title: Adherence to and acceptability of home fortification with vitamins and minerals in children aged 6 to 23 months: a systematic review.
abstract: BACKGROUND
  Vitamin and mineral deficiencies affect more than two million people worldwide. In 2011, based on recent scientific evidence and the low effectiveness of current strategies, the World Health Organization recommended home fortification of foods with multiple micronutrients in powder (MNP) as a new strategy to prevent and control anaemia during childhood. This systematic review assessed adherence to and acceptability of home fortification with multiple micronutrients in powder (MNP) in complementary feeding.
  
  
  METHODS
  Adherence was assessed based on number or percentage of prescribed sachets that were consumed, and acceptability was assessed according to perceptions of caregivers and children about MNP.
  
  
  RESULTS
  In summary, the studies indicated that home fortification with MNP has good adherence, ranging from 50% to over 90% of the prescribed sachets and that MNP was well accepted by caregivers. Caregivers reported side effects in 3% to 32% of children taking MNP in many studies; diarrhoea, vomiting, and constipation were the most common.
  
  
  CONCLUSIONS
  Home fortification with MNP has good adherence and acceptability in infants, with higher adherence in non-daily or flexible administration regimens. Characteristics of the target population and increased diarrhoea burden should be considered for planning public health programs with long term use of MNP. Acceptability of the MNP is satisfactory, when the use and perceived beneficial effects on children's health are considered.
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, São Paulo, SP, 01246-904, Brazil.
authors.forename: Samara Fernandes
authors.initials: SF
authors.lastname: de Barros
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr. Arnaldo 715, São Paulo, SP, 01246-904, Brazil. marlyac@usp.br.
authors.forename: Marly Augusto
authors.initials: MA
authors.lastname: Cardoso
mesh_terms: D000740:Anemia / Q000517:prevention & control; D017028:Caregivers / Q000523:psychology*; D005527:Food, Fortified / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008903:Minerals / Q000008:administration & dosage*; D011208:Powders; D016032:Randomized Controlled Trials as Topic; D014815:Vitamins / Q000008:administration & dosage*
chemical_list: D008903:Minerals; D011208:Powders; D014815:Vitamins
keywords: Complementary feeding; Home fortification; Multiple micronutrients in powder