The effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial

BMC Public Health

Research Article

Linxiu Zhang¹  Ai Yue²  Yaojiang Shi²  Renfu Luo³  Scott Rozelle⁴  Alexis Medina⁴  Sean Sylvia⁵  Reynaldo Martorell⁶  Huan Zhou⁷ 

[1] Center for Chinese Agricultural Policy, Chinese Academy of Sciences, Beijing, China;Center for Experimental Economics in Education, Shaanxi Normal University, 620 Chang’an Road West, 710119, Xi’an, China;China Center for Agricultural Policy, School of Advanced Agricultural Sciences, Peking University, Beijing, China;Freeman Spogli Institute for International Studies, Stanford University, Stanford, USA;Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA;Rollins School of Public Health, Emory University, Atlanta, USA;West China School of Public Health, Sichuan University, Chengdu, China;

关键词: Micronutrient supplementation;    Anemia;    Cognition;    Early childhood;   

DOI  :  10.1186/s12889-017-4755-0

 received in 2017-05-31, accepted in 2017-09-12,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAnemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.MethodsWe conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6–11 months in target villages. Following a baseline survey, investigators randomly assigned each village/cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development.ResultsOne thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017–3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061–4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed.ConclusionsProviding caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline.Trial registrationISRCTN44149146; prospectively registered on 15th April 2013.

【 授权许可】

CC BY   
© The Author(s). 2017