Impact of Iron Fortification on Anaemia and Iron Deficiency among Pre-school Children Living in Rural Ghana
Authors: Tchum Samuel Kofi , Arthur Fareed Kow , Adu Bright , Sakyi Samuel Asamoah , Abubakar Latifatu Alhassan , Atibilla Dorcas , Amenga-Etego Seeba Ibn , Oppong Felix Boakye , Dzabeng Francis , Amoani Benjamin , Gyan Thomas , Poku-Asante Kwaku 
Published: May 2020

Abstract
Background Micronutrient interventions, principally vitamin A and zinc supplementation for children, and fortification of foods with iron and iodine, are considered the most cost-effective global development efforts. Multiple micronutrient powder is a mixture of at least iron, zinc and vitamin A used to prevent malnutrition in children and during health emergencies. Micronutrient deficiencies are a universal health burden among young children in developing countries. However, the use of this low cost but sustainable micronutrient powder as an innovative home-fortification approach to control a common nutritional disorder like iron deficiency anaemia among pre-school children living in malaria endemic sub-Saharan Africa is unclear. The aim of our study was to determine the effect of providing long-term continued prophylactic micronutrient powder with iron on the risk of iron deficiency and anaemia among pre-school children living in rural Ghana.Methods This population-based randomized-cluster trial was conducted in the Bono region of Ghana from 3rd April to 6th July 2010. 1958 children were recruited, and 967 randomly assigned to receive prophylactic micronutrient powder with iron and 991 assigned to receive placebo. The trial participants were children aged between 6 to 35 months, identified at home and able to eat semi-solid foods (with or without breast milk). Structured questionnaires were administered, their blood samples were also taken for biochemical analysis. They were randomly assigned to receive daily micronutrient powder without or with iron (12·5 mg) added to complementary meals immediately after enrollment for five months. Each participant also received anti-malaria treated bednet and chemotherapy. Weekly follow up visits were conducted at home or health facility where data on malaria using rapid diagnostic test and hospital admissions were collected. The primary outcome was post supplementation of prophylactic micronutrient powder with iron to mitigate the effects of iron deficiency and anaemia.Results 1958 children were recruited and 967 randomly assigned to receive prophylactic micronutrient powder with iron and 991 assigned to receive placebo. Loss to follow up was 7 % (143), with vital status at 35 months of age reported for 1904 (97.2 %). Anthropometry, anaemia, iron status, demographic characteristics and dietary intakes were similar between the groups at baseline. Baseline haemoglobin level was significantly higher compared to haemoglobin level at endline (p < 0.0001). Though, we recorded an increase in haemoglobin (p = 0.0001) and ferritin (p = 0.0002) levels in the iron group than in the placebo group at the end of the intervention. Soluble transferrin receptor levels were more saturated among children from the iron group compared to placebo group (p = 0.012). Anaemic status in the iron group improved compared to the non-iron group (p = 0.03).Conclusion The risk of childhood morbidity and mortality in rural Ghana is high, mainly due to iron deficiency anaemia. National nutritional policy coupled with the current WHO recommendations are required to support the provision of prophylactic micronutrient powder with iron in order to improve anaemic and iron status among pre-school children in rural Ghana.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01001871. Registered 27th October 2009, http://www. ClinicalTrials.gov/ NCT01001871