title: Selling Sprinkles micronutrient powder reduces anemia, iron deficiency, and vitamin A deficiency in young children in Western Kenya: a cluster-randomized controlled trial.
abstract: BACKGROUND
  Although the efficacy of micronutrient powders [MNPs; eg, Sprinkles MNP (Sprinkles Global Health Initiative)] in the reduction of anemia has been established, the effectiveness of these powders in real-world programs has seldom been assessed.
  
  
  OBJECTIVE
  In this study, we evaluated the effect of community-based marketing and distribution of Sprinkles MNP on childhood rates of anemia and iron and vitamin A deficiency.
  
  
  METHODS
  In a cluster-randomized trial in children aged 6-35 mo in Western Kenya, 60 villages were randomly assigned to either intervention or control groups. Community vendors marketed and sold sachets of Sprinkles MNP in intervention villages. Biweekly household visits monitored the use of Sprinkles MNP. Hemoglobin, ferritin, retinol binding protein, malaria, and anthropometric measures were assessed at baseline (n = 1063) and 12 mo of follow-up (n = 862). Data were analyzed by using an intention-to-treat analysis and generalized linear mixed models.
  
  
  RESULTS
  On average, 33% of households in intervention villages purchased Sprinkles MNP; the average weekly intake per child was 0.9 sachets (∼11.3 mg Fe and ∼328 μg vitamin A). Compared with control subjects, intervention children had greater improvements in hemoglobin concentrations (increase of 0.9 compared with 0.6 g/dL, respectively; P = 0.02), iron deficiency (decrease of 19.3% compared with 5.3%, respectively; P = 0.001), and vitamin A deficiency (decrease of 7.5% compared with an increase of 2.5%, respectively; P = 0.01). Results adjusted for age, sex, socioeconomic status, and maternal education showed a significant association between the hemoglobin, iron, and vitamin A concentrations of children and the number of Sprinkles MNP sachets the children consumed. The prevalence of malaria, wasting, and stunting did not change significantly in either group.
  
  
  CONCLUSIONS
  Even with relatively low and infrequent use, Sprinkles MNP sales through community vendors were associated with decreased rates of anemia and iron and vitamin A deficiency in children in a resource-poor setting. This trial was registered at clinicaltrials.gov as NCT01088958.
authors.affiliation: Nutrition Branch, CDC, Atlanta, GA 30341, USA. psuchdev@cdc.gov
authors.forename: Parminder S
authors.initials: PS
authors.lastname: Suchdev
authors.forename: Laird J
authors.initials: LJ
authors.lastname: Ruth
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Woodruff
authors.forename: Charles
authors.initials: C
authors.lastname: Mbakaya
authors.forename: Usha
authors.initials: U
authors.lastname: Mandava
authors.forename: Rafael
authors.initials: R
authors.lastname: Flores-Ayala
authors.forename: Maria Elena D
authors.initials: ME
authors.lastname: Jefferds
authors.forename: Robert
authors.initials: R
authors.lastname: Quick
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy / Q000453:epidemiology*; D002675:Child, Preschool; D016000:Cluster Analysis; D019587:Dietary Supplements; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis / Q000378:metabolism; D006801:Humans; D007223:Infant; D019266:Iron, Dietary / Q000008:administration & dosage*; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D011208:Powders; D015995:Prevalence; D014801:Vitamin A / Q000008:administration & dosage*; D014802:Vitamin A Deficiency / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary; D018977:Micronutrients; D011208:Powders; D014801:Vitamin A; D005293:Ferritins