousafzai 2014 Community‐based, cluster‐randomised effectiveness trial in rural Sindh, Pakistan, from June 2009 to March 2012. The objective was to assess if responsive stimulation or enhanced care for nutrition intervention delivered alone, or a combined approach, would have an independent and additive or synergistic effect on child development, growth, and morbidity outcomes at 24 months. 1489 children younger than 24 months of age, from 80 clusters, were randomly allocated to receive:

  1. Routine health and nutrition services (control; n = 368)

  2. Nutrition education and MNP (enhanced nutrition; n = 364)

  3. Responsive stimulation (responsive stimulation; n = 383) or

  4. A combination of both enriched interventions (n = 374)


MNP contained iron, folic acid, vitamin A, and vitamin C. Primary endpoints were child development at 12 and 24 months of age (assessed with Bayley Scales of Infant and Toddler Development) and growth at 24 months of age. We excluded the study because the MNP did not contain zinc and thus did not comply with the definition used in this review of MNP requiring 3 or more micronutrients with at least iron, vitamin A, and zinc
Zlotkin 2001 Randomised controlled trial with 557 anaemic children between 6 and 18 months of age from rural Ghana. This trial assessed the efficacy of home fortification with MNP containing 80 mg of elemental iron (microencapsulated ferrous fumarate) + 50 mg of ascorbic acid added to weaning foods, compared to iron drops (40 mg of elemental iron given 3 times/d), given for 2 months. Outcomes included anaemia, ferritin, serum zinc, and growth concentration. We excluded the study because the MNP formulation tested in this study included only 2 micronutrients and thus did not comply with the definition used in this review of MNP requiring 3 or more micronutrients with at least iron, vitamin A, and zinc
Zlotkin 2003a Randomised trial with 437 Ghanaian, non‐anaemic children aged 8 to 20 months who were ingesting a weaning food in addition to breast milk. Participants were randomised individually to 1 of 4 groups:

  1. Group 1 (n = 110) = iron‐only MNP, containing 40 mg of elemental iron (as microencapsulated ferrous fumarate) daily

  2. Group 2 (n = 107) = iron and vitamin A MNP, containing 40 mg of elemental iron (as microencapsulated ferrous fumarate) and 600 μg of retinol equivalents (as retinyl acetate) daily

  3. Group 3 (n = 112) = 12.5 mg of elemental iron (as ferrous sulphate iron drops) daily or

  4. Group 4 (n = 108) = placebo in powder form


Primary outcome measures were change in haemoglobin and anaemic status at baseline and end of study. Prophylactic supplementation was provided to children for 6 months (October 1999 to March 2000). Children who maintained Hb concentration ≥ 100 g/L at the end of the intervention were reassessed at 12 months post intervention. Acceptability of the powders was better in comparison to the iron drops. No significant changes were seen in mean haemoglobin, ferritin, or serum retinol values from baseline to the end of the supplementation period among groups. The study area was considered a setting where intestinal parasites, malaria, and infectious diarrhoea are common. The supplementation period began at the end of the rainy season and was finished by the end of the dry season, when the burden of malaria was lower
We excluded the study because the trial evaluated provision of MNP formulated with only 1 or 2 micronutrients and thus did not comply with the definition used in this review of MNP requiring 3 or more micronutrients with at least iron, vitamin A, and zinc
Zlotkin 2003b Randomised controlled trial with 304 anaemic children between 6 and 18 months of age from rural Ghana. This trial compared the efficacy of home fortification with MNP including 80 mg of elemental iron (as microencapsulated ferrous fumarate) + 50 mg of ascorbic acid vs that of 80 mg of elemental iron (as microencapsulated ferrous fumarate) and 5 mg of zinc (as gluconate), over 2 months. Outcomes included anaemia, ferritin, serum zinc, and growth concentration. We excluded the study because interventions evaluated in this study included MNP with only 1 or 2 micronutrients and thus did not comply with the definition used in this review of MNP requiring 3 or more micronutrients with at least iron, vitamin A, and zinc. In addition, the study did not compare MNP vs placebo or any other supplement
Zlotkin 2013 Double‐blind, cluster‐randomised trial with children 6 to 35 months of age, conducted over 6 months in a rural community setting in central Ghana ‐ an area with high malaria burden. This trial evaluated effects of providing MNP with or without iron on the incidence of malaria among children living in a high malaria‐endemic region. 1958 children living in 1552 clusters were randomly allocated to receive MNP with 12 mg/d iron (n = 967) or MNP without iron (n = 991). Outcomes included malaria (defined as parasitaemia of any density plus reported fever within 48 hours or axillary temperature higher than 37.5 °C), malaria with parasite density higher than 5000/μL, anaemia (haemoglobin level < 10 g/dL), iron deficiency (ferritin level < 30 μg/L), hospital admission, and clinical diagnoses of pneumonia, diarrhoea (> 3 loose or watery stools in 24 hours), cerebral malaria, or meningitis among children who were admitted to a health facility during the study period. We excluded this study because there was no appropriate comparison arm (comparison vs placebo or another type of supplement)

Ca: calcium
 CG: control group.
 EDTA: ethylenediaminetetraacetic acid.
 Fe: iron.
 Hb: haemoglobin.
 MNP: micronutrient powder.
 MUAC: mid‐upper arm circumference.
 NaFeEDTA: mixture of ferric sodium ethylenediaminetetraacetate.
 RCT: randomised controlled trial.
 RUFT: ready‐to‐use therapeutic food.
 sTfR: soluble transferrin receptor.