Sprinkles

The Journal of Nutrition
Community and International Nutrition

Micronutrient Sprinkles Reduce Anemia among
9- to 24-Mo-Old Children When Delivered
through an Integrated Health and Nutrition
Program in Rural Haiti1
Purnima Menon,2* Marie T. Ruel,3 Cornelia U. Loechl,4 Mary Arimond,3 Jean-Pierre Habicht,2
Gretel Pelto,2 and Lesly Michaud5
2
Division of Nutritional Sciences, CornellUniversity, Ithaca, NY 14853; 3Food Consumption and Nutrition Division, International Food
Policy Research Institute, Washington, DC 20006; 4International Potato Center (CIP-SSA), Kampala, Uganda; and 5World Vision,
Juvenat, Port au Prince, Haiti

Abstract
mg folic acid, and 30 mg vitamin C in reducing anemia among children 9- to 24 mo old in Haiti. Ten food distribution points
(FDP) wherechildren received take-home rations of fortified wheat-soy blend (WSB) were randomly allocated into 2 groups:
1) Sprinkles-WSB (S-WSB) (6 FDP; n ¼ 254), receiving 30 sachets of Sprinkles monthly for 2 mo; and 2) WSB only (WSB) (4
FDP; n ¼ 161), not receiving Sprinkles. At baseline, anemia prevalence [hemoglobin (Hb) , 100 g/L], adjusted for age and
sex, was 54 and 39% in S-WSB and WSB groups,respectively. After the 2-mo intervention (1st follow-up), anemia, adjusted
for baseline prevalence, age, and sex dropped to 24% in S-WSB (P , 0.001) and increased to 43% in WSB (P ¼ 0.07). At 7 mo
postintervention, anemia in S-WSB declined to 14%; 92% of children who were nonanemic at 1st follow-up remained so
without further Sprinkles consumption. From baseline to 1st follow-up, mean Hb increased by5.5 g/L and dropped by 1.0 g/L
in the S-WSB and WSB groups, respectively (P , 0.001). From baseline to 2nd follow-up, mean Hb increased by 10.9 g/L in
S-WSB (P , 0.001). Changes in mean Hb were greater for younger children (,21 mo at onset of intervention) (P , 0.05) and
for children who were anemic at baseline (P , 0.001). In populations with a high prevalence of anemia, such as rural Haiti,2 mo of Sprinkles are effective in reducing anemia among 9- to 24-mo-old children. J. Nutr. 137: 1023–1030, 2007.

Introduction
Iron-deficiency anemia is a persistent and highly prevalent
nutritional problem worldwide, particularly among women, infants, and young children. In many contexts, high-quality, fortified foods are unavailable or unaffordable for those who need
them and traditionaliron supplementation programs face challenges with compliance and supply. Newer methods for addressing iron deficiency include micronutrient Sprinkles, ‘‘foodlets’’
(chewable tablets), or high-nutrient density spreads that were
found to reduce anemia in efficacy trials in a variety of contexts
(1–4).
In Haiti, more than one-half of rural children under the age of
2 y are anemic [hemoglobin (Hb)6 ,100 g/L] (5). In previous
work in Haiti, we documented that iron-fortified, donated food
commodities [wheat-soy blend (WSB) or corn-soy blend]7 could
not provide sufficient iron to meet the iron needs of infants
participating in a maternal and child health and nutrition
(MCHN) program, even when combined with heme iron-rich,
locally available foods such as meat or organ meats (6). These
1Supported by the Micronutrient Initiative, Ottawa; Food and Nutrition Technical
Assistance (FANTA) Project, USAID; World Vision-Haiti; Government of Germany.
* To whom correspondence should be addressed. E-mail: pm38@cornell.edu.

findings highlighted the need to identify and evaluate new
solutions to address iron-deficiency anemia in this population,
such as micronutrient Sprinkles.
Theobjective of this research was to assess the effectiveness
of an intervention providing 2 mo of micronutrient Sprinkles
(containing 12.5 mg iron and other key micronutrients) in
reducing anemia among children 9–24 mo of age in rural Haiti.
Separately, we also assessed the feasibility of integrating this
intervention into the existing MCHN program system (7).
Our primary hypothesis was that a...