Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age.
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ABSTRACT:
SUBMITTER: Suchdev PS
PROVIDER: S-EPMC7046492 | biostudies-literature | 2020 Feb
REPOSITORIES: biostudies-literature
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Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age.
Suchdev Parminder S PS Jefferds Maria Elena D MED Ota Erika E da Silva Lopes Katharina K De-Regil Luz Maria LM
The Cochrane database of systematic reviews 20200228
<h4>Background</h4>Vitamin and mineral deficiencies, particularly those of iron, vitamin A, and zinc, affect more than two billion people worldwide. Young children are highly vulnerable because of rapid growth and inadequate dietary practices. Multiple micronutrient powders (MNPs) are single-dose packets containing multiple vitamins and minerals in powder form, which are mixed into any semi-solid food for children six months of age or older. The use of MNPs for home or point-of-use fortification ...[more]
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Project description: Not available
| S-EPMC6486284 | biostudies-literature
Project description:Home fortification of complementary foods (CFs) with multiple micronutrient powders (MNPs) is being scaled up in various countries, but little is known about the prevailing complementary feeding practices and the type and nutrient gaps to be filled with MNPs. The present study evaluated the complementary feeding practices of young children and simulated the risk of inadequate and excessive intakes associated with home fortification with MNPs. We have assessed the sociodemographic status, anthropometry, and complementary feeding practices of young children (N = 122) in Mecha district, rural Ethiopia. Using a 2-day, quantitative 24-hr recall, usual intakes of energy, protein, iron, zinc, and calcium were estimated. The risks of inadequate and excessive iron and zinc intakes with or without home fortification scenarios were assessed. The simulations considered intakes from CFs assuming average breast milk contributions and additional nutrients provided by the MNPs. Stunting was highly prevalent (50%) and was associated with a lower dietary diversity (P = .009) and nutrient intakes from the CFs. Median energy, zinc, and calcium intakes were below the estimated needs from CFs; protein needs were met. Median dietary iron intake appeared adequate, but 76%, 95% CI [68%, 84%], of children had inadequate intake (assuming low bioavailability), whereas another 8%, 95% CI: [3%, 13%], had excessive intakes. Simulation of daily and alternative day's fortification with MNP decreased the prevalence of inadequate iron and zinc intake but significantly increased the risk of excessive intakes that remained unacceptably high for iron (>2.5%). Untargeted MNP interventions may lead to excessive intakes, even in settings where poor complementary feeding practices are prevalent.
| S-EPMC6866026 | biostudies-literature
Project description:BackgroundThe efficacy of home fortification with iron-containing micronutrient powders varies between trials, perhaps in part due to population differences in adherence. We aimed to assess to what extent adherence measured by sachet count or self-reporting forms is in agreement with adherence measured by electronic device. In addition, we explored how each method of adherence assessment (electronic device, sachet count, self-reporting forms) is associated with haemoglobin concentration measured at the end of intervention; and to what extent baseline factors were associated with adherence as measured by electronic device.MethodsThree hundred thirty-eight rural Kenyan children aged 12-36 months were randomly allocated to three treatment arms (home fortification with two different iron formulations or placebo). Home fortificants were administered daily by parents or guardians over a 30 day-intervention period. We assessed adherence using an electronic device that stores and provides information of the time and day of opening of the container that was used to store the fortificants sachets in each child's residence. In addition, we assessed adherence by self-reporting and sachet counts. We also measured haemoglobin concentration at the end of intervention.ResultsAdherence, defined as having received at least 24 sachets (≥ 80%), during the 30-day intervention period was attained by only 60.6% of children as assessed by the electronic device. The corresponding values were higher when adherence was assessed by self-report (83.9%; difference: 23.3%, 95% CI: 18.8% to 27.8%) or sachet count (86.3%; difference: 25.7%, 95% CI: 21.0% to 30.4%). Among children who received iron, each 10 openings of the electronic cap of the sachet storage container were associated with an increase in haemoglobin concentration at the end of intervention by 1.2 g/L (95% CI: 0.0 to 1.9 g/L). Adherence was associated with the age of the parent but not with intervention group; with age, sex or anthropometric indices of the child; or with age or sex of the parent or guardian.ConclusionsThe use of self -reporting and sachet count may lead to overestimates of adherence to home fortification.Trial registrationThe trial was registered with ClinicalTrials.gov ( NCT02073149 ) on 25 February 2014.
