A Blinded, Cluster-Randomized, Placebo-Controlled School FeedingTrial in Burundi Using Rice Fortified With Iron, Zinc, Thiamine, and Folic Acid.

BACKGROUND: Iron-deficiency anemia is a major public health problem among school-aged children in sub-Saharan Africa. OBJECTIVE: To evaluate the effectiveness of micronutrient-fortified rice to increase hemoglobin (Hb) concentration and reduce the prevalence of anemia among schoolchildren. METHODS: Nine hundred four schoolchildren participated in this cluster-randomized trial during a 7-month intervention period. The study was conducted in 12 primary schools in rural Burundi. Hemoglobin, socioeconomic status, febrile illness, and dietary diversity were measured at baseline and follow-up. The changes in Hb concentration and anemia status were analyzed using linear and logistic mixed models, respectively. The micronutrient formulation contained an iron-to-zinc molar ratio of approximately 2.2. RESULTS: There was no significant difference in Hb concentration between the intervention and control groups (ß = .09 g/dL; 95% confidence interval: -0.21 to 0.38) following the 7-month intervention. Nearly half the children reported having a fever within 2 weeks prior to baseline or follow-up. Children with febrile illness preceding follow-up were less than half as likely to show improvement in anemia status (odds ratio = 0.47, P < .001), with an average 0.56 g/dL smaller improvement in Hb at follow-up (P < .001). CONCLUSION: The high prevalence of fever and low iron-to-zinc molar ratio of the Ultra Rice formulation may have contributed to the lack of improvement in Hb. Alternatively, the detected anemia may not have been due to nutrient deficiencies. Anemia interventions in Burundi should implement multiple strategies to eliminate both iron deficiency and infectious causes of anemia.

The multidimensional vulnerability of people with disability to HIV infection: Results from the handiSSR study in Bujumbura, Burundi.

BACKGROUND: In resource-limited contexts, available data indicate that people with disability are disproportionally affected by the HIV epidemic. While disability resulting from chronic HIV infection has received some attention, few epidemiologic studies have examined the vulnerability of people with disability to HIV acquisition. The aims of the study were as follows: to estimate and compare HIV prevalence among people with and without disability living in Bujumbura, Burundi; to examine how the interaction among disability, gender and socioeconomic environment shapes vulnerability to HIV; and to identify potential pathways to higher HIV risk. METHODS: In this cross-sectional population-based study, 623 persons with disability (302 with disability onset ≤10 years ["early disability"]) and 609 persons without disability matched for age, sex and location were randomly selected to be tested for HIV and to participate in an interview about their life history, their social environment and their knowledge of sexual health. FINDINGS: A total of 68% of men and 75% of women with disability were affected by multidimensional poverty compared to 54% and 46% of their peers without disability (p<0.0001). Higher HIV prevalence was observed among women with disability (12.1% [8.2-16]) than among those without (3.8% [1.7-6], ORa 3.8, p<0.0001), while it was similar among men with disability and those without (p = 0·8). Women with disability were also at higher risk of sexual violence than were those without (ORa 2.7, p<0.0001). The vulnerability of women with early disability to HIV was higher among those who were socially isolated (HIV prevalence in this group: 19% [12-27]). In addition, education level and sexual violence mediated 53% of the association between early disability and HIV (p = 0.001). INTERPRETATION: This study highlights how the intersection of disability, gender and social environment shapes vulnerability to HIV. It also shows that the vulnerability to HIV of women who grew up with a disability is mediated by sexual violence. FUNDING: This research was funded by the Netherlands Organization for Scientific Research (Grant W08.560.005) and the Initiative HIV-TB-Malaria (new name of the organisation).

Treatment of Anemia with Iron-fortified Rice in a School Lunch Program in Burundi.

Objectives: This cluster-randomized trial tested the efficacy of fortified rice for the treatment of anemia in Burundi. Ultra Rice® (UR) premix kernels were manufactured to contain 100% of the recommended nutrient intakes (RNI) for iron, zinc, thiamin, and folic acid for children 7-9 years. The operational feasibility of providing a stable fortified rice product was also assessed in the Burundian context. Methods: Twelve schools were randomly assigned to receive either UR fortified rice or traditional rice for seven months through a school feeding program. Hemoglobin status was evaluated at baseline and follow-up. Data were collected on the organoleptic acceptability of fortified rice, micronutrient stability with the UR technology, and the blend homogeneity of the rice. Results: Anemia was highly prevalent in schools in Muyinga Province. The fortified rice product was considered acceptable to the local community, maintained stable micronutrient levels, and blended homogeneity. Over the course of the study, anemia status and hemoglobin levels improved in both the control and intervention groups. The intervention did not lead to a significantly greater change in hemoglobin level among those children eating fortified rice (β=0.085 g/dl, 95% CI: -0.21-0.38). Conclusions: High prevalence of fever among the children and the high zinc content of the UR formulation are likely responsible for the non-significant improvement in hemoglobin. Anemia interventions in Burundi should implement multiple strategies to eliminate both iron deficiency and infectious causes of anemia. The zinc content of a multiple micronutrient grain should be studied more carefully to maximize iron uptake. *Funded by USDA/NIFA.