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Assessing the impacts of home fortification with micronutrient powders on anemia, growth, and diarrhoea in children aged 6 - 24 months living in rural Rwanda Michaux, Kristina


Rwanda is a country with a high burden of childhood undernutrition with >40% of children <5y anemic and ~45% chronically undernourished (stunted). Home fortification (HF) with micronutrient powders (MNP) has shown to reduce iron deficiency and anemia in resource poor settings; however, it remains unclear whether MNP can reduce stunting and there are concerns that it may increase the risk of illness in young children. The aims of this study were to determine if HF with MNP is an effective strategy to reduce anemia and stunting in children 6 – 24 mo in Rwanda, as well as determine whether MNP increases the risk of illness. A quasi-experimental trial was conducted in two intervention districts (Musanze and Nyaruguru; n=580) and two comparison districts (Nyamagabe and Burera; n=486). Children 6 – 12 mo were enrolled and followed for one year. Haemoglobin (Hb) concentration, anthropometry, Infant and Young Child Feeding practices, and morbidity were assessed at baseline, midpoint and 12-mo. Multivariate analyses were used to assess the impact of the MNP on Hb concentration, anemia, stunting, and illness. There were no differences in Hb concentration between groups at 6– or 12–mo (P > 0.05). A sub-group analysis of only children who were anemic at baseline revealed greater Hb concentration in the MNP Group at 6– (mean diff: 0.27 g/dL, 95% CI: 0.06, 0.47, P=0.010) and 12– mo (mean diff: 0.24 g/dL, 95% CI: 0.04, 0.44, P=0.018). Similarly, children in the Comparison Group had higher risk of being anemic at 6– (OR: 1.52, 95% CI: 1.09, 2.08; P<0.05) and 12– mo (OR: 1.35, 95% CI: 0.92, 1.89; P=0.075). At 12–mo, there were no differences in stunting prevalence between groups (P=0.750). Children receiving MNP had lower risk of cough at 6–mo (OR: 0.67, 95% CI: 0.51, 0.88), and fever at 12– mo (OR: 0.71, 95% CI: 0.71, 0.93). These findings suggest that MNP are effective at improving Hb concentration in anemic children living in Rwanda, with no effect on stunting observed. Future research should focus on determining the actual proportion of anemia attributable to micronutrient deficiencies and/or non-nutritional causes of anemia in Rwanda.

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