Assessment of Implementation of an Anaemia Reduction Initiative Including Blanket Supplementary Feeding Distributing LNS and MNP on Anaemia in a Protracted Refugee Situation.

Objectives: Micronutrient malnutrition, commonly manifested as stunting and anaemia, is a persistent public health problems in populations experiencing a protracted refugee situation like the Western Sahara refugees living in south-west Algeria. A UNHCR and partners' strategy to address this issue was to implement a blanket supplementary feeding programme providing lipid-based nutrient supplements (LNS) and micronutrient powders (MNP) to children aged 6-35 and 36-59 months, respectively. We present data on anaemia prevalence in children aged 6-59 months after two-years of implementation. Methods: Routine pre- (2010) and post-intervention (2012) cross-sectional nutrition surveys were conducted assessing anaemia (Hb<11g/dL) in four Western Sahara refugee camps. Data on coverage was obtained by questionnaire in the post-intervention nutrition survey. Results: Overall, we observed a significant reduction in anaemia prevalence in children 6-59 months between baseline (52.8%; 95%CI: 49.1-56.6) and end-line (28.4%; 95% CI: 25.7-31.0); and an increase in mean haemoglobin concentration from 10.7 g/dL (s.d.:1.7) to 11.6 g/dL (s.d.:1.4). A similar pattern of differences for anaemia prevalence was observed when the analysis was stratified by camp. Coverage for LNS among children aged 6-35 months was 70%, contrasting with 14% for MNP among children aged 36-59 months.

Assessment of the Effectiveness of Nutributter® Distribution on Anaemia and Stunting in Refugee Populations in Djibouti and Kenya.

Objectives: Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. UNHCR and partners use blanket supplementary feeding programmes (BSFP) using Nutributter®, a low-quantity lipid-based nutrient supplement, as one of the approaches to confront these problems. However, the evidence base for the efficacy and effectiveness of Nutributter® is limited. This secondary analysis aimed to assess the impact on anaemia and stunting in children 6-23 months and 6-59 months of a blanket Nutributter® distribution implemented in Dadaab, Kakuma, and Ali Addeh refugee camps. Methods: A plausibility design using routine pre- and post-intervention cross-sectional nutrition survey data was conducted. Trends in total anaemia (Hb<11g/dl), anaemia categories (mild, moderate and severe), and stunting (HAZ<2) between 2008-2011 were explored and interpreted using available contextual, and Nutributter® programme monitoring data. Results: In all camps, a significant reduction was seen in the prevalence of anaemia in children 6- 23 and 6-59 months between baseline and endline; percentage point reduction ranged from 9.3% to 23%, and 18.3% to 29.3% for each age group, respectively. Improvements were largely due to reductions in moderate and severe anaemia. The prevalence of stunting remained similar for children 6-59 and 6-23 showing little change after introduction of the intervention. Conclusions: The replicability of findings suggests that Nutributter® distribution is associated with a reduction in anaemia, especially in its most severe forms, among refugees in the Horn of Africa. These results need to be interpreted taking into account other anaemia reduction activities implemented in the camps between 2008 - 2011.

Controlling iron deficiency anemia through the use of home-fortified complementary foods.

Iron deficiency anemia (IDA) is more common in South Asian countries including India, Bangladesh and Pakistan than anywhere else in the world. During infancy and early childhood, IDA is associated with impaired psycho-motor development and cognitive function that may be irreversible. As a consequence, there is a growing awareness that IDA is one of many factors impeding socio-economic prosperity of developing nations. The combination of unacceptably high prevalence rates and inadequate preventative programs highlights the need for new effective sustainable strategies to control IDA. The burden of iron deficiency can be reduced by taking a more holistic approach that would include promotion of healthy weaning practices and use of appropriate complementary foods, together with improving the nutritional value of such foods. There is an increasing body of peer-reviewed literature to support the contention that "micronutrient Sprinkles" is an effective strategy to improve the nutritional value of home-prepared complementary foods and thus to reduce the burden of iron deficiency among children. By combining data from recently conducted randomised control trials, Sprinkles were shown to be as efficacious as iron drops for treating childhood anemia. The iron in Sprinkles is well absorbed, and Sprinkles are easy to use and well accepted by young children and their caregivers. Integrated into existing public health programs, Sprinkles has the potential to improve the effectiveness of such programs.