Effectiveness of Micronutrient Sprinkles Distribution in Western Kenya

Background:

Iron deficiency anemia affects over 60% of children in western Kenya and is treatable with iron. Despite established efficacy of Sprinkles for home-fortification of complementary foods, there is little evidence on the best mechanism for sustainable delivery of Sprinkles in resource-poor communities. In March, 2007 the Centers for Disease Control and Prevention joined with partners to implement an effectiveness study that combines social marketing with mobilization of local institutions to promote the sale of Sprinkles along with various other evidence-based health products.

Methods:

We randomly selected 60 villages and allocated them into intervention and comparison groups. In intervention villages, Sprinkles are distributed by vendors, who sell health products to their neighbors as an income-generating activity. In comparison communities, Sprinkles are not promoted or marketed. This 24 month evaluation includes: 1) baseline and follow-up cross-sectional surveys, including measurement of selected biomarkers among children aged 6-35 months; 2) active biweekly surveillance to determine Sprinkles use and health status; and 3) qualitative data collection to assess acceptability of Sprinkles over time.

Results:

At baseline, we enrolled 1586 households and collected survey data and laboratory specimens on 1049 children aged 6-35 months. Over 86% of households fell into the poorest socioeconomic quintile for Kenya. Among children, 28.2% were stunted (height-for-age z-score < -2), 66.2% were anemic (hemoglobin < 11.0 g/dL), 44.6% were iron deficient (ferritin < 12.0 ng/mL), and 19.2% had malaria parasitemia. Furthermore, 29.1% reported an acute respiratory infection and 11.6% reported diarrhea in the preceding 24 hours. In the first 6 months of distribution, over 100,000 Sprinkles sachets have been sold, and 30-40% of households are reporting Sprinkles use.

Discussion:

Preliminary data suggest that uptake of Sprinkles is good and that this distribution method may be effective in improving access to preventive health products in resource-poor settings. Moreover, this evaluation will assess the effectiveness of long-term Sprinkles distribution in this setting.