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Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control

European Journal of Clinical Nutrition volume 63, pages 165–172 (2009)Cite this article

Abstract

Background/Objectives:

Despite repeated public commitments and availability of various forms of iron supplements, rates of anaemia in developing countries remain high. A major reason for this lack of success has been poor adherence. The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence, acceptability and haematological status among young children in rural Bangladesh.

Subjects/Methods:

A sample of 362 children (haemoglobin (Hb)⩾70 g l−1) aged 6–24 months were cluster-randomized to receive 60 sachets of Sprinkles either (i) daily over 2 months; (ii) flexibly over 3 months; or (iii) flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day. Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussions. Haemoglobin was measured at baseline, at the end of each intervention period and 6 months post-intervention.

Results:

Mean percent adherence was significantly higher in the flexible-4-month group (98%) compared to the flexible-3-month (93%) and daily-2-month (88%) groups (P<0.01). Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use. Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group (P=0.03). Anaemia prevalence decreased by 65% in the flexible-4-month group compared to 54% in the flexible-3-month and 51% in the daily-2-month groups. Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month (82%) and flexible-3-month (80%) groups than the daily-2-month (53%) group (P<0.05).

Conclusions:

The adherence, acceptability and haematological response to flexible administration over 4 months were found preferable to daily.

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Acknowledgements

We thank and acknowledge the colleagues at BRAC including Fazlul Karim, Nuzhat Choudhury, Mizanur Rahman, Late MG Sattar and Imran Matin for their support. We thank Mélody Tondeur for her contribution in reviewing the manuscript. Finally, we thank the mothers and the community at large without whom this research project would not have been successfully completed. This study was funded by the Hospital for Sick Children through a generous grant from the HJ Heinz Company Foundation, Pittsburg, USA.

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Authors and Affiliations

  1. Formerly affiliated with the Department of Nutritional Sciences, University of Toronto and Program in Metabolism and Integrated Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada

    H Ip

  2. Canada and Department of Public Health Sciences, Program in Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, University of Toronto, Toronto, Canada

    S M Z Hyder

  3. Research and Evaluation Division, BRAC, Dhaka, Bangladesh

    F Haseen & M Rahman

  4. Division of Gastroenterology, Department of Paediatrics and Research Institute, Canada and the Departments of Paediatrics, Hepatology and Nutrition and Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Nutritional Sciences and Public Health Sciences, University of Toronto, Toronto, Canada

    S H Zlotkin

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Correspondence to S H Zlotkin.

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Ip, H., Hyder, S., Haseen, F. et al. Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control. Eur J Clin Nutr 63, 165–172 (2009). https://doi.org/10.1038/sj.ejcn.1602917

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