Perinatal & Pediatric
Effectiveness of Powdered Micronutrients in Complementary Feeding for Anemia Prevention in Primary Health Care: A Pragmatic Clinical Trial in an African Context Ana Raquel Ernesto Manuel Gotine* Ana Gotine Marly Augusto Cardoso
Introduction: Anemia continues to be a significant public health issue among children, particularly in vulnerable populations, requiring the evaluation of strategies for its prevention and control. Aim: To assess the effectiveness of micronutrient powders (MNP) for preventing anemia during the first year of life, distributed by health professionals at primary health care in Nampula, Mozambique. Methods: This pragmatic clinical trial was conducted across two health centers, involving 275 infants who were randomly assigned to either the intervention group (IG, n=135) or the control group (CG, n=135). The IG received 90 sachets of MNP to be consumed once daily for up to 180 days. Data were collected through a sociodemographic questionnaire, hemoglobin (Hb) measurements (HemoCue®), and rapid malaria tests (First Response® Malaria Antigen P. falciparum Card Test). Intention-to-treat statistical analyses were performed using Stata 18, with t-tests, Pearson’s chi-square tests, and adjusted linear regression for Hb mean differences (before and after the intervention), with significance set at p < 0.05. Results: At baseline, infants aged 6 to 8 months had a mean Hb of 102.0 g/L (SD 11.0) in the IG and 104.0 g/L (SD 11.0) in the CG. Anemia rates (Hb <110 g/L) were 74% (95% CI 66–80) in the IG and 66% (95% CI 58–74) in the CG. After the intervention, at 12 to 14 months, the IG had a mean Hb of 106.2 g/L (SD 10.6) and an anemia prevalence of 56% (95% CI 48–66), while the CG had a mean Hb of 99.5 g/L (SD 11.7) and an anemia rate of 79% (95% CI 70–85). After adjusting for variables such as child’s age, wealth index, maternal age and education, prenatal visits, and stunting at baseline, the IG showed an increase in the adjusted mean Hb difference of 0.28 g/L (95% CI 0.02–0.55), while the CG showed a decrease of -0.43 g/L (95% CI -0.72 to -0.15). Conclusion: The findings suggest that MNP supplementation, when distributed by health professionals, has a positive impact on hemoglobin levels, underscoring the importance of nutritional interventions in regions with high anemia prevalence during infancy.
Keywords: Anemia; iron deficiency, complementary feeding, micronutrients, home fortification.