Introduction
Methods
Inclusion criteria
Abstraction, analysis and summary measure
Quantitative data synthesis
Results
Study | Country | Target Group | MNP Composition | Duration |
---|---|---|---|---|
Adu-Afarwuah 2007 | Ghana | 6-12 month olds | Β-Carotene-300 µg RE, Vitamin C-50 mg, Vitamin D3-7.5 µg, Folic acid- 150 µg, Iron (Fumarate)- 12.5 mg, Zinc (Gluconate)- 5 mg | 1 year |
Adu-Afarwuah 2008 | Ghana | 6-12 month olds | Β-Carotene-300 µg RE, Vitamin C-50 mg, Vitamin D3- 7.5 µg, Folic acid- 150 µg, Iron (Fumarate)-12.5 mg, Zinc (Gluconate)- 5 mg | 1 year |
Agostoni 2007 | Cambodia | 6 month olds | Fe- 12.5mg (fumarate), Zn- 5 mg (gluconate), Vitamin C - 50mg, Vitamin A - 300mg, Vitamin D3-7.5mg, Folic acid - 150mg, Potato maltodextrins SQ to 1 g. | 1 year |
Kounnavong 2011 | Lao People’s Democratic Republic | 6-52 month olds | Vitamin A - 400μg RE, Vitamin D- 35 μg, Vitamin E - 5 mg TE, Vitamin B1, B2, B6 - each 0.5 mg, Folic acid- 150 μg, Niacin- 6 mg, Vitamin B12- 0.9 μg, Vitamin C- 30 mg, Iron- 10 mg, Zinc- 4.1 mg, Selenium- 17 μg, Copper- 0.56 mg, Iodine- 90 μg | 6 months |
Kumar 2007 | India | 7-11 year olds | Vitamin A 1500 IU/g, Vitamin B2, B6, B12 each -1 mg/g, Calcium pentothenate- 1 mg/g, Niacin -15 mg/g, Folic acid-100 mcg/g, Vitamin E -30 IU/g, Vitamin C- 30 mg/g, Iron - 10 mg/g, Lysine - 250 mg/g, Calcium - 15.63 % | 1 year |
Lundeen 2010 | Kyrgyzistan | 6-36 months old | Elemental iron (fumarate)- 12.5 mg, Vitamin A - 300 μg, Zinc (gluconate)- 5 mg, Vitamin C (ascorbic acid) - 30 mg, Folic acid- 160 μg | 2 months |
Macharia-Mutie 2012 | Kenya | 1-5 year olds | Retinyl palmitate - 100 mg RE, Cholecalciferol- 5 mg, 1-a tocopheryl acetate- 5 mg TE , Phylloquinone - 30 mg, Thiamin- 0.5 mg, Riboflavin - 0.5 mg, Pyridoxine - 0.5 mg, Folic acid - 90 mg, Niacin - 6 mg, Vitamin B-12 - 0.9 mg, Vitamin C - 60 mg, Iron (as NaFeEDTA) - 2.5 mg, Zinc - 2.5 mg, Selenium - 17 mg, Copper - 0.34 mg, Iodine- 30 mg | 4 months |
Menon 2007 | Haiti | 9-24 month olds | Iron- 12.5 mg, Zinc- 5mg, Vitamin A- 400mg, Folic acid - 160mg, Vitamin C- 30mg | 2 months |
Osei 2010 | India | 6-10 year olds | Iron (NaFeEDTA)- 10 mg, Vitamin A (retinyl acetate)- 375 mg, Zinc (zinc gluconate) -4.2 mg, Folic acid - 225 mg, Iodine (potassium iodide) - 90 mg, Vitamin C (ascorbic acid) - 26.25 mg, Thiamine (thiamine mononitrate)- 0.68 mg, Riboflavin- 0.68 mg, Niacin (nicotinamide) - 9 mg, Vitamin B-12- 1.35 mg, Vitamin B-6- 0.75 mg, Vitamin D (ergocalciferol) - 3.75 mg, Vitamin E - 5.25 mg, Copper [CuSO4.(H2O)5]- 0.45 mg | 8 months |
Sharieff 2006 | Pakistan | 6-12 month olds | Zinc gluconate- 5 mg, Ferrous fumarate - 30 mg, Vitamin C - 50 mg, Vitamin A - 300 mg, Vitamin D3 - 7.5 mg, Folic acid- 150 mg | 2 months |
Varma 2007 | India | 36-66 month olds | Ferrous fumarate- 14 mg, Vitamin A- 500 IU, Folic acid- 0.05 mg | 6 months |
Giovannini 2006 | Cambodia | 6 month olds | Fe (iron II fumarate) - 12.5 mg, Zn (gluconate) - 5 mg, Vitamin C - 50 mg, Vitamin A - 300 µg, Vitamin D3 - 7.5 µg, Folic acid 50- 150 µg, Potato maltodextrins - SQ to 1 g | 1 year |
Sharieff 2007 | China | 3-6 years | Iron (ferrous fumarate)- 30 mg, Zinc gluconate- 5mg, Vitamin C- 50 mg, Vitamin A- 300 mg, Vitamin D3 - 7.5mg, Folic acid- 150mg | 3 months |