| S-EPMC5796300 | biostudies-literature
Project description:BackgroundThe WHO recommends daily use of micronutrient powder for infants and toddlers at risk of micronutrient deficiencies in low-and-middle-income countries. China has established a micronutrient powder distribution program in many rural townships and villages, yet adherence to micronutrient powder remains suboptimal; a little is known about the behavioral inputs that may influence adherence. This study examines direct and indirect behavioral inputs in micronutrient powder adherence among caregivers in rural western China following the Integrated Behavioral Model (IBM) framework.MethodsCross-sectional data were collected from April to May 2019 among 958 caregivers of children aged 6 to 24 months in six counties. Data were collected on micronutrient powder adherence behavior, direct behavioral inputs (knowledge and skills, intention, salience, environmental constraints, and habits), and indirect behavioral inputs (attitudes, perceived social norms, and personal agency). Structural equation modeling (SEM) adjusted for sociodemographic covariates was used to evaluate the IBM framework.ResultsMean micronutrient powder adherence in the previous seven days was 53.02%, and only 22.86% of caregivers consistently fed micronutrient powder from the start of micronutrient powder distribution at six months of age. The SEM model revealed small- to medium-sized effects of salience (β = 0.440, P < 0.001), intention (β = 0.374, P < 0.001), knowledge and skills (β = 0.214, P < 0.001), personal agency (st. effect = 0.172, P < 0.001), environmental constraints (β=-0.142, P < 0.001), and caregiver generation (β = 0.119, P < 0.05) on micronutrient powder adherence. Overall, 54.7% of the variance in micronutrient powder adherence was explained by the IBM framework. Salience had the largest impact on micronutrient powder adherence (Cohen's f 2 = 0.227). Compared to parent caregivers, grandparents had a higher degree of micronutrient powder adherence on average (P < 0.001), and behavioral inputs were consistent among both parent and grandparent caregivers.ConclusionThere is a need to improve micronutrient powder adherence among rural caregivers. The IBM framework showed a high degree of explanatory power in predicting micronutrient powder adherence behavior. The findings suggest that increased reminders from doctors regarding micronutrient powder and coaching to improve personal agency in micronutrient powder feeding may increase adherence.
| S-EPMC9719183 | biostudies-literature
Project description:Adherence to home fortification of foods with multiple micronutrient powders (MNPs) is an essential indicator of effective implementation of MNP programmes. A meta-analysis was conducted to evaluate the high adherence rate (HAR) to MNPs and further investigate the factors that influence HAR. We searched PubMed, Web of Science, Embase, CAB Abstracts, MEDLINE (OVID), Cochrane Library, China National Knowledge Infrastructure, Wanfang and VP, from the date of database inception to 9 November 2020. We included peer-reviewed observational studies that investigated adherence to MNPs. Data on the HAR to MNPs and influencing factors on HAR were extracted and then pooled together. A total of 10 studies were included. The pooled HAR to MNPs was 63.28% (51.12%-74.64%). Among HARs, rates were higher in middle-income countries (65.21%) than low-income countries (55.23%). Parental age over 30 years (maternal age OR = 1.25, 95% CI: 1.08-1.44; paternal age OR = 1.17, 95% CI: 1.04-1.32), children aged 18-36 months (OR = 1.45, 95% CI: 1.12-1.88), maternal educational attainment of college or above (OR = 1.38, 95% CI:1.10-1.73), caregiver with the perception that other mothers use MNPs (OR = 1.52, 95% CI:1.19-1.95), caregiver being aware of the importance of iron (OR = 1.42, 95% CI: 1.18-1.71), caregiver having correct knowledge of MNPs (OR = 1.36, 95% CI:1.19-1.57) and caregiver reporting children have no side effects from MNPs (OR = 2.77, 95% CI: 2.46-3.11) were contributing factors to high adherence to MNPs. The overall HAR to MNPs was relatively low; hence, effective and trusted communication channels need to be established, along with more thorough dissemination of the knowledge of MNPs to caregivers, to improve MNPs adherence rates, especially in low-income countries.
