Nutrition Branch, CDC, Atlanta, GA 30341, USA.
Am J Clin Nutr. 2012 May;95(5):1223-30. doi: 10.3945/ajcn.111.030072. Epub 2012 Apr 4.
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.
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.
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.
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.
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.
虽然微量营养素粉（例如 Sprinkles MNP[Sprinkles 全球健康倡议]）在减少贫血方面的疗效已经得到证实，但这些粉末在实际项目中的有效性很少得到评估。
本研究评估了基于社区的 Sprinkles MNP 营销和分销对儿童贫血率以及铁和维生素 A 缺乏率的影响。
在肯尼亚西部 6-35 月龄儿童中进行的一项整群随机试验中，将 60 个村庄随机分配到干预组或对照组。社区销售人员在干预村销售 Sprinkles MNP 小袋。每两周一次的家访监测 Sprinkles MNP 的使用情况。在基线（n=1063）和 12 个月随访（n=862）时评估血红蛋白、铁蛋白、视黄醇结合蛋白、疟疾和人体测量指标。数据分析采用意向治疗分析和广义线性混合模型。
平均而言，干预村 33%的家庭购买了 Sprinkles MNP；每个儿童的平均每周摄入量为 0.9 小袋（约 11.3mg Fe 和 328μg 维生素 A）。与对照组相比，干预组儿童的血红蛋白浓度有更大的改善（分别增加 0.9g/dL 和 0.6g/dL；P=0.02），铁缺乏症（分别下降 19.3%和 5.3%；P=0.001）和维生素 A 缺乏症（分别下降 7.5%和增加 2.5%；P=0.01）。对年龄、性别、社会经济地位和母亲教育进行调整后的结果表明，儿童的血红蛋白、铁和维生素 A 浓度与儿童消耗的 Sprinkles MNP 小袋数量之间存在显著关联。两组的疟疾、消瘦和发育迟缓的患病率均无显著变化。
即使使用量较低且不频繁，通过社区销售人员销售 Sprinkles MNP 也与资源匮乏环境中儿童贫血和铁及维生素 A 缺乏率的降低有关。该试验在 clinicaltrials.gov 注册，编号为 NCT01088958。
