evidence-based blog of Filippo Dibari

Posts Tagged ‘low income countries’

Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review)

In Under-nutrition on June 2, 2013 at 1:12 pm

by De-Regil LM, Suchdev PS, Vist GE, Walleser S, Peña-Rosas JP

Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Summary

Use of a powder mix of vitamins and minerals to fortify complementary foods immediately before consumption and improve health and nutrition in children under two years of age.

Deficiencies of vitamins and minerals, particularly of iron, vitamin A and zinc, affect approximately half of the infants and young children under two years of age worldwide. Exclusive breastfeeding until six months of age and continued breastfeeding for at least two years are recommended to maintain children’s adequate health and nutrition. After six months of age, infants start receiving semi-solid foods but the amount of vitamins and minerals can be insufficient to fulfil all the requirements of the growing baby.

Micronutrient powders (MNP) are single-dose packets of powder containing iron, vitamin A, zinc and other vitamins and minerals that can be sprinkled onto any semi-solid food at home or at any other point of use to increase the content of essential nutrients in the infant’s diet during this period. This is done without changing the usual baby diet.

This review includes eight good quality trials that involved 3748 infants and young children from low income countries in Asia, Africa and the Caribbean. We found that a variety of MNP formulations containing between five and 15 vitamins and minerals have been given for between two and 12 months to infants and young children aged six to 23 months of age.

The use of MNP containing at least iron, zinc and vitamin A for home fortification of foods was associated with a reduced risk of anaemia and iron deficiency in children under two. The studies did not find any effects on growth. Although the acceptability of this innovative intervention was high, there is no additional benefit to usually recommended iron drops or syrups, however few studies compared these different interventions. No deaths were reported in the trials and information on side effects and morbidity, including malaria, was scarce.

The use of MNP was beneficial for male and female infants and young children six to 23 months of age, independent of whether they lived in settings with different anaemia and malaria backgrounds or whether the intervention was provided for two, six or 12 months. The most appropriate arrangements for use (daily or intermittently), the appropriate vitamin and mineral composition of the mix of powders and the way to deliver this intervention effectively in public health programmes to address multiple micronutrient deficiencies remain unclear.

 

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Development of a crossover-randomized trial method to determine the acceptability and safety of novel ready-to-use therapeutic foods (ahead of print)

In Under-nutrition on September 19, 2012 at 5:07 pm

by Dibari F, Bahwere P, Huerga H, Irena AH, Owino V, Collins S, Seal A.

Nutrition (article in press).

Abstract

Objective: To develop a method for determining the acceptability and safety of ready-to-use therapeutic foods (RUTF) before clinical trialing. Acceptability was defined using a combination of three consumption, nine safety, and six preference criteria. These were used to compare a soy/maize/sorghum RUTF (SMS-RUTFh), designed for the rehabilitation of human immunodeficiency virus/tuberculosis (HIV/TB) wasted adults, with a peanut-butter/milk-powder paste (P-RUTF; brand: Plumpy’nut) designed for pediatric treatment.

Methods: A cross-over, randomized, controlled trial was conducted in Kenya. Ten days of repeated measures of product intake by 41 HIV/TB patients, >18 y old, body mass index (BMI) 18-24 kg/m^2, 250 g were offered daily under direct observation as a replacement lunch meal. Consumption, comorbidity, and preferences were recorded.

Results: The study arms had similar age, sex, marital status, initial BMI, and middle upper-arm circumference. No carryover effect or serious adverse events were found. SMS-RUTFh energy intake was not statistically different from the control, when adjusted for BMI on day 1, and the presence of throat sores. General preference, taste, and sweetness scores were higher for SMS-RUTFh compared to the control (P < 0.05). Most consumption, safety, and preference criteria for SMS-RUTFh were satisfied except for the average number of days of nausea (0.16 versus 0.09 d) and vomiting (0.04 versus 0.02 d), which occurred with a higher frequency (P < 0.05).

Conclusion: SMS-RUTFh appears to be acceptable and can be safely clinically trialed, if close monitoring of vomiting and nausea is included. The method reported here is a useful and feasible approach for testing the acceptability of ready-to-use foods in low income countries.

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