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Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren.

ABSTRACT: Micronutrient deficiencies are associated with impaired growth and cognitive function. A school-based fortification program might benefit schoolchildren but a high prevalence of parasite infestation might affect effectiveness. A randomized, double-blind, placebo-controlled 2 × 2 factorial trial was conducted to assess the efficacy of multi-micronutrient fortified biscuits with or without de-worming on growth, cognitive function, and parasite load in Vietnamese schoolchildren. Schoolchildren (n = 510), 6-8 years of age were randomly allocated to receive albendazole or placebo at baseline and four months of multi-micronutrient fortified biscuits (FB) or non-fortified biscuits. Children receiving FB for four months scored higher on two cognitive tests: Raven's Colored Progressive Matrices and the Digit Span Forward test. Children receiving albendazole plus FB had the lowest parasite load after four months. In children receiving FB, mid-upper arm circumference was slightly improved (+0.082 cm) but there were no differences in other indexes of anthropometry. Combining multi-micronutrient fortified biscuits with de-worming is an effective strategy.

SUBMITTER: Nga TT

PROVIDER: S-EPMC3144834 | biostudies-literature | 2011 Aug

REPOSITORIES: biostudies-literature

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Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren.

Nga Tran T TT Winichagoon Pattanee P Dijkhuizen Marjoleine A MA Khan Nguyen C NC Wasantwisut Emorn E Wieringa Frank T FT

The American journal of tropical medicine and hygiene 20110801 2

Micronutrient deficiencies are associated with impaired growth and cognitive function. A school-based fortification program might benefit schoolchildren but a high prevalence of parasite infestation might affect effectiveness. A randomized, double-blind, placebo-controlled 2 × 2 factorial trial was conducted to assess the efficacy of multi-micronutrient fortified biscuits with or without de-worming on growth, cognitive function, and parasite load in Vietnamese schoolchildren. Schoolchildren (n = ...[more]

PMID: 21813856

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Project description:BackgroundMicronutrient deficiencies can compromise the development potential of school-aged children, and their later health and productivity as adults. School feeding and school-based fortification approaches have been utilized globally to redress nutritional deficiencies in this age group.ObjectiveWe explored the acceptability and micronutrient impact of a Bangladesh Government supported school-based micronutrient fortification program for children attending rural primary schools in 10 disadvantaged sub-districts.MethodsWe applied a mixed methods approach. The quantitative component assessed the impact of micronutrient fortification on 351 children aged 6-11 years using a cohort pre-post research design with a control group. The qualitative component explored the acceptability of the intervention using focus group discussions, body mapping and semi-structured interviews with teachers, school-going children and school authorities.ResultsDaily consumption of fortified biscuits by primary school children had a significant positive impact on mean levels of iron, folic acid, vitamin B12, retinol and vitamin D controlling for sex, baseline deficiency status, CRP, and H. pylori. Levels of anemia and vitamin D deficiency were also significantly reduced. Qualitative findings indicated the widespread acceptability of the daily biscuit. Teachers perceived students to be more attentive in class, less tired, and some attributed better school performance to biscuit consumption. Children reported similar improvements in concentration and energy levels.ConclusionsThis study is among the first in Bangladesh to comprehensively assess a school-based fortification program in terms of its acceptability and impact on micronutrient status of children aged 6-11 years of age. While results strongly support this modality of school feeding, research on the cognitive impacts of micronutrient fortified biscuits will help clarify the case for scaled-up investments in school- based feeding program in Bangladesh and other low and middle income countries.

Project description:Micronutrient deficiency is one of the biggest public health concerns in Bangladesh. As per World Health Organisation (WHO) in the 2016 report, 40% women of reproductive age suffer from anaemia. According to the National Micronutrient Survey 2011-2012, 57% women suffer from zinc deficiency. The objective of the present study was to determine the effectiveness of fortified rice (FFR in addressing anaemia and zinc deficiency among vulnerable women. Baseline and endline surveys were conducted among female Vulnerable Group Development (VDG) beneficiaries in five districts in Bangladesh before and after 12 months of FFR distribution. The intervention group received 30 kg FFR; the control group received 30 kg non-FFR for every month from January 2013 to December 2013. The sample sizes were 870 women (435/group) at baseline and 800 (400/group) at endline. Difference-in-difference (DID) was estimated to measure the effect of FFR on anaemia and serum zinc. In the baseline survey, 39% of the FFR group and 34% of the non-FFR group had anaemia. At endline, 34% of women in the FFR group were anaemic compared to 40.7% in the non-FFR group. At endline, prevalence of anaemia was reduced in the FFR group by 4.8% but increased in the non-FFR group by 6.7%. The DID estimation showed the reduction in anaemia after 12 months of FFR consumption was significant (p = 0.035). The DID in mean haemoglobin level after 12 months of FFR consumption was also statistically significant (p = 0.002). Zinc deficiency decreased by 6% in the FFR group at endline, though the DID was not significant. Most of the respondents of the FFR group reported that they received their entitled rice on a regular basis however only half of the non-FFR respondents received every month in 12 months. Anaemia was significantly associated with not consuming fortified rice, geographical region, older age and heavy menstrual bleeding (P<0.05). FFR reduced anaemia and zinc deficiency prevalence. Replacement of regular rice with FFR in the VGD programme is recommended to reduce anaemia among vulnerable groups.

Project description:In Cambodia, micronutrient deficiencies remain a critical public health problem. Our objective was to evaluate the impact of multi-micronutrient fortified rice (MMFR) formulations, distributed through a World Food Program school-meals program (WFP-SMP), on the hemoglobin concentrations and iron and vitamin A (VA) status of Cambodian schoolchildren. The FORISCA-UltraRice+NutriRice study was a double-blind, cluster-randomized, placebo-controlled trial. Sixteen schools participating in WFP-SMP were randomly assigned to receive extrusion-fortified rice (UltraRice Original, UltraRice New (URN), or NutriRice) or unfortified rice (placebo) six days a week for six months. Four additional schools not participating in WFP-SMP were randomly selected as controls. A total of 2440 schoolchildren (6-16 years old) participated in the biochemical study. Hemoglobin, iron status, estimated using inflammation-adjusted ferritin and transferrin receptors concentrations, and VA status, assessed using inflammation-adjusted retinol-binding protein concentration, were measured at the baseline, as well as at three and six months. Baseline prevalence of anemia, depleted iron stores, tissue iron deficiency, marginal VA status and VA deficiency were 15.6%, 1.4%, 51.0%, 7.9%, and 0.7%, respectively. The strongest risk factors for anemia were hemoglobinopathy, VA deficiency, and depleted iron stores (all p < 0.01). After six months, children receiving NutriRice and URN had 4 and 5 times less risk of low VA status, respectively, in comparison to the placebo group. Hemoglobin significantly increased (+0.8 g/L) after three months for the URN group in comparison to the placebo group; however, this difference was no longer significant after six months, except for children without inflammation. MMFR containing VA effectively improved the VA status of schoolchildren. The impact on hemoglobin and iron status was limited, partly by sub-clinical inflammation. MMFR combined with non-nutritional approaches addressing anemia and inflammation should be further investigated.

Dataset Information

Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren.

Publications

Decreased parasite load and improved cognitive outcomes caused by deworming and consumption of multi-micronutrient fortified biscuits in rural Vietnamese schoolchildren.

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