Monitoring and Evaluation of Micronutrients (Sprinkles) Project

Not Applicable

Completed

Interventions: Dietary Supplement: SPRINKLES
Behavioral: Nutrition education

Brief Summary: The purpose of this study is 1) to evaluate the effectiveness in reducing anemia among children 6-24 months of age by providing daily micronutrient Sprinkles through the Government of Pakistan's Lady Health Worker program; 2) to assist in the monitoring the National Sprinkles Pilot Project.

Detailed Description: According to the recent National Nutrition Survey in Pakistan (2001-2002), approximately 66.5% of children under five have anaemia.

Looking at the magnitude of the problem, National Program for Family Planning (FP) and Primary Health Care (PHC) (also known as the Lady Health Workers (LHW) Program) has developed National Sprinkles Pilot Project Proposal with technical assistance of Micronutrient Initiative and Aga Khan University (AKU). As the projects technical partner, AKU is responsible to conduct the monitoring and evaluation of the project.

The study will use a cluster randomized pre-post intervention design that compares before and after hemoglobin (Hb) measurements, serum ferritin, serum retinol and urinary iodine among children who received Sprinkles and age-appropriate feeding advice (Sprinkles-Advice group) and children who only receive age-appropriate feeding advice (Advice-only group). Age-appropriate feeding advice is part of the standard nutrition messages given by all Lady Health Workers (LHWs) during their community visits. However, intervention LHWs, will give additional advice regarding the benefits of Sprinkles and its appropriate use.

The target population selected for the study consisted of children between the ages of six and eighteen months of age in the catchment area of the Lady Health Workers.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Any household in which consent is not given
Children with any congenital or physical disability (such as cleft palate, Down's Syndrome, etc.)
Child from a family which intends to migrate during the study period

Arm && Interventions

Group	Intervention	Description
Intervention	SPRINKLES	Multiple micronutrient fortificant (Sprinkles) and nutrition education given by LHWs.
Intervention	Nutrition education	Multiple micronutrient fortificant (Sprinkles) and nutrition education given by LHWs.

Primary Outcome Measures

Name	Time	Method
Number of Participants With Moderate to Severe Anemia	Baseline Hb taken at time of enrollment; Endline Hb taken 4-5 months post enrollment	number of participants with moderate - severe anemia defined as Hb \< 10g/dL
Number of Participants With Anemia	Baseline hemoglobin (Hb) taken at time of enrollment; Endline Hb taken 4-5 months post enrollment	number with mild to severe anemia (hemoglobin(Hb)\<11g/dL)
Mean Hemoglobin of Participants Post Intervention	Endline Hb taken 4-5 months post enrollment

Secondary Outcome Measures

Name	Time	Method
Percentage of Underweight Participants	Baseline measurements taken at time of enrollment; Endline measurements taken 4-5 months post enrollment	Underweight defined as Weight for Age Z score \< -2 standard deviation (SD)
Vitamin A Status of Participants - Post Intervention	Measurement taken 4-5 months post enrollment	Categorized as \<20ug/dL; 20-40 ug/dL; \>40 ug/dl
Percentage of Participants With Stunted Growth	Baseline measurements taken at time of enrollment; Endline measurments taken 4-5 months post enrollment	Stunted defined as Height for Age Z-score \< -2 standard deviation
Mean Vitamin A Serum Retinol (ug]dl) Taken Post Intervention	Measurement taken 4-5 months post enrollment
Percentage of Participants With Wasted Growth	Baseline measurements taken at time of enrollment; Endline measurements taken 4-5 months post enrollment	Wasted defined as Weight for Height Z-score \< -2SD