The Effects of Selling Micronutrient Powders on Morbidity Incidence among Preschool Children in Western Kenya

Abstract

Objectives: Although micronutrient powders (MNPs) are considered the preferred approach for childhood anemia control, concerns about iron-related morbidity from clinical trials challenge programmatic scale-up. We aimed to measure the association of community-based sales of MNPs with incidence of diarrhea, fever, and cough in children 6-35 months. Methods: The study was a community-based, cluster-randomized trial in 60 villages in western Kenya. MNPs and other health products (e.g., insecticide-treated bednets, soap, water disinfectant) were marketed in 30 intervention villages from July 2007-March 2008, followed by expansion of the intervention to both arms. Biweekly household visits monitored self-reported MNP use and morbidity. Using morbidity as the outcomes and MNP as the exposure variable, relative risks were estimated via generalized mixed models with random intercepts for repeated measures within a child and for multiple children from a household, while accommodating potential confounders as fixed effects. Results: Of the 1079 children enrolled, 881 (81.6%) had data on MNP use; average intake in intervention villages was 0.9 sachets/week. MNP intake was captured as continuous mean sachets and categories of use, but no significant effects were observed on incidence of diarrhea, fever or cough. Conclusions: Increased MNP use in western Kenya through community-based marketing did not result in increased incidence of infectious morbidity among young children. Integrated distribution of MNPs with other health interventions should be explored further in settings with high child malnutrition and infection burden.