Relative efficacy of micronutrient powders versus iron-folic acid tablets in controlling anemia in women in the second trimester of pregnancy.
BACKGROUND
Iron deficiency is a major cause of anemia and the most prevalent nutrient deficiency among pregnant women in developing countries. The use of iron and folic acid supplements to treat and prevent iron-deficiency anemia has limited effectiveness, mainly due to poor adherence. Home fortification with a micronutrient powder for pregnant women may be an effective and acceptable alternative to traditional drug models.


OBJECTIVE
To determine whether home fortification with micronutrient powders is at least as efficacious as iron and folic acid tablets for improving hemoglobin concentration in pregnant women.


METHODS
A cluster-randomized noninferiority trial was conducted in the rural subdistrict of Kaliganj in central Bangladesh. Pregnant women (gestational age 14-22 weeks, n=478), were recruited from 42 community-based Antenatal Care Centres. Each centre was randomly allocated to receive either a micronutrient powder (containing iron,folic acid, vitamin C, and zinc) or iron and folic acid tablets. Changes in hemoglobin from baseline were compared across groups using a linear mixed-effects regression model.


RESULTS
At enrolment, the overall prevalence of anemia was 45% (n = 213/478). After the intervention period, the mean hemoglobin concentrations among women receiving the micronutrient powder were not inferior to those among women receiving tablets (109.5 ± 12.9 vs. 112.0 ± 11.2 g/L; 95% CI, -0.757 to 5.716). Adherence to the micronutrient powder was lower than adherence to tablets (57.5 ± 22.5% vs. 76.0 ± 13.7%; 95% CI, -22.39 to -12.94); however, in both groups, increased adherence was positively correlated with hemoglobin concentration.


CONCLUSIONS
The micronutrient powder was at least as efficacious as the iron and folic acid tablets in controlling moderate to severe anemia during pregnancy.
Research and Evaluation Division, Bangladesh Rural Advancement Committee, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka.
Nuzhat
N
Choudhury
Ashley
A
Aimone
S M Ziauddin
SM
Hyder
Stanley H
SH
Zlotkin
D000293:Adolescent; D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000178:diet therapy* / Q000208:ethnology / Q000503:physiopathology; D001459:Bangladesh; D003906:Developing Countries; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006801:Humans; D019266:Iron, Dietary / Q000627:therapeutic use*; D018977:Micronutrients / Q000627:therapeutic use*; D010349:Patient Compliance / Q000208:ethnology; D011208:Powders; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood / Q000178:diet therapy* / Q000208:ethnology / Q000503:physiopathology; D011262:Pregnancy Trimester, Second; D039401:Prenatal Nutritional Physiological Phenomena / Q000208:ethnology; D012423:Rural Health / Q000208:ethnology; D012720:Severity of Illness Index; D013607:Tablets; D055815:Young Adult
D019266:Iron, Dietary; D018977:Micronutrients; D011208:Powders; D013607:Tablets; D005492:Folic Acid