Poster Topical Area: Global Nutrition

Location: Hall D

Poster Board Number: 562

P12-029 - An Integrated Micronutrient Powder Intervention Did Not Affect Anemia or Iron Status among Children 6-23 Months in Eastern Uganda

Sunday, Jun 10
8:00 AM – 6:00 PM

Objective: Micronutrient powders (MNP) can reduce iron deficiency and anemia in children. We evaluated the impact of an integrated infant and young child feeding (IYCF) – MNP intervention on anemia and iron status among children 12-23 mo in Eastern Uganda.




Methods:
Population-based cross-sectional surveys representative of children 12-23 mo in Amuria (intervention) and Soroti (non-intervention) districts were collected in June/July at baseline 2015 (N=1260) and 12 months after implementation at endline 2016 (N=1490). From pooled capillary blood samples, hemoglobin (Hb) was assessed by Hemocue®, malaria by rapid test kit, and ferritin, C-reactive protein, and alpha-1 acid glycoprotein by sandwich ELISA. Ferritin was regression-adjusted to correct for inflammation. Caregivers reported sociodemographic characteristics and MNP knowledge and practices, including experiences with MNP mixed into food cooked with soda ash; soda ash can increase the pH of food, cause organoleptic changes, and decrease micronutrient bioavailability. Linear regression estimated double-difference effect of MNP on Hb and ferritin concentrations and logistic regression estimated double-difference effect of MNP on anemia (Hb <11.0 g/dL), iron deficiency (ferritin <12.0 μg/L), and iron deficiency anemia (Hb <11.0 g/dL and ferritin <12.0 μg/L). Weighting accounted for the sampling design.




Results:
In Amuria, 97% of caregivers reported their child had ever consumed MNP vs. <1% in Soroti. In Amuria, 65% reported consumption in the two weeks prior to the endline. More than half of caregivers (54%) reported organoleptic changes when MNP were added to foods cooked with soda ash. Adjusting for age, sex, malaria status, two week morbidity, and household-level factors, the intervention was associated with -0.83 g/dL lower Hb (95% CI -1.08, -0.57 g/dL) but not with anemia (Odds Ratio [OR] 1.29; 95% CI 0.94, 1.76), ferritin (1.53 µg/L; 95% CI -0.44, 3.50 µg/L), iron deficiency (OR 0.88; 95% CI 0.61, 1.26), or with iron deficiency anemia (OR 0.84; 95% CI 0.53, 1.33).




Conclusion:
Despite high coverage and adherence, the intervention was not associated with change in anemia or iron status. Contextual factors, such as cooking with soda ash, might help explain the lack of MNP effectiveness in Eastern Uganda.




Funding Source: The Government of Uganda, Ministry of Health and World Food Programme Uganda Country Office supported the implementation of the pilot intervention. World Food Programme Uganda funded an external agency to conduct the baseline survey. The U.S. Centres for Disease Control and Prevention (CDC) provided technical assistance for this survey through a Memorandum of Agreement with the World Food Programme.

CoAuthors: Laird Ruth – U.S. Centers for Disease Control and Prevention; Sarah Ngalombi – Uganda Ministry of Health; Abdelrahman Lubowa – Makerere University; Siti Halati – United Nations World Food Programme; Martin Ahimbisibwe – United Nations World Food Programme; Rhona Baingana – Makerere University; Ralph Whitehead – U.S. Centers for Disease Control and Prevention; Carine Mapango – U.S. Centers for Disease Control and Prevention; Maria Elena Jefferds – U.S. Centers for Disease Control and Prevention

Nicole D. Ford

Micronutrient Specialist (contractor)
U.S. Centers for Disease Control and Prevention
Atlanta, Georgia