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.

Anaemia in Pregnancy: Factors Associated with Maternal Anaemia in the Dadaab Refugee Camps, Kenya (2001-2002).

Objectives: 1) Describe the socioeconomic and health status of this population of pregnant women; 2) Determine the anaemia prevalence using a series of diagnostic markers (haemoglobin, sTFR, and ZPP); 3) Explore the relationship between a variety of socio-demographic, nutritional, and disease-related factors, and anaemia. Methods: This paper was developed using data collected during a longitudinal cohort study conducted between 2001-2002, which investigated the effectiveness of a new antenatal micronutrient supplement. A preliminary literature review identified known biological and socioeconomic risk factors associated with anaemia. Chi2, students t-test, correlation, and logistic regression analyses explored the strength of association between exposure variables and anaemia. Results: The prevalence of maternal anaemia in this population was 75% at 16-24 weeks gestation. Iron deficiency was similarly widespread; 65% and 45% of women exceeded the threshold for deficiency as defined by ZPP and sTFR indicators respectively. Malaria schistosomiasis, and hookworm infections were not significantly associated with anaemia in this population. MUAC and BMI were strongly correlated with anaemia, as was Somali ethnicity, iron deficiency (sTFR), and living in a rural context pre-displacement. Conclusions: The prevalence of anaemia and iron deficiency among pregnant women in Dadaab constituted a severe public health problem, as defined by the World Health Organisation. Since this study, a strategy for the control and reduction of anaemia has been developed by UNHCR and implemented in the Dadaab camps and elsewhere. However, data published more recently suggests that maternal anaemia remains a persistent problem (74%, 2005; 69%, 2008) that requires further attention and a continued response.

Monitoring of Flour Fortification Programs: Case Studies in Three Countries.

Objectives: Although monitoring should be an integral part of any fortification program, little is publicly known about the design, implementation, and results of flour fortification monitoring systems. The objectives are to assess the monitoring systems in three countries including the strengths and weaknesses of each system, how weaknesses are addressed, and lessons learned. Methods: South Africa, Indonesia, and Chile were selected using predetermined criteria (e.g., mandatory fortification legislation, represent different world regions, importation of flour, and existence of a functioning flour fortification monitoring system). Eight categories of regulatory and household/individual monitoring were assessed. Results: The monitoring systems for each country had different strengths and weaknesses. Overall, strengths included having a structured plan for at least some aspects of monitoring, an adequate number of trained inspectors, and the ability to modify regulations and protocols. Monitoring weaknesses included an insufficient multiple agency approach with poor communications within and between organizations, absent commercial monitoring, and lack of laboratory resources and funds. None of the countries had a cohesive monitoring program with regular collection of regulatory and household/individual monitoring information. Conclusions: A functioning flour fortification program depends on having an effective monitoring system in place. Critical to a successful monitoring system was the planning, budget, human resources, and political will necessary to implement monitoring and review monitoring data on a regular basis.