Journal Article

Predictors of Anaemia Among Young Children Receiving Daily Micronutrient Powders (MNPs) for 24 Weeks in Bangladesh: A Secondary Analysis of the Zinc in Powders Trial

Arnold, Charles, Islam, M. Munirul, Thompson, Lauren, Peerson, Janet, McDonald, Christine M., Black, Robert E., Krebs, Nancy F., Long, Julie M., Westcott, Jamie L. E.

2025

Overview

In Bangladesh, anaemia is estimated to affect 52% of children 6–59 months, with the youngest children (6–23 months) experiencing the highest levels of anaemia (71%). Micronutrient powders (MNPs) are designed to increase micronutrient intake in young children; however, in some settings, the prevalence of anaemia may remain elevated despite the high coverage of MNPs. In a secondary analysis of the Zinc in Powders trial (ZiPT), we identified risk factors that were associated with anaemia among Bangladeshi children 9–11 months of age who received standard 15‐component MNPs, including 10 mg of iron, daily for 24 weeks. At enrolment, socio‐demographic characteristics were collected. Morbidity symptoms were assessed on a semi‐weekly basis. Haemoglobin (measured via single‐drop capillary blood using Hemocue 301+) and child anthropometry were assessed at enrolment and endline (24 weeks). Risk factors for anaemia at endline (24 weeks) were identified using minimally adjusted (age and sex) logistic regression models. Multivariate models were subsequently constructed, controlling for age, sex and significant risk factors. Of the 481 children randomized to the MNP arm, 442 completed the trial and had haemoglobin data available at endline. Anaemia (haemoglobin < 10.5 g/dL) prevalence declined from 54.1% at baseline to 32.6% at endline. In minimally adjusted models, season of enrolment, underweight at enrolment, asset score, hygiene score and frequent morbidity symptoms were associated with the odds of anaemia at endline. However, some factors lost statistical significance in multivariate models. MNPs are an important tool for anaemia prevention; however, they should be part of an integrated approach for anaemia control. Micronutrient powders (MNPs) are recommended by the World Health Organization to address and prevent anaemia among children in nutritionally vulnerable settings with a high prevalence of anaemia (> 40%); however, following a 24‐week intervention of daily MNP provision among young Bangladeshi children, anaemia was associated with factors related to poverty, suboptimal hygiene practices, poor growth, season and frequent morbidity. This suggests that MNPs may be insufficient to adequately control anaemia, and multi‐pronged interventions that address the underlying, multifactorial causes of anaemia and integrate prevention and treatment are necessary. Summary Among young Bangladeshi children who received standard MNPs for 24 weeks, anaemia (haemoglobin < 10.5 mg/dL) prevalence declined from 54% to 33%, still above the World Health Organization's threshold for a public health problem. Anaemia at endline (24 weeks) was significantly associated with factors related to poverty, suboptimal hygiene practices, poor growth, season and frequent morbidity in bivariate models, yet some factors lost statistical significance in multivariate models. In nutritionally vulnerable settings with a high prevalence of anaemia, MNPs may be insufficient to adequately control anaemia. Multi‐pronged interventions that address the underlying, multifactorial causes of anaemia and integrate prevention and treatment are necessary.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Age / anaemia / Anemia / Anemia - epidemiology / Anemia - prevention & control / Anemia, Iron-Deficiency - epidemiology / Anemia, Iron-Deficiency - prevention & control / Anthropometry / Bangladesh / Bangladesh - epidemiology / Child, Preschool / Children / Demography / Dietary Supplements / Enrollments / Female / Hemoglobin / Hemoglobins - analysis / Humans / Infant / Integrative approach / Iron - administration & dosage / Male / micronutrient interventions / micronutrient powders / Micronutrients - administration & dosage / Morbidity / Original / Powders / Prevalence / Risk Factors / Secondary analysis / Statistical significance / Underweight / Zinc / Zinc - administration & dosage