Suchdev 2010 | Kenya | 6-35 month olds | Ferrous fumarate- 12.5mg, Vitamin A- 375 µg, Zinc- 5 mg, Folic acid- 150 µg, Vitamin C-35 mg, Vitamin D3 - 5 µg, Vitamin E- 6 mg, Niacin- 6 mg, Copper- 0.6 mg, Iodine - 50 µg, Thiamine, riboflavin and vitamin B-6 - 0.5 mg, Vitamin B-12- 0.9 mg | 1 year |
Jack 2012 | Cambodia | 6 month olds | Iron (ferrous fumarate) - 12.5 mg, Zinc gluconate - 10 mg, Vitamin A - 300μg, Iodine - 90 μg, Vitamin B1 - 0.5 mg, Vitamin B2 - 0.5 mg, Vitamin B6 - 0.5 mg, Vitamin B12 - 0.9 μg, Niacin - 6 mg, Folate, folic acid - 160 μg, Vitamin C - 30 mg, Copper - 0.3 mg, Vitamin D - 5 μg, Vitamin E - 6 IU | 18 months |
Bhutta (unpublished) | Pakistan | 6-18 months | Ferrous fumarate- 12.5 mg, Vitamin C - 50 mg, Vitamin A (retinol acetate)- 300 μg, Vitamin D - 5 μg, Folic acid - 150 μg, Zinc gluconate- 10 mg | 24 months |
Quality Assessment | Summary of Findings | |||||||
---|---|---|---|---|---|---|---|---|
Directness | No of events | |||||||
No of studies | Design | Limitations | Consistency | Generalizability to population of interest | Generalizability to intervention of interest | Intervention | Control | RR / SMD (95% CI) |
Anemia:
Moderate outcome specific quality of evidence
| ||||||||
Eleven | RCT | Significant heterogeneity, random effect model used | Six of ten studies suggest benefit | All studies from the developing countries | The duration of the studies ranged from 2-12 months and the age of the children from 6 months to 10 years. | 1081 | 1443 | RR: 0.66 [0.57, 0.77] |
Iron deficiency Anemia:
Moderate outcome specific quality of evidence
| ||||||||
Seven studies (six data sets) | RCT | Significant heterogeneity, random effect model used | Four of six studies suggest benefit | All studies from the developing countries | The duration of the studies ranged from 2-12 months | 404 | 986 | RR: 0.43 [0.35, 0.52] |
Hemoglobin:
Moderate outcome specific quality of evidence
| ||||||||
Fourteen studies (Fifteen data sets) | RCT | Significant heterogeneity, random effect model used | Nine studies suggest benefit | All studies from the developing countries | Studies ranged in duration from 2-12 months. | 4571 | 3783 | SMD: 0.98 [0.55, 0.40] |
Serum Zinc:
Moderate outcome specific quality of evidence
| ||||||||
Three | RCT | Significant heterogeneity so a random effect model used | One study suggested benefit | All studies from developing countries | One study was conducted in school | 761 | 788 | SMD: -0.22 [-0.52, 0.09] |
Serum Retinol:
Moderate outcome specific quality of evidence
| ||||||||
Two | RCT | Significant heterogeneity so a random effect model used | One study suggest benefit | Both studies from India | Study duration ranged from 6-8 months. | 464 | 504 | SMD: 1.66 [-1.60, 4.92] |
Serum Ferritin:
Moderate outcome specific quality of evidence
| ||||||||
Four | RCT | Significant heterogeneity, random effect model used | Three studies suggest benefit | All studies from developing countries | Studies ranged in duration from 6 months to 12 months | 850 | 884 | SMD: 1.78 [-0.31, 3.88] |
Zinc Deficiency:
Moderate outcome specific quality of evidence
| ||||||||
Two | RCT | No significant heterogeneity, fixed effect model used | None of the study suggests benefit | All studies from the developing countries | The study duration ranged from 6-8 months. | 258 | 272 | RR: 1.02 [0.87, 1.19] |
Retinol Deficiency:
Moderate outcome specific quality of evidence
| ||||||||
