Zinc, Iron, Vitamin A and Psychosocial Care for Child Growth and Development
Condition: Development; Iron Deficiency; Zinc Deficiency
MeSH terms: Iron Deficiencies
Study type: Interventional
Phase: Phase 3

Summary: 
      Many Indonesian infants are already iron deficient before they reach the age of six months,
      which also determines the high prevalence of anemia among under-five children. Iron
      deficiency ultimately leads to anemia, and there is clear evidence that iron deficiency
      anemia during early childhood has a marked negative effect on child development and cognitive
      function (Lozoff et al.1991; Idjradinata & Pollitt, 1993). This negative impact on childhood
      development is one of the main reasons why iron deficiency during infancy should be prevented
      or treated.

      Since diets low in iron is usually also low in zinc, zinc deficiency --which has negative
      consequence on growth-- is common in iron deficiency area. In Southeast Asia, the condition
      is exacerbated by the rich phytate content in the complementary foods which inhibits the
      absorption of iron as well as zinc (Gibson, 1994). Thus, combining both iron and zinc, hence,
      is expected to decrease both iron and zinc deficiencies and hence improve growth and
      development of the children.

      Recently, there has been an emerging view which looks at the two-way relationship between
      nutrition, health, and psychosocial well-being. This concept is supported by studies on
      "positive deviance", a term used to refer to children who grow and develop well in
      impoverished environments where most children are victims of malnutrition and chronic illness
      (Zeitlin et al., 1990). The mechanism which helps to explain how psychosocial factors, such
      as the affect between mother and child, are associated with adequate growth and development:
      'Psychological stress has a negative effect on the use of nutrients whereas psychological
      well-being stimulates the secretion of growth-promoting hormones. Pleasantly stimulating
      interactions can enhance the child's tendency to exercise its developing organ systems and
      hence to utilize nutrients for growth and development'.

      Understanding how the psychosocial environment can promote or inhibit the benefit of
      supplementation intervention is necessary in order to have a better way of setting about
      providing supplements. In fact, many supplementation programs do not incorporate
      complementary program elements that would help to improve the health and psychosocial
      development of children at the same time that they improve nutritional status' (Myers, 1995).
      Looking from this perspective, not only will supplementation benefit the psychosocial
      development but also the psychosocial environment can promote the benefit of the
      supplementation on the nutritional status and developmental outcomes of infants.

      The purpose of the study is to investigate whether multi-micronutrient supplementations
      (zinc+iron, zinc+iron+vit.A) have positive effect on infants' growth and developmental
      outcomes, and whether the effect is modified by psychosocial care.
    


Intervention name(s): Zinc Alone; Iron and Zinc; Iron, Zinc and Vitamin A; Placebo
Intervention type(s): Dietary Supplement; Dietary Supplement; Dietary Supplement; Other
Intervention description(s): Zn-alone group received 10 mg/day of elemental zinc (as zinc sulphate); Zn+Fe group received 10 mg/day of elemental zinc (as zinc sulphate) and 10 mg/day of elemental iron (as ferrous sulphate); Zn+Fe+vit.A group received 10 mg/day of elemental zinc (as zinc sulphate) and 10 mg/day of elemental iron (as ferrous sulphate), plus 1,000 IU/day of vitamin A; Placebo group received no minerals/vitamin
Intervention MeSH terms: Vitamin A; Iron; Zinc
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)