ABSTRACT
Objectives: Although micronutrient powders (MNPs) are considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials challenge programmatic scale-up. We aimed to measure the association of community-based sales of MNPs with incidence of diarrhea, fever, and cough in children 6-35 months. Methods: The study was a community-based, cluster-randomized trial in 60 villages in western Kenya. MNPs and other health products (e.g., insecticide-treated bednets, soap, water disinfectant) were marketed in 30 intervention villages from July 2007-March 2008, followed by expansion of the intervention to both arms. Biweekly household visits monitored self-reported MNP use and morbidity. Using morbidity as the outcomes and MNP as the exposure variable, relative risks were estimated via generalized mixed models with random intercepts for repeated measures within a child and for multiple children from a household, while accommodating potential confounders as fixed effects. Results: Of the 1079 children enrolled, 881 (81.6%) had data on MNP use; average intake in intervention villages was 0.9 sachets/week. MNP intake was captured as continuous mean sachets and categories of use, but no significant effects were observed on incidence of diarrhea, fever or cough. Conclusions: Increased MNP use in western Kenya through community-based marketing did not result in increased incidence of infectious morbidity among young children. Integrated distribution of MNPs with other health interventions should be explored further in settings with high child malnutrition and infection burden.
ABSTRACT
Objectives: An important component of public health nutrition programs is the periodic assessment of vitamin and mineral nutritional status and coverage of micronutrient interventions. Performing high quality cross-sectional surveys can be enhanced by the availability of guidance on steps in survey methods, sample size, sampling methods, data collection, analysis and interpretation, dissemination of results, and appropriate feedback to improve intervention programs. A manual to assist implementers is described. Methods: A previously published manual, "Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations", by the Centers for Disease Control and Prevention (CDC) and the Micronutrient Initiative (MI) served as the basis for this newer manual. New technical partners, WHO and UNICEF, have collaborated in the development of this up-to-date "Micronutrient Survey Manual". Results: In addition to updated resources for the assessment of anemia and iodine, iron, and vitamin A deficiencies, the manual has added information on folate and zinc deficiencies. Program indicators for assessing fortification of staple foods, point-of-use fortification with micronutrient powders, micronutrient supplementation, and dietary counselling are included. The manual contains detailed information on biologic sample collection and processing, sample size calculations, and analysis of survey data. Quality assurance throughout the survey process is emphasized. The issues of ethics, confidentiality, and informed consent are addressed. Conclusions: The "Micronutrient Survey Manual" can assist survey managers to improve the validity, efficiency, and standardization of cross-sectional surveys to better serve public health practice.