| S-EPMC8710102 | biostudies-literature
Project description:Nearly two thirds of young children are anaemic in Bihar, India. Paediatric iron and folic acid syrup (IFAS) and multiple micronutrient powders (MNPs) are two evidence-based interventions to prevent anaemia. Using a randomized crossover design, we examined the acceptability of IFAS versus MNPs for children 6-23 months. In a catchment area of 2 health centres in Bihar, health front-line workers (FLWs) delivered either (a) IFAS twice weekly or (b) MNPs for 1 month followed by the other supplementation strategy for 1 month to the same families (NCT02610881). Household surveys were conducted at baseline (N = 100), 1 month after receiving the first intervention (1 month; N = 95), and 1 month after the second intervention (2 months; N = 93). Focus group discussions (10 FLWs) and in-depth interviews (20 mothers) were held at 1 and 2 months. We used chi-square and Fisher exact tests to test mothers' product preferences. Qualitative data were analysed using MaxQDA and Excel employing a thematic analysis approach. There was high adherence and acceptability for both products (>80%). There was no significant difference in preference (p < .05) on perceived benefits (39% MNPs, 40% IFAS), side effects (30% MNPs, 30% IFAS), ease of use (42% IFAS, 31% MNPs), child preference (45% IFAS, 37% MNPs), and maternal preference (44% IFAS, 34% MNPs). Mothers and FLWs indicated that the direct administration of IFAS ensured that children consumed the full dose, and MNPs intake depended on the quantity of food consumed, especially among younger children, which emphasizes the need to integrate supplementation with the promotion of optimal child feeding practices.
| S-EPMC5900720 | biostudies-literature
Project description:ObjectiveWe estimated the cost-effectiveness of home fortification with micronutrient powder delivered in a sales-based programme in reducing the prevalence of Fe deficiency anaemia among children 6-59 months in Bangladesh.DesignCross-sectional interviews with local and central-level programme staff and document reviews were conducted. Using an activity-based costing approach, we estimated start-up and implementation costs of the programme. The incremental cost per anaemia case averted and disability-adjusted life years (DALY) averted were estimated by comparing the home fortification programme and no intervention scenarios.SettingThe home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh.ParticipantsCaregivers of child 6-59 months and BRAC staff members including community health workers were the participants for this study.ResultsThe home fortification programme had an estimated total start-up cost of 35·46 million BDT (456 thousand USD) and implementation cost of 1111·63 million BDT (14·12 million USD). The incremental cost per Fe deficiency anaemia case averted and per DALY averted was estimated to be 1749 BDT (22·2 USD) and 12 558 BDT (159·3 USD), respectively. Considering per capita gross domestic product (1516·5 USD) as the cost-effectiveness threshold, the home fortification programme was highly cost-effective. The programme coverage and costs for nutritional counselling of the beneficiary were influential parameters for cost per DALY averted in the one-way sensitivity analysis.ConclusionsThe market-based home fortification programme was a highly cost-effective mechanism for delivering micronutrients to a large number of children in Bangladesh. The policymakers should consider funding and sustaining large-scale sales-based micronutrient home fortification efforts assuming the clear population-level need and potential to benefit persists.
| S-EPMC8042576 | biostudies-literature
Project description:ObjectiveTo examine the impact of a nutrition-sensitive social protection intervention on mothers' knowledge of Fe deficiency, awareness of multiple-micronutrient powders (MMP) and the consumption of MMP and other Fe supplements by their children aged 6-59 months.DesignTwo randomized controlled trials with treatment arms including cash transfers, food transfers, cash and food transfers, cash and nutrition behaviour change communication (BCC), and food and nutrition BCC were implemented over two years. Both included a control group that received no transfer or BCC. Transfer recipients were mothers living in poor households with at least one child aged less than 2 years at baseline. Probit models were used to analyse endline data.SettingRural areas in north-west and south Bangladesh.SubjectsMothers (n 4840) and children 6-59 months (n 4840).ResultsA transfer accompanied by nutrition BCC increased the share of mothers with knowledge of Fe deficiency (11·9 and 9·2 percentage points for North and South, respectively, P≤0·01), maternal awareness of MMP (29·0 and 22·2 percentage points, P≤0·01), the likelihood that their children 6-59 months had ever consumed MMP (32 and 11·9 percentage points, P≤0·01), consumed MMP in the preceding week (16·9 and 3·9 percentage points, P≤0·01) and consumed either MMP or an Fe supplement in the preceding week (22·3 and 7·1 percentage points, P≤0·01). Improvements were statistically significant relative to groups that received a transfer only.ConclusionsNutrition-sensitive social protection (transfers with BCC added) may be a promising way to advance progress on micronutrient deficiencies.
