Efficacy of a reduced dose of multiple micronutrient powder supplementation among children aged 6-59 months in Arusha district, Tanzania

A Dissertation Submitted in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy in Life Science and Engineering of the Nelson Mandela African Institution of Science and TechnologyIron deficiency anaemia is the most prevalent nutritional problem affecting children underfive years old in the developing countries. The deficiency is a result of inadequate intake and insufficient absorption of iron-rich foods that may be caused by diseases or dietary factors prevalent in rural areas. The most appropriate approach for solving the problem in rural settings is the use of Multiple Micronutrient Powder supplements (MNP). The recommended supplementary dose is one (1) sachet per day. However, in areas where resources are limited, the recommended weekly dose of seven sachets is considered expensive. The aim of this study was to assess the efficacy of a lower weekly dose, say three sachets of a MNP for dietary supplementation of complementary foods in Arusha district. A community-based longitudinal study with the intent to assess this efficacy was adopted for this study. Subjects were randomized into four intervention groups and given a Multiple Micronutrient Powder in different doses for six months. Anthropometric measurement, dietary assessment and haemoglobin levels were collected during the intervention involving 436 children under five years old in Arusha district of Tanzania. At baseline, 84.6% of the children were anaemic. Low birth weight and dietary factors (non-consumption of iron rich foods like meat, vegetable, and fruits) were predictors of anaemia. At the end of the intervention, haemoglobin levels were significantly higher in the groups which received three to five sachets of micronutrient powder per week than in children who received one or two sachets per week. Prevalence of infectious diseases was reduced significantly (p < 0.05) from 65% to 30.5% and anaemia, from 100% to 43.0% in all the groups. Two-thirds of mothers expressed willingness to pay for the micronutrient powder at the selling price of 150 TZS per sachet. However, the willingness to pay was associated with socio-demographic and economic characteristics of the participants. This study provides evidence that three to five sachets of MNP per week is an efficacious treatment for anaemia among children under-five years old in Arusha district. Families in low-income communities should be advised to use at least the lower weekly dose of 3 sachets to achieve the desired outcomes