Eff ect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trial

Methods We did a cluster randomised trial in urban and rural sites in Sindh, Pakistan. A baseline survey identifi ed 256 clusters, which were randomly assigned (within urban and rural strata, by computer-generated random numbers) to one of three groups: non-supplemented control (group A), micronutrient powder without zinc (group B), or micronutrient powder with 10 mg zinc (group C). Children in the clusters aged 6 months were eligible for inclusion in the study. Powders were to be given daily between 6 and 18 months of age; follow-up was to age 2 years. Micronutrient powder sachets for groups B and C were identical except for colour; investigators and fi eld and supervisory staff were masked to composition of the micronutrient powders until trial completion. Parents knew whether their child was receiving supplementation, but did not know whether the powder contained zinc. Primary outcomes were growth, episodes of diarrhoea, acute lower respiratory tract infection, fever, and incidence of admission to hospital. This trial is registered with ClinicalTrials.gov, number NCT00705445.

[1]  R. Glass,et al.  Diagnostic Microbiologic Methods in the GEMS-1 Case/Control Study , 2012, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  K. Wessells,et al.  Estimating the Global Prevalence of Zinc Deficiency: Results Based on Zinc Availability in National Food Supplies and the Prevalence of Stunting , 2012, PloS one.

[3]  M. Zimmermann,et al.  Maize porridge enriched with a micronutrient powder containing low-dose iron as NaFeEDTA but not amaranth grain flour reduces anemia and iron deficiency in Kenyan preschool children. , 2012, The Journal of nutrition.

[4]  S. Zlotkin.  More proof that home fortification is of value in children with iron deficiency anemia. , 2012, Archives of pediatrics & adolescent medicine.

[5]  L. Duley,et al.  Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. , 2012, The Cochrane database of systematic reviews.

[6]  R. Kraaijenhagen,et al.  Effect of Preventive Supplementation with Zinc and Other Micronutrients on Non-Malarial Morbidity in Tanzanian Pre-School Children: A Randomized Trial , 2012, PloS one.

[7]  M. Fried,et al.  Implications of Malaria On Iron Deficiency Control Strategies123 , 2012, Advances in nutrition.

[8]  R. Quick,et al.  Selling Sprinkles micronutrient powder reduces anemia, iron deficiency, and vitamin A deficiency in young children in Western Kenya: a cluster-randomized controlled trial. , 2012, The American journal of clinical nutrition.

[9]  D. Swinkels,et al.  Iron Availability Increases the Pathogenic Potential of Salmonella Typhimurium and Other Enteric Pathogens at the Intestinal Epithelial Interface , 2012, PloS one.

[10]  M. Hashizume,et al.  Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial , 2011, Nutrition journal.

[11]  Mathieu Lemaire,et al.  Iron-containing micronutrient powder provided to children with moderate-to-severe malnutrition increases hemoglobin concentrations but not the risk of infectious morbidity: a randomized, double-blind, placebo-controlled, noninferiority safety trial. , 2011, The American journal of clinical nutrition.

[12]  Z. Bhutta,et al.  Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: a meta-analysis of studies for input to the lives saved tool , 2011, BMC public health.

[13]  Robert E Black,et al.  Preventive zinc supplementation in developing countries: impact on mortality and morbidity due to diarrhea, pneumonia and malaria , 2011, BMC public health.

[14]  H. Kruger,et al.  Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa , 2011, International journal of food sciences and nutrition.

[15]  I. Rosenberg,et al.  Community-level micronutrient fortification of school lunch meals improved vitamin A, folate, and iron status of schoolchildren in Himalayan villages of India. , 2010, The Journal of nutrition.

[16]  F. Granado-Lorencio,et al.  Suitability of ultra-high performance liquid chromatography for the determination of fat-soluble nutritional status (vitamins A, E, D, and individual carotenoids) , 2010, Analytical and bioanalytical chemistry.

[17]  S. Abbott,et al.  The Genus Aeromonas: Taxonomy, Pathogenicity, and Infection , 2010, Clinical Microbiology Reviews.

[18]  D. O’Connor,et al.  Relative bioavailability of iron and folic acid from a new powdered supplement compared to a traditional tablet in pregnant women , 2009, BMC pregnancy and childbirth.

[19]  S. Zlotkin,et al.  Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control , 2009, European Journal of Clinical Nutrition.

[20]  Stanley Zlotkin,et al.  Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. , 2008, The American journal of clinical nutrition.

[21]  D. Hamer,et al.  Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo. , 2007, The American journal of clinical nutrition.

[22]  M. Ruel,et al.  Micronutrient Sprinkles reduce anemia among 9- to 24-mo-old children when delivered through an integrated health and nutrition program in rural Haiti. , 2007, The Journal of nutrition.

[23]  G. Tomlinson,et al.  Short-term daily or weekly administration of micronutrient Sprinkles™ has high compliance and does not cause iron overload in Chinese schoolchildren: a cluster-randomised trial , 2006, Public Health Nutrition.

[24]  Arjan de Wagt,et al.  Micronutrients in childhood and the influence of subclinical inflammation , 2005, Proceedings of the Nutrition Society.

[25]  G. Tomlinson,et al.  Micronutrients (including zinc) reduce diarrhoea in children: The Pakistan Sprinkles Diarrhoea Study , 2005, Archives of Disease in Childhood.

[26]  Reynaldo Martorell,et al.  Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. , 2004, Food and nutrition bulletin.

[27]  R. J. Hayes,et al.  Design and analysis issues in cluster-randomized trials of interventions against infectious diseases , 2000, Statistical methods in medical research.

[28]  D. Kerr,et al.  Anthropometric measurement error and the assessment of nutritional status , 1999, British Journal of Nutrition.

[29]  R. Stott,et al.  The World Bank , 2008, Annals of tropical medicine and parasitology.

[30]  D. Mahalanabis,et al.  Long-term oral supplementation with iron is not harmful for young children in a poor community of Bangladesh. , 1997, The Journal of nutrition.

[31]  J. Cristol,et al.  Determination of serum ferritin using immunoturbidimetry or chemiluminescent detection in comparison with radioimmunoassay a compendium of a methodological juxtaposition. , 2009, Clinical laboratory.

[32]  E. McLean,et al.  Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. , 2008 .

[33]  J. C. Smith,et al.  Analysis and evaluation of zinc and copper in human plasma and serum. , 1985, Journal of the American College of Nutrition.