Globally, about 600 million children of pre-school and school-going age (two to 12 years old) are anaemic, with an estimated 50% of such cases attributed to iron deficiency.
To lower the incidence of paediatric anaemia, point-of-use fortification of food with micronutrient powders (MNPs) has been recommended.
Iron alone or in combination with other vitamins and minerals in powder form can be added to energy-rich solid foods either during or after cooking, or immediately before consumption.
To assess the effectiveness of doing so, researchers at the Micronutrient Initiative in Canada, Centers for Disease Control and Prevention in the US, as well as at the WHO, conducted a review of RCTs and quasi-RCT trials.
The trials sample sizes ranged from as little as 90 subjects to as many as 2,193 subjects. Six of the studies exclusively involved participants below five years of age, four focused on children above the age of five, and the remaining three included children both below and above five years of age.
They reviewed 13 studies involving 5,810 subjects from Asia, Latin America and Africa; the MNPs used in said studies contained anywhere from two to 18 vitamins and minerals, and the iron doses in the different MNPs ranged from 2.5mg to 30mg.
Subsequently, researchers found that children who had been supplemented with MNPs containing iron ad point-of-use food fortification experienced a lower risk of anaemia and had higher haemoglobin levels, compared to those who had received a placebo or no intervention at all.
The researchers also observed, however, that information on mortality rates, morbidity, developmental outcomes and adverse effects was scant.
Of all the studies they reviewed, only one trial — involving 115 children — had reported on all-cause mortality; none of the children studied were affected.
They wrote: "We did not find any positive or negative effect on diarrhoea or mortality, but the data on these two outcomes were very limited."
Factors for the future
The researchers said that point-of-use food fortification using MNPs containing iron had been shown to alleviate anaemia and iron deficiency in children aged two to 12 years old.
They then concluded that "future research should aim to increase the body of evidence on mortality, morbidity, developmental outcomes and adverse effects.
"Due to the lack of trials, we were unable to determine at this time if this intervention has comparable effects to those observed with iron supplements (provided as drops, tablets or syrup)."
Source: Cochrane Library
"Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age"
Authors: Luz Maria De-Regil, et al.