Relationship between age at giving fortified powdered cow's milk and cessation of breastfeeding on the nutritional status of a Chilean child cohort followed from birth to 3 years of age.

BACKGROUND/OBJECTIVES: To examine how much of the variation in weight-for-height (WHZ) z-scores were associated with age at which breastfeeding ceased and provision of fortified cow's milk (Leche Purita Fortificada, LPF) commenced in a cohort of children studied from birth to 3 years of age. SUBJECTS/METHODS: Longitudinal data were obtained from routine medical check-ups on 8373 children from nine Chilean counties through convenience sampling. WHZ z-scores were generated at six-monthly intervals using WHO 2006 standards from birth to 3 years old (seven measurements). Age of cessation of breastfeeding and age of commencement of LPF were the independent variables. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements. Binomial generalised estimating equations (GEE) were used to analyse the effect of each independent variable on the change from normal to overweight, and normal to obese over the seven measurements. RESULTS: ANOVA indicated that children given LPF milk before 3 months of age had, on average, higher mean WHZ of about 0.11 SD from 18 months of age onwards (p < 0.001). GEE analyses showed that children given LPF before 3 months of age were significantly more likely to be overweight or obese (OR = 1) compared with children given LPF later (overweight OR: 0.809-0.970, p = 0.009, obese (OR: 0.666-0.901, p = 0.001). CONCLUSIONS: Early intake of LPF increases WHZ and is a risk factor for overweight and obesity in young children, while prolonged breastfeeding acts as protective factor against obesity.

The impact of an income-generating activities programme on children and mothers' undernutrition in extreme poor rural Bangladeshi households.

OBJECTIVE: The current study assessed changes in children and mothers' nutritional status before and after raising Bangladeshi households out of extreme poverty through an income-generating activities (IGA) programme. DESIGN: Extreme poor households took part in the IGA programme for 2 years and recruitment took place over four waves in annual cycles. Children and mothers were measured with regarding their nutritional status before and after the IGA programme commenced. SETTINGS: Rural Bangladesh. SUBJECTS: Three-hundred and eighty-two children under 5 years of age at recruitment, and their mothers. RESULTS: After 2 years of the IGA programme, the prevalence of stunting significantly declined from 40·3 % to 33·0 % (P = 0·003), anaemia declined from 51·6 % to 44·0 % (P = 0·020) while mothers' CED (Chronic Energy Deficiency) declined from 52·0 % to 42·7 % (P < 0·001), but no significant changes were found in children's wasting, declining from 25·4 % to 21·5 %, underweight which remained the same at 43·2 %, while mothers' anaemia rose from 39·3 % to 42·7 %. There were also highly significant improvements in household socio-economic status. Increases in socio-economic security (especially in relation to cash savings and net income) and improvements in food quantity and quality (indicated by greater food diversity and animal food intake) were associated with normal nutritional status, and cessation of open defecation was associated with reduction in mothers' and child anaemia. CONCLUSION: The IGA programme was associated with increased household socio-economic security, such as asset accumulation, food security and sanitation, and with improvements in the nutritional status of children and their mothers in extreme poor households.

DO BIOMARKERS VARY BY SOCIAL CLASS, EDUCATION AND REGION AND IS MIGRATION IMPORTANT? EVIDENCE FROM A COHORT OF BRITISH ADULTS.

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire & Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

Trends of weight gain and prevalence of overweight and obesity from birth to three years of age.

