Published on January 20, 2012
Hyderabad: Anemia continues to be the most prevalent public health problem in India, and parents are encouraged to provide their children with iron-rich foods (1). Without overemphasizing one can safely state that reducing the level of anemia in children in the country will have a far reaching consequences right up to improving the GDP in future. Government being aware of the fact that food sources of iron are scarce or unaffordable among the poor, had taken corrective measures by distributing 100 pediatric iron tablets per child per year through well organized ICDS programme. The compliance levels unfortunately were not to the desired expectations.
In recent years, fortifying home-prepared food has been widely promoted as a way to address micronutrient deficiencies and particularly iron. “Home fortification” entails adding inexpensive but effective food supplements containing iron and other essential micronutrients to home-cooked foods (2).
Speaking at a press conference at Press club, Somajiguda, today Dr. P. Jagannivas, Director, Heinz Nutrition Foundation India & Managing Editor ‘In Touch’ said, an innovative supplementation was introduced through Heinz Foundation in the powder form called ‘Nurturemate’ to provide iron and other essential micronutrients. It can also be used to treat acutely malnourished children and to prevent micronutrient deficiencies. It was expected that Nurturemate will be more widely accepted due to its pleasing packaging, lack of side effects, ease-of-use, no need to change feeding or eating habits and resistance to humidity.
Nurturemate is packed in single-serve sachets and mixed with home-made foods without any appreciable change to color, taste and flavor of the food. Nurturemate has been used to effectively and safely treat and prevent anemia among infants and young children in 11 countries in Asia and Africa including Cambodia ,China, Indonesia, Pakistan, Bangladesh and India (3). In addition to addressing micronutrient deficiencies, introducing Nurturemate to the population provides a key opportunity for promoting appropriate feeding practices among infants 2 years and older. These practices include use of locally available, low-cost food items, and proper feeding frequency – all accomplished without affecting cultural food consumption practices and preferences.
Efficacy Study
The study conducted in September 2004-August 2005 at KEM Hospital Research Centre among 432 children aged 6-18 months supported the efficacy of Sprinkles® (as Nurturemate was then called), as the number of anemic children decreased by 64% over a period of 2 months (4).
These results are similar to findings from in countries, such as Indonesia, Ghana, Bangladesh, and Pakistan. Furthermore, the efficacy of this Multi-Micro-Nutrient Powder (MMNP) in controlling iron deficiency was found to be similar to that of iron drops, but without the problems typically faced when using drops, including resistance or rejection by children, due to bad taste and the staining of teeth and clothes (4).
Ease of Distribution and Flexibility of Administration
In mid 2007, the Foundation provided funding to design and implement a pilot distribution study for MMNP, in the state of Maharashtra to assess the effectiveness of using the country’s Integrated Child Development Services (ICDS) program as a channel through which to address the problem of anemia in children and ease of distribution (5, submitted for publication). The project was headed by Dr. A. Pandit at the King Edward Memorial Hospital in Pune.
This study utilized a flexible administration model of MMNP which caregivers were instructed not to give more than one sachet to a child per day and to use all 90 of the sachets provided to them within 6 months. The study found that the flexible administration model of MMNP (giving 60 sachets, each containing 12.5 mg iron, over a 120-day period) reduced anemia from 77% to 30%. The level of anemia reduction, with continued MMNP use, was sustained even during a six month post intervention follow-up period (5). Under this flexible administration approach, caregivers were able to decide how frequently to give MMNP over the time period, but not exceeding one sachet per day.
To assess the impact of distributing MMNP through Anganwadi Centers on reducing anemia levels, multi-stage cluster sampling was used to randomly select a sub-sample of beneficiary children for hemoglobin assessment using the Hemocue method at baseline (n= 1,373) before the intervention was implemented. The children were of 0.6 to 6 years of age. After 120 days of intervention, a new sub-sample of 1,314 children was drawn using the same sampling methodology. The overall level of anemia (hemoglobin level below 11gm/dL in children <5 years and below 11.5gm/dL in children 5-6 years) dropped significantly (P<0.001) from 54% at baseline to 39% at end line. These findings suggest that flexibly administered MMNP is highly effective in reducing anemia among young children when introduced through an ongoing child health program such as that offered by the ICDS’ Anganwadi Centers.
Compliance Study
Having established the efficacy, it was decided to have comparative study of the compliance of the conventionally distributed iron tablets / syrup done by the ICDS and Nurturemate (in progress). The Directorate of Public Health and Preventive Medicine at Tamil Nadu undertook a study at Cuddalore District distributing Nurturemate and a comparative study at Dharmapuri where the regular administration of iron tablets was done. The final results are expected to be published shortly. In the meanwhile it is learnt that compliance with Nurturemate is very good and the feedback from consumers were very encouraging.
Social Marketing Model
Last year we started a social marketing project for Nurturemate with the help of a Chennai based social enterprise called v-shesh ( in progress). This project is being run by an NGO called IVDP based in Krishnagiri district in Tamil Nadu. It will cover 15,000 children in age group of 2-5 years in 2 phases. Phase 1 covering 1000 children is nearing completion and we have positive feedback from mothers of the children consuming Nurturemate. This project is in line with the H. J.Company Foundation’s approach of looking for sustainable solutions to get Nurturemate to as many children as possible. Even as the effort in Krishnagiri starts working on phase 2 that covers 14,000 children, we are already discussing ways of replicating this in other locations and with other partners. A face book page has been created for the project and those that are interested in tracking the progress of this project can visit – http://tinyurl.com/hmc-v-shesh
In summary, India is faced with a gigantic problem of iron deficiency among young children of preschool age. The problem is easily surmountable, if the stake holders are ready to accept iron-fortified MMNP, which are affordable, clinically-proven to be efficacious, easy to store and eat, and is compatible to usual feeding and eating habits of the children. Wide promotion of fortification of home -prepared foods for children significantly ensure anemia alleviation and promotion of the physical and mental health of our future generations.