| S-EPMC5962883 | biostudies-literature
Project description:BackgroundDespite concerted efforts to improve diet quality and reduce malnutrition, micronutrient deficiencies remain widespread globally, especially in low- and middle-income countries and among population groups with increased needs, where diets are often inadequate in iron, zinc, folate, vitamin A, calcium, and vitamin B12. There is a need to understand the density of these micronutrients and their bioavailability across diverse foods and the suitability of these foods to help meet requirements for populations with high burdens of micronutrient malnutrition.ObjectiveWe aimed to identify the top food sources of these commonly lacking micronutrients, which are essential for optimal health, to support efforts to reduce micronutrient malnutrition among various populations globally.MethodsWe built an aggregated global food composition database and calculated recommended nutrient intakes for five population groups with varying requirements. An approach was developed to rate foods according to their density in each and all priority micronutrients for various population groups with different nutrient requirements.ResultsWe find that the top sources of priority micronutrients are organs, small fish, dark green leafy vegetables, bivalves, crustaceans, goat, beef, eggs, milk, canned fish with bones, mutton, and lamb. Cheese, goat milk, and pork are also good sources, and to a lesser extent, yogurt, fresh fish, pulses, teff, and canned fish without bones.ConclusionThe results provide insight into which foods to prioritize to fill common micronutrient gaps and reduce undernutrition.
| S-EPMC8936507 | biostudies-literature
Project description:Micronutrient deficiencies are mostly hidden; clinically less visible compared to macronutrient deficiencies. Food fortification with multiple micronutrients (MMN) is provided for children between 6-23 months, daily for two months at three-time points. We assessed the acceptance and adherence of this nutritional intervention in an urban community setting in Sri Lanka. This cross-sectional study enrolled caregivers of children aged 7 to 23 months with a cluster sampling method. Caregivers ' acceptance of taste and smell, health gains, ease of use, and need perception (Cronbach's reliability: 0.801) were assessed. Also, anemia knowledge (Cronbach's reliability: 0.642), MMN knowledge, and reported adherence (number of sachets consumed per month) were evaluated through a self-administered questionnaire. Adequate adherence was defined as the use of ≥80% sachets. The univariate and multivariate statistical analysis examined the association of acceptability, adherence, and anemia knowledge with independent variables (socio-demographic, household characteristics, and knowledge). The survey included 153 respondents. The Median (range) age of children was 12 months (7-23). The mean (SD) acceptability score was 66.82% (9.78%). Acceptance of sensory qualities (smell/taste) had a lower score than perceived health benefit. Most consumed MMN adequately (72.5%). The mean (SD) anemia knowledge score was 62.20% (25.79%). In multivariate analysis, child's age (OR: -0.360, 95% CI:-0.510,-0.211) and father's education (OR: 2.148, 95% CI: 0.439, 3.857) were independently associated with acceptability. Child's age (OR: -0.108, 95% CI:0.818, 0.985), anemia knowledge (OR:0.016, 95% CI: 1.003, 1.031) and acceptability (OR:0.236, 95% CI:1.140, 1.406) were significant determinants of adherence. Anemia knowledge was significantly associated with the mother's education and household income when adjusted. In conclusion, unpleasant smell/taste and daily schedule were reported as barriers to MMN use. Yet, perception and trust regarding health benefits were encouraging. Reported adherence was somewhat high. Improving acceptability and anemia knowledge could enhance adherence further in this population.
| S-EPMC8694412 | biostudies-literature