OBJECTIVE: To examine the changes in children's weight-for-height at six monthly intervals between birth and three years old (3yo) from different counties across Chile and to determine if children had overweight or obesity, and if so, whether it was a transient or persistent change. SUBJECTS AND METHODS: Longitudinal data were obtained from routine medical check-ups and 8,373 children were selected from nine counties in Chile through a non-randomised sample design. Weight-for-height z-scores (WHZ) were generated and categorized as wasted, normal, overweight, and obese using WHO standards. Repeated-measures ANOVA were used to analyse the changes in WHZ over the seven measurements as well as based on having normal, overweight, or obese WHZ at 3yo. The number of times having overweight or obesity was counted (from 0 to 7 times). The timing of having overweight and obesity was computed as well as all combinations of the patterns. RESULTS: Mean WHZ significantly increased up to 18months of age and declined thereafter (p<<0.001). Overall mean WHZ was 0.743, prevalence of overweight 31.2% and prevalence of obesity 10.0%. Children categorised with overweight or obesity at 3yo showed significantly higher and sustained pattern of weight gain compared with children with normal WHZ. Once a child had overweight or obesity they tended to remain with it and did not return to a weight-for-height in the normal range. CONCLUSION: The increasing prevalence of overweight and obesity in Chilean children is of concern. There is a need for greater healthcare promotion and prevention of this disease from infancy.

Regional variation in weight-for-height z-scores and surface area/body mass ratio of Chilean children from birth to 3 years of age.

OBJECTIVE: The objectives of the study were to see how much of the variation in weight-for-height z-scores (WHZ) and surface area/body mass ratio (SA/mass) were associated with regional (county) differences including mean temperature. SUBJECTS AND METHODS: Longitudinal data were obtained from routine medical check-ups on 8,373 children from nine counties across Chile. WHZ and SA/mass were calculated from weight and height from birth to 3-years old at 6 monthly intervals. County of birth was used as an independent variable after controlling for sociodemographic factors. Sequential repeated-measures ANOVAs were used to analyze the changes in WHZ and SA/mass over the seven measurements from birth to 3 years of age. Simple and partial Pearson correlations were calculated between WHZ and annual mean temperature and between SA/mass and annual mean temperature after controlling for socioeconomic factors. RESULTS: County of birth was significantly (p < 0.001) associated with both WHZ and SA/mass. There was a progressive decrease in WHZ means and a progressive increase in SA/mass means from colder to warmer counties. Significant negative correlation in WHZ (r < -0.864) and significant positive correlations in SA/mass (r > 0.821) were found with the annual mean temperature from 18 months of age onwards and in the overall mean age. CONCLUSION: This study suggests that WHZ and SA/mass variation may be influenced by ecogeographical factors in this Chilean sample.

Biological aspects of human migration and mobility.

This paper reviews how migration, both geographical and social, impacts on variation in some human biological traits. Migration and mobility are considered in relation to anthropometric traits and indices, psychometric traits, health, disease and nutrition, temperature regulation and metabolism, mental health and gene flow. It is well known that migration is important in disease transmission but, as this paper demonstrates, migration can have both positive and negative impacts on both donor and recipient populations for a wide range of human traits.

SOCIOECONOMIC AND DEMOGRAPHIC VARIATION IN NUTRITIONAL STATUS OF UNDER-FIVE BANGLADESHI CHILDREN AND TREND OVER THE TWELVE-YEAR PERIOD 1996-2007.

The nutritional status of under-five-year-old children is a sensitive indicator of a country's health status as well as economic condition. The objectives of this study were to analyse trends in the nutritional status in Bangladeshi children over the period 1996-2007 and to examine the associations between nutritional and socioeconomic status variables. Bangladesh Demographic Health Surveys (BDHS) were the source of data, and a total of 16,278 children were examined. The Z-scores of the children were analysed as continuous as well as categorical variables (stunted, underweight and wasted). The socioeconomic status variables used were region, urban-rural residence, education and occupation of the parents, house type and household possession score. A series of General Linear Model and Sequential Linear and Binary Logistic Regression analyses were done to assess the relationship between demographic and socioeconomic variables and nutritional status. The trends of Z-scores were analysed by survey, as well as by child birth cohort. Region, house type, educational level of parents and household possession score showed significant associations with all three Z-scores of children after removing the effects of age, period of DHS and other explanatory variables in the model. No significant sex difference was observed between any of the Z-scores. There were improvements in mean WAZ and HAZ between 1996 and 2007 but deterioration in mean WHZ over this period. The obesity rate was below 2% in 2007, although the absolute numbers of obese children had nearly doubled in this 12-year period. Children from poorer households showed greater improvement than their better-off counterparts. The study reveals that over the years there has been substantial improvement in nutritional status of under-five children in Bangladesh and the main gains have been amongst the lower socioeconomic groups; it is also evident that malnutrition in Bangladesh is a multidimensional problem, like poverty itself, and warrants a proper policy mix and programme intervention.

