Investigation of the Exposure to Low-Iron Multiple Micronutrient Powders (Mnps) on Development, Anaemia and Growth of Infants and Young Children In Sidama Zone, Southern Ethiopia
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Date
2018-06-01
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Addis Ababa University
Abstract
Micronutrient malnutrition is estimated to affect 2 billion people worldwide. The deficiency is more
prevalent in infants and young children during complementary feeding period. Inappropriate
complementary feeding contributes to growth faltering, anemia, and cognitive impairments. Among the
various strategies designed to prevent and treat the nutritional deficiency home fortification with
micronutrient powders (MNP) is a novel alternative for delivering micronutrients with foods. Limited
programmatic evidence exists on the effectiveness of low-iron micronutrient powders (MNPs) on anemia,
growth and development when provided every other day in the first year of life.
This study investigated associations between exposure of low-iron MNPs with anemia, growth, and
development of infants in Southern Ethiopia. Using a retrospective cohort design, the associations between
MNP exposure (98 MNP exposed; 102 unexposed) and anemia, growth and motor development were
assessed among infants 9-11 months of age. This was followed by a prospective follow-up of the same
groups six months after the intervention was interrupted. Children’s developmental milestone acquisition
like language, social skills, and fine- and gross-motor skills were assessed. The retention of fat-soluble
vitamins in the home-fortified foods was evaluated using HPLC-DAD.
Socio-demographic characteristics and dietary patterns were similar between MNP exposed and
unexposed groups. Provision of low-Fe (6 mg) MNP every other day, for three months, was associated
with reduced risk of anaemia and stunting, and increased likelihood of standing alone (AOR=3.1; 95% CI:
1.53, 6.46) or walking alone (4.9; 95% CI 2.12, 11.37). Dietary diversity and mothers’ education were
also associated with motor development. The prospective follow-up (cohort) after the interruption of the
intervention revealed that difference-in-difference (DID) values between the two groups remained
significant and positive, meaning that earlier differences between the two groups widened with time even
in the absence of continued intervention. The risk of stunting and anemia in the MNP exposed infants were
still reduced by 32.6 % (RR: 0.67; 95% CI: 0.48, 0.94) and 42.6% (RR: 0.57; 95% CI: 0.44, 0.75),
respectively. Similarly, children exposed to MNP intervention in their first year of life had a lower risk of
deficits in the ability to walk alone (RR: 0.47; 95% CI: 0.38, 0.57) or standing alone (RR: 0.60; 95% CI:
0.46, 0.79) compared to those that were unexposed to MNP. Exposure to MNPs was positively associated
with various indicators of cognitive development like gross motor (β=0.59; 95% CI: 0.27, 0.91), fine
motor (β=0.48; 95% CI: 0.17, 0.79), language (β=0.48; 95% CI: 0.10, 0.85) and social skills (β= 0.16;
95% CI: 1.09, 2.24). Morbidity, head-circumference, and LAZ were all significantly associated with
development milestone acquisition (P<0.05). However, concentrations of retinol, cholecalciferol and α –
tocopherol were much lower than the expected values based on theoretical calculations.
Earlier exposure to improved nutrition can have long-term effects even when interventions are stopped.
Low-Fe MNPs provided on alternate days were associated with improved growth, lower risk of anemia
and better motor milestone acquisition. This should however be validated using a community-based
clinical trial. Improving the retention of fat soluble vitamins in MNPs would be critical to maximize
impact.
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Keywords
Micronutrient Powder, Undernutrition, Infant Development, Anaemia, Stunting