EFFICACY OF 'SPRINKLES' HOME FORTIFICATION TO REDUCE ANEMIA AND MICRONUTRIENT DEFICIENCIES IN YOUNG CHILDREN IN INDONESIA

E Martini, D Foote, S de Pee, J van Hees, S Halati, R Moench- Pfanner, D Yeung, S Kosen�, MW Bloem

Problem: Up to 70% of young children in urban poor areas of Indonesia are anemic. The negative consequences of anemia for child health and development warrant urgent intervention, but very few successful anemia prevention programs in poor settings have yet been conducted. Objectives: To evaluate the efficacy of daily use of an in-home fortificant ('sprinkles') on anemia, growth, and micronutrient status (plasma ferritin, retinol, and zinc concentrations) of children 6-30 months old.

Framework: In-home fortification may be a highly feasible intervention to address child anemia, especially in urban Indonesia. Mothers are accustomed to sachet use in preparing foods. Local corner shops and/or the community health posts are potential distribution points that are in close proximity to, and regularly used by mothers. Household expenditure data from this population suggest that the product would be affordable for mothers, and current production of sprinkles by private sector partners within Indonesia adds to potential sustainability.

Program: The efficacy study is the first phase of a program to test the efficacy and effectiveness of daily use of Vitalita (translated: vitamins for underfives) sprinkles. Vitalita sprinkles contain 1 RDA (1-3 year olds, US/Canada) of iron, vitamin A, zinc, vitamin C, and 10 other micronutrients. The Vitalita name and package design were developed through formative research in 2003.

Methods: 551 intervention and 266 control children aged 6-30 months from slum areas in Jakarta were enrolled during the baseline survey (Dec '03 to Feb '04). Anthropometry of mothers and children was measured, venous blood samples drawn, and information on household socio-economic status, dietary intake, and health status was collected. A supply of Vitalita is delivered to mothers on a weekly basis (for consumption on a daily basis), and consumption is recorded by mothers using a weekly calendar. The endline survey will be conducted Jul-Aug '04. Results will be available thereafter.

Implications: In-home fortification is an innovative potential strategy to address the problem of childhood anemia, and evidence of its efficacy will facilitate large scale expansion complementary to other nutrition and disease prevention efforts.