Baye, Kaleab (PhD)Geletu, Ashenafi2019-08-072023-11-092019-08-072023-11-092018-06-01http://10.90.10.223:4000/handle/123456789/18740Micronutrient 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.enMicronutrient PowderUndernutritionInfant DevelopmentAnaemiaStuntingThesis