Biosocial correlates of age at menarche in a British cohort.

BACKGROUND: A large number of biosocial variables have been shown to associate with age at menarche, but the results are inconsistent and differentiate not only between countries but within countries as well. AIM: This study examined age at menarche in a British national cohort in relation to 21 biosocial and anthropometric variables. SUBJECTS AND METHODS: The analyses were based on 4483 girls from the British National Child Development Study (NCDS). RESULTS: The majority of girls reached menarche between 12-14 years of age. Girls from smaller families, those living in the East and South East, South West, West Midlands and Wales regions, in tied housing and uncrowded conditions, not sharing a bedroom, not having free school meals, whose families lived in households without financial problems had started menstruating earlier than their peers from families with lower socioeconomic status. However, when all the significant variables were analysed together significant associations remained only for mother's age at menarche, height and weight at 7 years, family size and tenure. CONCLUSIONS: The results of this study support the hypotheses that intra-uterine growth and conditions in early life as well as socio-economic background are associated with the timing of menarche and that greater childhood growth and better SES are related to earlier menarche.

THE BIOLOGICAL STATUS OF CHILDREN LIVING IN DISADVANTAGED REGIONS OF HUNGARY.

The aim of this study was to find out whether differences exist in the physical development, nutritional status and psychosomatic status of children living in deprived regions of Hungary compared with the Hungarian national reference values. The Hungarian government's decree No. 24/2003 created a complex indicator of social and economic conditions by which the country's regions were graded into deprived and non-deprived regions. This study examined 3128 children (aged 3-18 years) living in the deprived regions and their biological status was compared with the national reference values (2nd Hungarian National Growth Study). Children's body development was assessed via some absolute body dimensions. Nutritional status was estimated by BMI with children being divided into 'underweight', 'normal', 'overweight' and 'obese' categories. For children aged 7-18 years a standard symptoms list was used to characterize psychosomatic status. The subjects were asked to rate their health status as excellent, good, fair or poor. The body development of children living in these deprived regions was significantly retarded compared with the national references in the age groups 7-9 years and 14-17 years for boys and in the age groups 4-6 and 14-17 for girls. The prevalence of underweight was significantly higher in children and adolescents living in deprived regions (boys: 4.8%; girls: 5.9%) than the national references (boys: 2.9%; girls: 4.0%), while the prevalence of overweight and obese children did not differ between deprived regions (boys: 20.2%; girls: 19.8%) and the national references (boys: 21.5%; girls: 19.1%). Children and adolescents living in the deprived regions rated their health status worse, and experienced more psychosomatic complaints (abdominal discomfort and fear), than the national references. Although the majority of body dimensions of children in deprived regions were close to the 50th centile of the Hungarian national references, a sizeable minority (31%) were 0.20SD or more away from the median value, which has implications as to how social, medical and public welfare policy can be shaped.

Is human mating for height associated with fertility? Results from a British National Cohort Study.

OBJECTIVES: Very few studies have investigated whether spousal similarity for height is related to fertility. This study examined the relationship between mating for height and fertility after correction for spousal age, social class, education, and region. METHODS: The data used were collected as part of the British National Child Development Study and 6,535 husband-wife pairs for whom data were available on measured height, spousal age, education, social class, region, and the number of children were studied. RESULTS: Fertility varied between the regions with the highest fertility in Scotland. Fertility tended to increase from more to less educated and from higher to lower social classes in both sexes. These relationships remained significant after correction for mean age. A negative association between husband's height in relation to fertility was noted as well as the negative and the quadratic term for wife's height. Both the linear as well as the quadratic effects of parental height difference were significantly related to fertility, but after removing the effects of mean age, age difference and mean height these effects disappeared. Analysis of region, mean age, social class, education, height, and differences in age, social class, education, and height together revealed that 32.4% of variation in fertility was explained but only mean age, mean social class and mean height and difference in social class remained significant. CONCLUSIONS: The results did not provide any evidence that differential fertility was associated with spousal height difference after taking into account age, social class, education and region.