Three | RCT | No significant heterogeneity, fixed effect model used | None of the study suggests benefit | All studies from the developing countries | The study duration ranged from 6-12 months. | 111 | 145 | RR: 0.79 [0.64, 0.98] |
Stunting: Moderate outcome specific quality of evidence | ||||||||
---|---|---|---|---|---|---|---|---|
Two study (three data sets) | RCT | No significant heterogeneity, fixed effect model used | None of the study suggests benefit | All studies from the developing countries | 810 | 838 | RR: 0.92 [0.81, 1.04] | |
Wasting:
Moderate outcome specific quality of evidence
| ||||||||
Two study (three data sets) | RCT | No significant heterogeneity, fixed effect model used | None of the study suggests benefit | All studies from the developing countries | 263 | 234 | RR: 1.13 [0.91, 1.40] | |
Underweight:
Moderate outcome specific quality of evidence
| ||||||||
Three studies (four data sets) | RCT | No significant heterogeneity, fixed effect model used | None of the studies suggest significant benefit | All the studies from developing countries | All studies included more than 3 micronutrients. The studies ranged in duration from 4-12 months. | 671 | 679 | RR: 0.96 [0.83, 1.10] |
HAZ: Moderate outcome specific quality of evidence
| ||||||||
Three | RCT | No significant heterogeneity, fixed effect model used | None of the studies suggest significant benefit | All studies are from Africa | All studies included more than 3 micronutrients. The studies ranged in duration from 6-12 months. | 271 | 253 | SMD: 0.04 [-0.13, 0.22] |
WAZ: Moderate outcome specific quality of evidence
| ||||||||
Three | RCT | No significant heterogeneity, fixed effect model used | None of the studies suggest significant benefit | All studies from Africa | All studies included more than 3 micronutrients. The studies ranged in duration from 6-12 months. | 271 | 253 | SMD: 0.05 [-0.12, 0.23] |
WHZ:
Moderate outcome specific quality of evidence
| ||||||||
Three | RCT | No significant heterogeneity, fixed effect model used | None of the studies suggest significant benefit | All studies from Africa | All studies included more than 3 micronutrients. The studies ranged in duration from 6-12 months. | 271 | 253 | SMD: 0.04 [-0.13, 0.21] |
Diarrhea:
Moderate outcome specific quality of evidence
| ||||||||
Four studies (five data sets) | RCT | No significant heterogeneity, fixed effect model used | Direction of evidence is consistent across studies | All the studies from developing countries | Number of micronutrients ranged from 5-15. Duration varied from 2-12 months. One of the studies targeted children in school. | 1692 | 1679 | RR: 1.04 [1.01, 1.06] |
Recurrent Diarrhea:
Moderate outcome specific quality of evidence
| ||||||||
One | RCT | Only one study | Study was conducted in Cambodia | Study was conducted over a 12 month period | 1 | 0 | RR: 2.86 [0.12, 69.00] | |
URI: Moderate outcome specific quality of evidence
| ||||||||
Two | RCT | No significant heterogeneity, fixed effect model used | None of the studies suggest benefit | All the studies from developing countries | Number of micronutrients ranged from 5-14. Duration varied from 8-12 months. One of the studies targeted children in school. | 30 | 26 | RR: 1.17 [0.71, 1.92] |
Fever: Moderate outcome specific quality of evidence
| ||||||||
One | RCT | Only one study | Study was conducted in India | 41 | 41 | RR: 1.03 [0.70, 1.51] |