MNP Pilot Study for Development of a Micronutrient Powder Home Fortification Program to Combat Anaemia Among Children 6-23 Months in Zambia

1. Purpose While Zambia has made progress towards reducing under-nutrition among children, as measured by underweight, other indicators of nutritional status, particularly stunting and anaemia have remained unchanged over the past decades. Repeated national surveys show that anaemia remains of public health significance among Zambian children. According to WHO classification, a prevalence of anaemia above 40% is categorized as a severe public health problem. There has been no significant reduction in anaemia among children 6-59 months over the past two decades with an estimated prevalence of 60% in 1998, 53% in 20032 and 49% in 20093. Further, younger infants were found to be more affected than older children with an estimated prevalence of 81% in children 6-18 months in 1992 and 61% in children 6-24 months in 2009. In developing countries approximately 50% of all anaemia is attributed to iron deficiency. It is further estimated that the frequency of iron deficiency is about 2.5 times that of anaemia, and when anaemia prevalence exceeds 40%, it is assumed that the entire population is suffering from some degree of iron deficiency. It is therefore assumed that this is the case with young children in Zambia. It is well established that iron deficiency has adverse health consequences even before anaemia develops. These include cognitive impairment, decreased physical capacity and reduced immunity.

The most promising strategy for this age group is 'home fortification' of staple complementary foods (foods that are consumed in addition to breast milk after 6 months of age) with small packets of Micronutrient Powders (MNP) that can be easily mixed with home-prepared food.

MNP are packed in single-serve sachets of mixed vitamins and minerals in powder form, which can be instantly sprinkled on prepared ready-to-eat complementary foods for young children without changing the colour or taste of the food. The sachets are packed to ensure that the correct amounts of micronutrients are given.

As 'stunting', low height for age, is a problem of public health significance in Zambia with 45% of children under five being stunted, this programme will specifically address practices that will help to improve nutritional intake and reduce infection in order to promote growth during the early years of life.

Therefore the purpose of this project will be to conduct a 12 month trial of MNP in the Northern Province of Zambia, in order to inform a future scale up. 2. Justification Home fortification with MNP has proved to be efficacious and effective in reducing the prevalence of iron deficiency anaemia in young children. Today, MNP are successfully used in 45-50 countries worldwide. Based on the large body of evidence available, the WHO strongly recommends the use of MNP containing at least iron, vitamin A and zinc to improve iron status and reduce anaemia in children 6-23 months of age where the prevalence of anaemia in children under two years or under five years of age is 20% or higher.