title: Effects of multimicronutrient home fortification on anemia and growth in Bhutanese refugee children.
abstract: BACKGROUND
  Anemia remains a significant public health problem in refugee settings. Home fortification with micronutrient powders has been proposed as a feasible option to alleviate micronutrient deficiencies; its efficacy in reducing anemia in children aged 6 to 24 months has been demonstrated in several trials.
  
  
  OBJECTIVE
  To evaluate the effectiveness of a large-scale micronutrient powder distribution program in reducing anemia prevalence and promoting growth in refugee children aged 6 to 59 months.
  
  
  METHODS
  Four representative cross-sectional surveys were conducted 13 months before and 7, 14, and 26 months after initiation of the supplementation program. Data collected on children aged 6 to 59 months included hemoglobin concentration, anthropometric indicators, morbidity, feeding practices, and information on the micronutrient distribution program. The study had a pre-post design with no control group.
  
  
  RESULTS
  The overall prevalence of anemia in children did not change significantly between baseline (43.3%) and endpoint (40.2%). The prevalence of moderate anemia decreased over the same period from 18.9% to 14.4% (p < .05). The levels of severe anemia were negligible (< 1%) in all surveys. The prevalence of stunting decreased significantly from 39.2% at baseline to 23.4% at endpoint (p < .001), a relative decrease of40%. Reported coverage, use, and acceptance of micronutrient supplements remained consistently high throughout the study.
  
  
  CONCLUSIONS
  In the absence of a control group, changes in key outcomes should be interpreted with caution. The minor effect on hemoglobin status requires further investigation of underlying causes of anemia in this population. The large positive effect on linear growth may be a significant benefit of supplementation if confirmed by future studies.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. obilukha1@cdc.gov
authors.forename: Oleg
authors.initials: O
authors.lastname: Bilukha
authors.forename: Christopher
authors.initials: C
authors.lastname: Howard
authors.forename: Caroline
authors.initials: C
authors.lastname: Wilkinson
authors.forename: Sapna
authors.initials: S
authors.lastname: Bamrah
authors.forename: Farah
authors.initials: F
authors.lastname: Husain
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology* / Q000517:prevention & control; D000886:Anthropometry; D001631:Bhutan / Q000453:epidemiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis / Q000172:deficiency; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D018977:Micronutrients / Q000008:administration & dosage*; D009749:Nutrition Surveys; D009751:Nutritional Requirements; D009752:Nutritional Status; D015995:Prevalence; D011634:Public Health; D012036:Refugees; D014131:Trace Elements
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D014131:Trace Elements