Flexible Administration of Sprinkles® in Infants and Young Children in Rural Bangladesh.
Millions of people worldwide are affected by iron deficiency anemia (IDA). IDA is a widespread serious public health problem, especially for infants in developing countries mainly because of inadequate intake of iron due to the poor bioavailability of dietary iron in predominately cereal based diets. One of the ways to combat iron deficiency anemia is by supplementation to targeted populations. Although iron drops have been used, they have been largely unsuccessful in reducing the prevalence of anemia because of compliance, distribution and supply issues. Sprinkles® are a new approach to iron delivery that is as efficacious as iron drops and more acceptable. For Sprinkles® to be implemented into nation-wide programs as a sustainable alternative to current iron supplementation approaches, an optimal model of use and distribution for Sprinkles® needs to be established. By comparing daily versus flexible use of Sprinkles® (60 sachets over 60, 90 and 120 days) among infants and young children aged 6-24 months, the primary objectives are to study the effect of the three administration models of Sprinkles® on changes in:
- hemoglobin concentration; and
- compliance or adherence to the intervention.
ii. The secondary objective of this study is to determine the acceptability of each of the three intervention models.
We hypothesize that adherence will be greater and hemoglobin concentration response will be higher in those given 'flexible' instructions to use all of the Sprinkles® supplied over a specific period of time compared to those given strict instructions for daily use.
|Study Design:||Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind
Primary Purpose: Treatment
|Official Title:||The Effectiveness of Flexible Administration of Sprinkles® in a Mixed Population of Anemic and Non-anemic Infants and Young Children in Rural Bangladesh.|
- hemoglobin concentration [ Time Frame: at end of treatment and 6 months post-treatment ] [ Designated as safety issue: No ]
- adherence measured by the number of sachets used [ Time Frame: end of treatment ] [ Designated as safety issue: No ]
- Acceptability measured through interview with mothers
- weaning food practice at treatment end and 6 months post-treatment
- length and weight at treatment end and 6 months post-treatment [ Designated as safety issue: No ]
- morbidity from diarrhea and acute respiratory infections at treatment end and 6 months post treatment
|Study Start Date:||May 2004|
|Estimated Study Completion Date:||March 2005|
This study will follow a community-based cluster randomized clinical trial design involving three intervention groups. Total number of villages included in the study will be determined by the availability of the eligible children. In each village, all eligible children will be screened through house-to-house visits. After the screening, all the children will be randomized by village using a table with randomly assorted table into one of three groups:
- Daily use of 60 Sprinkles® sachets over 60 days.
- Flexible use of 60 Sprinkles® sachets over 90 days.
- Flexible use of 60 Sprinkles® sachets over 120 days.
In all groups, assessments will be done at baseline, at the end of a group's intervention and at 6 months after intervention in each group for follow-up.
The study will take place in Kaligong sub-district in Bangladesh. All villages in Kaligonj sub-district consist of plain agricultural land. Subsistence farming is the major source of livelihood. Rice is the commonly eaten staple mixed with lentil and vegetable curry and occasionally with pieces of fish and meat. Similar to the rest of the plain areas of the country, malnutrition among women and children is widespread, but malaria is extremely uncommon and the prevalence of hookworm is fairly low (less than 2%%).
|Research and Evaluation Division, BRAC|
|Principal Investigator:||Stanley H Zlotkin, PhD||The Hospital for Sick Children, Toronto, Canada|