Regional variation in maternal and childhood undernutrition in Bangladesh: evidence from demographic and health surveys.

BACKGROUND: Undernutrition among mothers and children is currently a major public health and development concern in Bangladesh. In literature relating to nutritional determinants, of particular interest is the geography, as regions with poor nutrition tend to pull down the overall nutritional status of the country. As such, reducing the regional gap can alone reduce overall undernutrition significantly, especially when regional gaps are high. The aim of this study is, therefore, to assess the magnitude of inequalities in undernutrition in children aged under 5 years in Bangladesh and their mothers, and relate this to the administrative divisions of the country. METHODS: The Bangladesh Demographic and Health Surveys (1996-1997, 1999-2000, 2004 and 2007) were the sources of data, and a total of 16 278 mother-child pairs whose records were complete for the required individual and household-level variables were included in the analysis. Maternal nutritional status was measured by the body mass index (BMI). Weight-for-age, height-for-age and weight-for-height z-scores were calculated by use of the World Health Organization (WHO) Child Growth Standards to assess the nutritional status of children aged under 5 years. General linear model, sequential linear and multinomial logistic regression analyses were done to assess the inequalities in maternal and child nutritional status among the six administrative divisions of Bangladesh. Socioeconomic variables that were controlled for were residency, education and occupation of the mothers and their husbands, house type and possession score in the household. RESULTS: Maternal BMI and prevalence of underweight, stunting and wasting in children aged under 5 years were found to vary significantly according to administrative division. Of the six divisions, Sylhet was found to have highest prevalence of undernourished mothers and children. The trends from 1996 to 2007 also established Sylhet as the poorest-performing region overall. CONCLUSION: The Sylhet administrative division needs specially focused attention from policy-makers if the overall performance of the health, nutrition and population sector is to reach the targets set by the country.

Educational and social class assortative mating in fertile British couples.

BACKGROUND: Positive assortative mating for education and social position has been widely reported in a number of countries, but very few studies have tested whether or not educational or social class homogamy is related to differential fertility. AIM: This study examined the relationship between educational and social class assortative mating and fertility in a British national cohort. SUBJECTS AND METHODS: The analyses were based on 7452 husband-wife pairs from the British National Child Development Study (NCDS). RESULTS: The mean fertility was 3.22 children per couple; the number of children significantly increased from higher to lower social classes and from the more educated to the less educated. The extent of assortative mating for social class and educational level was related to fertility; as educational assortative mating decreased so did the average number of children, whereas the opposite trend was observed for social class. When assortative mating for education and social class were considered together, educational assortative mating was the more significant predictor of the number of children and educationally homogamous couples had higher fertility independent of their social class assortative mating. CONCLUSIONS: The relationship between assortative mating and fertility for education and social class appeared to be acting in the opposite direction.

Prevalence and public health relevance of micronutrient deficiencies and undernutrition in pre-school children and women of reproductive age in Côte d'Ivoire, West Africa.

OBJECTIVE: To provide nationally representative data on the prevalence of anaemia, vitamin A and Fe deficiencies among pre-school age children (pre-SAC) and non-pregnant women of reproductive age (WRA), and on vitamin B12 and folate deficiencies in WRA, and the influence of inflammation on their interpretation. DESIGN: A cross-sectional survey to measure anthropometry, malaria parasitaemia and micronutrient status. Specifically, blood samples were analysed for Hb, plasma ferritin, soluble transferrin receptors, C-reactive protein, α1-acid glycoprotein, retinol-binding protein, vitamin B12 and folate. SETTING: Côte d'Ivoire in 2007. SUBJECTS: Nine hundred and twenty-eight WRA and 879 pre-SAC. RESULTS: In WRA, prevalence of Plasmodium parasitaemia (5 %) was low, but inflammation (34 %) was higher. Anaemia was a severe public health problem and prevalence differed by residency and eco-region. Inflammation-adjusted Fe deficiency was highest in urban areas (20 %). Nationally, folate deficiency was 86 %, higher in urban areas and varied by eco-region. Prevalence of vitamin B12 deficiency was low but higher in the rural areas and the north. Inflammation-adjusted vitamin A deficiency was very low (1 %). In pre-SAC, prevalence of inflammation (67 %) and Plasmodium parasites (25 %) was high; the latter was associated with poverty, rural residency and higher ferritin concentrations. Anaemia was classified as a severe public health problem (72 %), and was higher in rural areas (76 %) and the north (87 %). A quarter of pre-SAC suffered from vitamin A deficiency (inflammation-adjusted) and prevalence of undernutrition was high. CONCLUSIONS: Prevalence of inflammation, Plasmodium parasitaemia and micronutrient deficiencies were high in Côte d'Ivoire, particularly in pre-SAC. Nutritional interventions should be accompanied by strategies to reduce exposure to infections.

