title: A Blinded, Cluster-Randomized, Placebo-Controlled School FeedingTrial in Burundi Using Rice Fortified With Iron, Zinc, Thiamine, and Folic Acid.
abstract: BACKGROUND
  Iron-deficiency anemia is a major public health problem among school-aged children in sub-Saharan Africa.
  
  
  OBJECTIVE
  To evaluate the effectiveness of micronutrient-fortified rice to increase hemoglobin (Hb) concentration and reduce the prevalence of anemia among schoolchildren.
  
  
  METHODS
  Nine hundred four schoolchildren participated in this cluster-randomized trial during a 7-month intervention period. The study was conducted in 12 primary schools in rural Burundi. Hemoglobin, socioeconomic status, febrile illness, and dietary diversity were measured at baseline and follow-up. The changes in Hb concentration and anemia status were analyzed using linear and logistic mixed models, respectively. The micronutrient formulation contained an iron-to-zinc molar ratio of approximately 2.2.
  
  
  RESULTS
  There was no significant difference in Hb concentration between the intervention and control groups (β = .09 g/dL; 95% confidence interval: -0.21 to 0.38) following the 7-month intervention. Nearly half the children reported having a fever within 2 weeks prior to baseline or follow-up. Children with febrile illness preceding follow-up were less than half as likely to show improvement in anemia status (odds ratio = 0.47, P < .001), with an average 0.56 g/dL smaller improvement in Hb at follow-up (P < .001).
  
  
  CONCLUSIONS
  The high prevalence of fever and low iron-to-zinc molar ratio of the Ultra Rice formulation may have contributed to the lack of improvement in Hb. Alternatively, the detected anemia may not have been due to nutrient deficiencies. Anemia interventions in Burundi should implement multiple strategies to eliminate both iron deficiency and infectious causes of anemia.
authors.affiliation: PATH, Seattle, WA, USA mparker@path.org.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Parker
authors.affiliation: The University of Washington School of Public Health, Seattle, WA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Mosites
authors.affiliation: World Vision US, Washington, DC, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Reider
authors.affiliation: ISTEEBU, Bujumbura, Burundi.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Ndayishimiye
authors.affiliation: Institute for Research on Poverty University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Melody
authors.initials: M
authors.lastname: Waring
authors.affiliation: World Vision Burundi, Bujumbura, Burundi.
authors.forename: Gloriose
authors.initials: G
authors.lastname: Nyandimbane
authors.affiliation: World Vision Burundi, Bujumbura, Burundi.
authors.forename: Dominique
authors.initials: D
authors.lastname: Masumbuko
authors.affiliation: World Vision Burundi, Bujumbura, Burundi.
authors.forename: Leonidas
authors.initials: L
authors.lastname: Ndikuriyo
authors.affiliation: PATH, Seattle, WA, USA.
authors.forename: Dipika
authors.initials: D
authors.lastname: Matthias
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000628:therapy; D002063:Burundi / Q000453:epidemiology; D002648:Child; D005260:Female; D005334:Fever / Q000453:epidemiology; D005492:Folic Acid / Q000008:administration & dosage*; D005527:Food, Fortified; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007501:Iron / Q000008:administration & dosage*; D008297:Male; D012275:Oryza / Q000737:chemistry*; D010919:Placebos; D012424:Rural Population; D012572:School Health Services; D012574:Schools; D016037:Single-Blind Method; D013831:Thiamine / Q000008:administration & dosage*; D016896:Treatment Outcome; D015032:Zinc / Q000008:administration & dosage*
chemical_list: D006454:Hemoglobins; D010919:Placebos; D005492:Folic Acid; D007501:Iron; D015032:Zinc; D013831:Thiamine
keywords: Burundi; anemia; fortified rice; hemoglobin; schoolchildren