Effects of Consumption of Fortified Complementary Food and Promotion of Responsive Feeding on the Hemoglobin and Micronutrient Status of Young Children in a Controlled, Cluster Randomized Trial in the District of Amparafaravola in Madagascar.
Yannick Razafindratsima, Andry Razakandrainy, Sonia Fortin et al.
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In 30 seconds
This 2 × 2 factorial cluster-randomized intervention trial assessed responsive feeding (RF) and fortified complementary food (FCF), alone or together, in 706 infants recruited at 6–7 months in Amparafaravola, Madagascar. After 9 months, 85% of children had at least one micronutrient deficiency. FCF consumption increased hemoglobin by +5.43 g/L (95% CI: +2.52, +8.3) and retinol-binding protein. RF improved retinol-binding protein but was associated with poorer iron, zinc, and thiamine status; significant interactions between RF and FCF occurred for most micronutrient indicators.
Key findings
- At baseline, 85% of children had one or more micronutrient deficiencies.
- FCF increased hemoglobin by +5.43 g/L (95% CI: +2.52, +8.3) and retinol-binding protein by +0.09 μmol/L (95% CI: +0.04, +0.14).
- RF increased retinol-binding protein by +0.06 μmol/L (95% CI: +0.01, +0.11), but was associated with poorer iron, zinc, and thiamine status.
- Significant interactions between RF and FCF were observed for most micronutrient-status indicators.
Why it matters
The high prevalence of deficiency highlights substantial micronutrient needs among young children in this setting. The trial suggests fortified complementary food may improve hemoglobin and retinol-binding protein, while the unexpected adverse micronutrient findings with responsive-feeding promotion show that nutrition interventions can have differing effects when combined and warrant careful evaluation.
What to keep in mind
The intervention and population were specific to one district in Madagascar, which may limit generalizability. Outcomes were assessed after 9 months.