Micronutrient Supplementation and Children Living in Impoverished Environments
Children under 5y of age are particularly susceptible to anemia, infections, and diarrhea. Children from the poorest households are nearly twice as likely as their counterparts to die before their 5th birthday.
Nutrition and sanitation are key elements to slow, and hopefully stop, cycles of poverty and disadvantage. Nutritional supplements in the form of micronutrient powders (MNPs) or ready-to-use-foods (RUTF) can help provide young children with essential vitamins and minerals. MNPs can be added to food prepared for infants and young children.
Suchdev and colleagues conducted a cluster-randomized trial in rural Western Kenya where 60 villages were randomly assigned to receive health products (water disinfectant, soap, insecticide-treated bednets, and condoms for the adults) [control] or health products and MNPs for the children [MNP]. The MNP sachets contained iron, zinc, vitamin A, iodine, copper, and vitamins C, D, B1, B2, B3, B6, B12, E, and folic acid. Vendors were permitted to sell the MNPs in control villages. Children from the MNP villages had ~60% fewer hospitalizations for diarrhea and 70% fewer for fever.
Van der Kam and colleagues evaluated the impact of nutritional supplementation in trials in Africa conducted by Medecins Sans Frontieres. The study was unique. In a region where childhood malnutrition is chronic, ill children presenting at clinics and diagnosed with malaria, diarrhea, or lower respiratory tract infections but NOT malnourished were randomized to one of 3 treatments 1) 1 sachet /d of RUTF, 2) 2 sachets/d of MNP/d, or 3) no supplement (control) for 14 days for each illness for 6 months. 2,202 children were randomized. The primary outcome was the incidence of first negative nutritional outcome (NNO) during the following 6 months. An NNO was defined as a weight-for-height z-score > -2, mid-upper arm circumference < 115 mm, or nutritional edema, whichever came first. The incidence rates of NNO were low (<0.15). MNP and RUTF lowered the incidence rate ratio but non-significantly and there were no difference in the proportion of children who died.
Both papers demonstrate the difficulties in conducting nutrition intervention trials in malnourished children. Both papers demonstrate that preventing malnutrition is important, especially for the children.
Suchdev PS, Addo OY, Martorell R, Grant FKE, Ruth LJ, Patel MK, Juliao PC, Quick R, Flores-Ayala R. Effects of community-based sales of micronutrient powders on morbidity episodes in preschool children in Western Kenya. 2016 Am J Clin Nutr doi: 10.3945/ajcn.115.118000
Van der Kam S, Roll S, Swarthout T, Edyegu-Otelu G, Matsumoto A, Kasujja FX, Casademont C, Shanks L, Salse-Ubach N. Effect of short-term supplementation with ready-to-use therapeutic food or micronutrients for children after illness for prevention of malnutrition: A randomized controlled trial in Uganda. 2016 PLoSMED doi: 10.1371/journal.pmed.1001951
For Every Child, A Fair Chance: The Promise of Equity, published by UNICEF, 2015 ISBN:978-92-806-4817-1