A global treatment for iron deficiency

01/18/05

Iron deficiency is the world's most common preventable nutritional problem. It has largely been eradicated from developed countries, but more than 750 million children in the developing world have iron-deficiency anemia. According to an article by researchers at The Hospital for Sick Children in Toronto, Canada, published in this month's issue of the open access global health journal PLoS Medicine, a simple sachet called "Sprinkles" could be the key to eradicating this type of anemia.

In developing countries, the standard strategy to try and control iron-deficiency anemia is the use of an iron supplement (ferrous sulphate) given to children as a syrup. But children often find the treatment hard to take, since it has an unpleasant metallic aftertaste, it leaves a dark stain on their teeth, and it can give them abdominal discomfort. In contrast, Sprinkles--sachets containing microencapsulated iron and other micronutrients as a powder that is sprinkled onto foods--avoids these side effects. When it was tested in clinical trials in Bangladesh and Ghana, all of the mothers surveyed found the treatment acceptable.

In the article, Stanley H. Zlotkin and colleagues summarize the results of seven community-based trials of using Sprinkles in four different countries. They found that Sprinkles were just as good as ferrous sulphate at raising the level of hemoglobin in children's blood (in other words, at treating anemia).

"Each stage in the evolution of the Sprinkles intervention has been evaluated in a controlled manner," say the authors. "We determined that the use of encapsulated iron did not appreciably change the taste or color of the food to which it was added, we showed that the haemoglobin response in anaemic infants was equivalent to the current standard of practice, and we documented the acceptability of Sprinkles among caregivers who used Sprinkles in their homes."

Importantly, the authors have developed a collaborative model to scale up the intervention for countrywide use, including providing Sprinkles to the most vulnerable populations in the developing world. In Mongolia, for example, Sprinkles have been distributed to over 15,000 children in seven districts by a non-governmental organization called World Vision. The cost was about US$0.03 per sachet. In the project area, the prevalence of anemia fell from 42% to 24%, and of rickets from 48% to 33%.

Stanley H. Zlotkin owns the intellectual property rights to Sprinkles, and the H.J. Heinz Company is supporting the technical development of Sprinkles on a cost-recovery basis. Any profit from royalty fees on the technology transfer of Sprinkles is currently donated to The Hospital for Sick Children Foundation.

"By developing Sprinkles as a cost-effective and simple strategy to fortify foods in the home," said Professor Zlotkin, "we hope to improve the nutritional health and well-being of disadvantaged infants, young children, and pregnant women worldwide, so that they can meet their genetic potential for growth, health and development."

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