The WHO recommendation of home fortification of foods with multiple-micronutrient powders in children under 2 years of age and its effectiveness on anaemia and weight: a pragmatic cluster-randomized controlled trial.

OBJECTIVE: To assess under real community settings the effectiveness of the WHO strategy of home fortification of foods (HFF) with multiple-micronutrient powders on Hb change, anaemia and weight in children. DESIGN: A pragmatic cluster-randomized controlled trial. SETTING: Forty villages in the Nioro Circle in Mali and 722 children aged 6-23 months were randomized to the intervention or control group. The intervention consisted of a daily dose of multiple-micronutrient powder for 3 months; in the control group, no supplement was given. In both groups, mothers received group education on child complementary feeding. Changes in weight, Hb concentration and anaemia were assessed as primary outcomes at baseline and 3 months. The HFF effect was determined using regression analyses and quantile regression with standard errors taking account of the cluster design. SUBJECTS: Children aged 6-23 months. RESULTS: Overall prevalence of anaemia in the sample was high: 90 %. HFF provided a modest but statistically significant Hb change v. no intervention (0·50 v. 0·09 g/dl, P=0·023). Prevalence of anaemia changed little: 91·3-85·8 % (P=0·04) in the intervention group v. 88·1-87·5 % % (P=0·86) in the control group. Proportion of severe anaemia was reduced by 84 % (from 9·8 to 1·6 %) in the intervention group, but increased in the control group (from 8·5 to 10·8 %). No effect was observed on weight. CONCLUSIONS: The WHO HFF strategy to fight anaemia showed a modest change on Hb concentration and significantly reduced the rate of severe anaemia.

Malaria and Iron Load at the First Antenatal Visit in the Rural South Kivu, Democratic Republic of the Congo: Is Iron Supplementation Safe or Could It Be Harmful?

We investigated the relationship between malaria infection and iron status in 531 pregnant women in South Kivu, Democratic Republic of the Congo. Sociodemographic data, information on morbidity, and clinical data were collected. A blood sample was collected at the first antenatal visit to diagnose malaria and measure serum ferritin (SF), soluble transferrin receptor, C-reactive protein, and α1-acid-glycoprotein. Malaria prevalence was 7.5%. Median (interquartile range) SF (adjusted for inflammation) was significantly higher in malaria-infected (82.9 µg/L [56.3-130.4]) than in non-infected (39.8 µg/L [23.6-60.8]) women (P < 0.001). Similarly, estimated mean body iron store was higher in malaria-infected women (P < 0.001). Malaria was significantly and independently associated with high levels of SF. Efforts to improve malaria prevention while correcting iron deficiency and anemia during pregnancy are warranted.

Randomized controlled trial of the effectiveness of a soybean-maize-sorghum-based ready-to-use complementary food paste on infant growth in South Kivu, Democratic Republic of Congo.

BACKGROUND: Evidence of the effectiveness of lipid-based ready-to-use complementary foods (RUCF) at improving linear growth among infants aged 6-12 mo is scarce, and further work is warranted. OBJECTIVE: The objective was to assess the effectiveness of a fortified soybean-maize-sorghum RUCF paste compared with a fortified corn soy blend (UNIMIX) porridge on the prevalence of underweight and stunting among infants in South Kivu Province, Democratic Republic of Congo. DESIGN: Infants were randomly assigned at 6 mo of age to receive either RUCF (n = 691) or UNIMIX (n = 692) for 6 mo. In addition to admission and monthly anthropometric measurements, hemoglobin, triglyceride, and cholesterol were measured at enrollment and at the end of the study. RESULTS: No significant differences in the prevalence of stunting (RUCF: 48.6%; UNIMIX: 46.4%; P = 0.31), the prevalence of underweight (RUCF: 20.4%; UNIMIX: 18.2%; P = 0.42), or weight gain (RUCF: 1.2 ± 0.7 kg; UNIMIX: 1.3 ± 0.7 kg; P = 0.08) were found. A small but statistically significant difference in length gain (RUCF: 5.2 ± 2.0; UNIMIX: 5.4 ± 2.0; P = 0.03) was found. No significant differences in the concentrations of hemoglobin, serum triglyceride, and serum cholesterol were found between the 2 groups. CONCLUSION: No significant differences were found between the RUCF and UNIMIX in the reduction of the prevalence of stunting and underweight at 12 mo of age among rural Congolese infants. This trial was registered at controlled-trials.com as ISRCTN20267635.

[Therapeutic itinerary of poor patients in Benin (poverty and health care)]. / Itineraire therapeutique des malades indigents au Benin (Pauvrete et soins de sante).

OBJECTIVE: There is great risk of excluding the poor in a system where patients are charged for medical care. Our objective was to identify the stages of the therapeutic itinerary of poor and nonpoor patients in case of illness. METHOD: Prospective study over 12 months, in 16 sites selected randomly after dividing the territory of Benin into four strata. The sample included 1312 households (668 poor and 644 nonpoor) and 9554 people. Those who were ill during the study period were interviewed on the therapeutic itinerary chosen. RESULTS: A total of 1959 (20.5%, of whom 1091 were poor) of the 9554 people in our sample experienced at least one episode of illness. The nonpoor chose the health centres in the first instance more frequently than the poor (26.3%vs. 20%; P < 0.001); but the first choice of most patients (66.4% of poor and 63.9% of the nonpoor patients) was modern or traditional self-medication. Within the strata (regions), indigents and nonpoor in the urban region and the north chose different treatments in the first instance (P < 0.001). Apart from the first treatment chosen, no significant difference was observed between the therapeutic satisfaction of both groups. Patients unsatisfied with the first step of treatment were essentially those who used traditional or modern self-medication. Despite this, modern and traditional self-medication remain the most frequent second step choice for both poor and nonpoor patients. CONCLUSION: The main difference between poor and nonpoor people's therapeutic itinerary is that nonpoor people more often use state health facilities first than the poor.

[Healthcare access in Benin: poverty and community aid networks]. / Accès aux soins de santé au Bénin: indigence et réseaux d'aide communautaire.

The objective of this study was to evaluate the capacity of poor and non-poor households to pay for health care and to show how existing community assistance (or solidarity) networks (CAN) may compensate for this inability. Sixteen (16) study sites were randomly selected after stratification of Benin into four groups. All 1,312 households in our sample (668 poor and 664 non-poor) were interviewed, and 48 focus group were held with opinion leaders, women, healthcare workers, social workers, and persons responsible for these networks. The survey showed that only 27% of the heads of households have permanent financial access to health care and health services. This financial access is lower for the poor (9%) than for others (46%). However, the capacity of heads of households to pay reached 84% (87% for the non-poor and 81% for the poor, with P<0.01). Capacity to pay differs between strata (P<0.001) and is higher in the urban strata. For 25% of the families, intervention of the CAN made payment possible, preferentially for the poor. In 90% of cases, this community support came from the family network. Health centre management committees contributed in only 0.8% of cases. In general, help covered only a small percentage of those in need. The health policy of African countries must ensure that health care is accessible to the population, especially the poor.