258851 Association between multi-vitamin food fortification in infants aged 6 to 12 months and decreased rates of visits to primary care clinics and the emergency room for infectious diseases

Wednesday, October 31, 2012 : 1:10 PM - 1:30 PM

Ilana Belmaker, MD MPH , Ben-Gurion University of the Negev, Health in the Community, Faculty of Life Sciences, Beer-Sheva, Israel
Drora Fraser, PhD , The S. Daniel Abraham International Center for Health and Nutrition, Department of Epidemiology and Health Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Natalya Bilenko, MD MPH PhD , Southern Region Office, Israeli Ministry of Health, Department of Public health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Introduction: Childhood micronutrient deficiencies are known to influence host resistance mechanisms, thereby altering susceptibility to infectious diseases. Methods: Controlled cluster randomized trial, with Maternal and Child Health clinics (MCHCs) as the randomization unit, stratified by population group (Bedouin Arab and Jewish) was performed. Infants at age 6m were enrolled during 2005-2007 at MCHCs which were randomized to receive home food fortification with "Sprinkles", containing iron, folic acid, vitamins A, D, C and zinc; or standard supplementation, liquid iron, Vitamin A&D ("Controls"). Hematological indices, and iron stores, zinc and folate, were measured at age 6&12m. Data on primary care and emergency room (ER) visits due to infectious diseases was obtained during monthly home interviews. Results: The study population included 328 Bedouin Arab infants (192 in "Sprinkles" and 136 in "Controls"). Receiving "Sprinkles" was associated with a significantly lower rate of reporting of clinic visits, 43.0% of visits among Bedouin in the "Sprinkles" versus 62.5% among "Controls"; p<0.001. Corresponding rates for the Jewish population were 23.4% versus 40.8%; p=0.002. "Sprinkles" supplementation was associated with significantly fewer ER visits due to infectious disease in both populations (8.1% in the "Controls" versus 3.7% in "Sprinkles" for Bedouins, p=0.06; and 17.8% in "Controls" versus 9.2% in "Sprinkles" for Jews; p=0.04. Conclusion. Multi-nutrient food fortification by "Sprinkles" has protective effect on reported infectious diseases serious enough to warrant a clinic or ER visits. These results need to be confirmed with a study with enough power to identify those infectious diseases most preventable by multi-nutrient food supplementation.

Learning Areas:
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research

Learning Objectives:
Examine in a prospective, controlled, randomized community trial the efficacy of multi-nutrient home food fortification with a powdered formulation of iron (12.5 mg of microencapsulated ferrous fumarate), zinc (5 mg), Vitamin A (300 microgram), vitamin D (7.5 microgram), folic acid (150 microgram) and ascorbic acid (50 mg) packaged in individual sachets for daily use ("Sprinkles") versus the standard oral supplementation with liquid iron (15 mg), Vitamin A (300 micrograms) and Vitamin D (10 micrograms) recommended by the Ministry of Health on reported infectious disease morbidity.

Keywords: Infectious Diseases, Food and Nutrition

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was Regional Medical Officer of the Ministry of Health, southern district of Israel for 25 years (now retired). I am Professor in the Division of Health in The Community at the Faculty of th Sciences, Ben Gurion University of the Negev, Beersheva, Israel. I am active in a various scientific projects and teaching in the Faculty of Health Sciences, in the supervision of student projects and theses and in various national committees
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5180.0: Maternal and Child Nutrition