Effectiveness of micronutrient powder intervention in reducing anemia among children under six years of age: a rapid review

Abstract

Anemia is a major public health problem among the children under six years of age. Iron deficiency is the primary cause, while deficiencies in vitamin A, folic acid, and zinc also contributes. Childhood anemia impairs the cognitive and physical development and increases the susceptibility to infections. Micronutrient powders (MNPs) are widely used as home fortifiers to reduce anemia prevalence. This rapid review consolidated the evidence from observational and interventional studies on MNP use and anemia prevalence in children under six. PubMed and Cochrane were searched for the English full-text studies conducted in Asia. Eligible designs included the randomized controlled trials, cohort, case-control, and cross-sectional studies. Data extraction followed PICO based criteria, with over twelve studies meeting inclusion. MNP use consistently improved the hemoglobin levels and reduced anemia prevalence, particularly with iron inclusive formulations and high adherence. Improvements were also noted in the micronutrient status. Although effect sizes varied, supplementation generally raised hemoglobin concentrations. Program delivery structure and adherence were critical determinants of the success. MNPs significantly improve the hemoglobin concentrations and also reduce the anemia prevalence, especially among children under two years or those with moderate baseline anemia. Adherence (≥75%) was a vital factor, with compliant studies showing substantially better outcomes. Active involvement of the community health workers in distributing MNPs and educating caregivers enhanced the program success. Targeting interventions to the vulnerable populations such as anemic or at-risk children (6–24 months) may achieve greater impact than universal administration.