The light skin allele of SLC24A5 in South Asians and Europeans shares identity by descent.

Skin pigmentation is one of the most variable phenotypic traits in humans. A non-synonymous substitution (rs1426654) in the third exon of SLC24A5 accounts for lighter skin in Europeans but not in East Asians. A previous genome-wide association study carried out in a heterogeneous sample of UK immigrants of South Asian descent suggested that this gene also contributes significantly to skin pigmentation variation among South Asians. In the present study, we have quantitatively assessed skin pigmentation for a largely homogeneous cohort of 1228 individuals from the Southern region of the Indian subcontinent. Our data confirm significant association of rs1426654 SNP with skin pigmentation, explaining about 27% of total phenotypic variation in the cohort studied. Our extensive survey of the polymorphism in 1573 individuals from 54 ethnic populations across the Indian subcontinent reveals wide presence of the derived-A allele, although the frequencies vary substantially among populations. We also show that the geospatial pattern of this allele is complex, but most importantly, reflects strong influence of language, geography and demographic history of the populations. Sequencing 11.74 kb of SLC24A5 in 95 individuals worldwide reveals that the rs1426654-A alleles in South Asian and West Eurasian populations are monophyletic and occur on the background of a common haplotype that is characterized by low genetic diversity. We date the coalescence of the light skin associated allele at 22-28 KYA. Both our sequence and genome-wide genotype data confirm that this gene has been a target for positive selection among Europeans. However, the latter also shows additional evidence of selection in populations of the Middle East, Central Asia, Pakistan and North India but not in South India.

Biosocial correlates of inter-generational social mobility in a British cohort.

The relationship between inter-generational social mobility of sons and daughters between 1958 and 1991 and biosocial variables, i.e. birth order, number of children in family, father's social class, region, educational attainment of child and father, educational and cognitive test scores (reading, mathematics, verbal and non-verbal IQ tests), was studied in a large British cohort study. The data used were collected as part of the British National Child Development Study (NCDS). The extent of social class mobility was determined inter-generationally and was categorized as none (no change in social class between the father's and index child's social class), upwardly mobile (where the index child moved up one or more social classes compared with their father) or downwardly mobile (where the index child moved down one or more social classes compared with their father). All of the biosocial variables were associated with social mobility when analysed separately. Multivariate analyses revealed that the most significant predictor of mobility categories in both sexes was education of the cohort member, followed by social class of the father. In both sexes mathematics score was a significant predicator, while in sons reading and non-verbal IQ scores were also important predictors. In the light of these results, it appears that social mobility in Britain takes place largely on meritocratic principles.

Comparison of a possession score and a poverty index in predicting anaemia and undernutrition in pre-school children and women of reproductive age in rural and urban Côte d'Ivoire.

