Micronutrient Supplementation during Pregnancy among Mildly and Non-anemic Women: Effects on Iron Status and Hemoglobin.

Objectives: Universal prenatal iron-folic acid and other micronutrient supplements are recommended to prevent anemia during pregnancy, but the evidence of their effect on iron status among women with mild or no anemia is limited. This study is to describe the iron status [serum ferritin (SF), serum transferrin receptor (sTfR), and body iron (BI)] before and after micronutrient supplementation during pregnancy. Methods: Among 834 pregnant women with mild or no anemia (Hb >110 g/L) from a subset of participants in a randomized, double-blind trial in China, women were randomly assigned to daily 400 µg folic acid (FA) (control), folic acid plus 30mg iron (IFA,), or folic acid, iron, plus 13 additional multiple micronutrients (MM) provided before 20 weeks gestation to delivery. Venous blood was collected during study enrollment (<20 weeks gestation) and at 28-32 weeks gestation. Results: At 28-32 weeks gestation , compared to FA group, both the IFA and MM group showed significantly lower prevalence of iron deficiency (ID) no matter which indicator (SF, sTfR, or BI) was used for defining ID. The prevalence of ID at 28-32 weeks gestation for IFA, MM, and FA were 35.3%, 42.7%, and 59.6% respectively using low SF; were 53.6%, 59.9%, and 69.9% respectively using high sTfR; and were 34.5%, 41.2%, and 59.6% respectively using low BI. However, there was no difference on anemia prevalence between FA and IFA or MM groups. Conclusions: Compared to FA alone, prenatal IFA and MM supplements provided to women with no or mild anemia improved later pregnancy iron status but did not affect perinatal anemia.

The Effects of Selling Micronutrient Powders on Morbidity Incidence among Preschool Children in Western Kenya.

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.

Prevención de la desnutrición de la madre y el niño: el componente de nutrición de la Iniciativa Salud Mesoamérica 2015 / Preventing maternal and child malnutrition: The nutrition component of the Mesoamerican Health Initiative 2015

Describir un plan maestro para el desarrollo de planes nacionales para prevenir la desnutrición materno-infantil en Mesoamérica en un plazo de cinco años. Para ello se elaboró un análisis sobre los principales problemas, políticas y programas de nutrición en Mesoamérica. A partir del análisis y de la revisión de la literatura sobre las mejores prácticas en el combate a la desnutrición, el Grupo Técnico de Nutrición desarrolló, discutió y validó el plan durante varias reuniones presenciales. Se desarrolló la teoría de cambio que identifica los problemas y barreras, las acciones propuestas, los cambios e impactos esperados. Se propone la implementación de paquetes de intervenciones para reducir la desnutrición y deficiencia de micronutrientes de utilidad para diversos contextos epidemiológicos. El plan maestro de nutrición constituye un insumo que puede facilitar la elaboración de propuestas de programas y políticas dirigidos a reducir la desnutrición y promover la toma de decisiones basadas en evidencia.

To describe the regional master plan of nutrition to address maternal and child malnutrition in a 5- year period developed by the Nutrition Technical Group. The Nutrition Technical Group developed a situation analysis describing the main nutrition problems, policies and programs in Mesoamerica. The situation analysis and a literature review about effective interventions to address malnutrition were conducted to develop a nutrition master plan. The Nutrition Technical Group held various meetings to develop, discuss and validate the master plan. Theory of change identified problems and barriers, the actions to be developed, the changes and impacts expected. A package of interventions is proposed to reduce undernutrition and micronutrient deficiencies useful under different epidemiological contexts. The nutrition master plan provides a guideline of best practices that can be used for evidence-informed decision making and the development of national policies and programs to reduce malnutrition.