OBJECTIVE: To determine whether a possession score or a poverty index best predicts undernutrition and anaemia in women of reproductive age (15-49 years; WRA) and children aged 6-59 months living in Côte d'Ivoire. DESIGN: Anthropometric measurements were converted to Z-scores to assess stunting, wasting and underweight in children, and converted to BMI in WRA. A venous blood sample was drawn, and Hb concentration and Plasmodium spp. infection were determined. A possession score was generated with categories of zero to four possessions. A five-point (quintile) poverty index using household assets was created using principal component analysis. These socio-economic measures were compared for their ability to predict anaemia and malnutrition. SETTING: Data were from a nationally representative survey conducted in Côte d'Ivoire in 2007. SUBJECTS: A sample of 768 WRA and 717 children aged 6-59 months was analysed. RESULTS: Overall, 74·9 % of children and 50·2 % of WRA were anaemic; 39·5 % of the children were stunted, 28·1 % underweight and 12·8 % wasted, while 7·4 % of WRA had BMI < 18·5 kg/m2. In general, there were more stunted and underweight children and thin WRA in rural areas. The poverty index showed a stronger relationship with nutritional status than the possession score; mean Hb difference between the poorest and wealthiest quintiles in children and WRA was 8·2 g/l and 6·5 g/l, respectively (13·9 % and 19·8 % difference in anaemia, respectively; P < 0·001), and Z-scores and BMI were significantly better in the wealthiest quintile (P < 0·001). CONCLUSIONS: The poverty index was generally a better predictor of undernutrition in WRA and pre-school children than the possession score.

Short- and long-term impact of health education in improving water supply, sanitation and knowledge about intestinal helminths in rural Bangladesh.

OBJECTIVE: To investigate the long-term impact of health education in intestinal helminth infection control in rural Bangladesh. STUDY DESIGN: Longitudinal study to compare knowledge, awareness and practice for intestinal helminths between four communities: two receiving health education and two not receiving health education. METHODS: Parents of 1497 children aged between 2 and 8 years [781 (52.2%) received health education] were investigated by interview at baseline, endline (18 months) and follow-up (5 years). RESULTS: Health education had a significant effect on the installment of tubewells and latrines, but only had a temporary effect on health knowledge. CONCLUSION: This long-term follow-up study showed the lack of sustainability of knowledge and awareness in the long-term after health education interventions.

Impact of social mobility and geographical migration on variation in male height, weight and body mass index in a British cohort.

Using a sample of 2090 British father and son pairs the relationships between social and geographical intra- and inter-generational mobility were examined in relation to height, weight and body mass index (BMI). There was much more social mobility than geographical (regional) migration. Social mobility and geographical migration were not independent: socially non-mobile fathers and sons were more likely to be geographical non-migrants, and upwardly socially mobile fathers and sons were more likely to be regional migrants. Upwardly socially mobile fathers and sons were, on average, taller and had a lower BMI than non-mobile and downwardly mobile fathers and sons. In general, no significant associations were found between geographical migration and height or weight. Migrating fathers had a lower BMI than sedentes, as did their sons who migrated between 1965 and 1991. There was no significant interaction that indicated that social mobility and geographical migration were acting in a simple additive way on height, weight and BMI.

Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial.

BACKGROUND: Multiple micronutrient deficiencies, in particular iron deficiency anaemia (IDA) is a severe public health problem in Lao People's Democratic Republic (Lao PDR). Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children, recently, home-fortification with multivitamins and minerals sprinkles was recommended. This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder (MMP) on anaemia prevalence, haemoglobin concentration, and growth in infants and young children in a rural community in Lao PDR. METHODS: A randomized trial was conducted in six rural communities. Children aged 6 to 52 months (n = 336) were randomly assigned to a control group (n = 110) or to one of two intervention groups receiving either two sachets per week (n = 115) or a daily sachet (n = 111) of MMP for 24 weeks; 331 children completed the study. A finger prick of blood was taken at baseline, at week 12, and again at week 24 to determine haemoglobin concentration. Anthropometric measurements were taken every 4 weeks. The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups. RESULTS: MMP supplementation resulted in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group (p <0.001). The severely to moderately anaemic children (Hb <100 g/L) on daily supplementation recovered faster than those on twice weekly supplementation. MMP was well accepted and compliance was high in both treatment groups. Overall, the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups. CONCLUSIONS: MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration. For severely to moderately anaemic children, daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence. A longer intervention period is probably needed to have a positive effect on growth.