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Daily vs. Weekly Study

Among the first Sprinkles activities conducted as part of Sprinkles program development in Bangladesh was a study that compared the efficacy of daily versus weekly use of Sprinkles among children 12-24 months of age in the Kalinganj village area. The intervention lasted 8 weeks and took place from September to December 2003 with the goal of identifying a suitable dose-frequency of Sprinkles for infants in rural Bangladesh and assessing the compliance and acceptability of intervention through focus group discussions (FGDs). In a subgroup of children (n=150) with initial hemoglobin <100 g/L, hemoglobin increased by 21 g/L and 16 g/L (p=0.199) and anemia (defined as Hb <100 g/L) decreased by 85% and 62% (p=0.034) in the daily and weekly groups, respectively. Although the daily administration of Sprinkles (12mg of elemental iron per sachet) seemed to have a better impact on anemia, significant improvement of hemoglobin concentrations and reduction in anemia was also observed in the group who received Sprinkles only once a week (30mg elemental iron). It is concluded from this study that both daily and weekly administration of Sprinkles are efficacious in the reduction of anemia, but that daily administration had a relatively better effect on Hb and iron status and may be more appropriate. Weekly use may have additional benefits at the population level including reduced program costs, but if not adequately supervised, a weekly regimen can lead to lower effectiveness. In this study, 60% of mothers 'extremely liked' and 30% 'liked' the Sprinkles intervention.

‘Flexible’ Administration study

Acceptability of the frequency of administration as revealed during focus group discussions in the daily versus weekly efficacy study suggested that mothers preferred more 'flexible' instructions for Sprinkles use rather than a medical model or prescribed dosing regimen, whether daily or weekly. Therefore, a new study initiated in April 2004 is currently ongoing at BRAC, the largest national NGO in Bangladesh, to test the efficacy and effectiveness of the 'flexible' administration of Sprinkles with the goal of determining an optimal model of Sprinkles use in real-life community settings. The study includes a mixed anemic and non-anemic population of infants 6-24 months of age. Each child is randomized to either: Daily use of Sprinkles over 60 days (Group 1); 'Flexible' use of 60 Sprinkles sachets over 90 days (Group 2); or 'Flexible' use of 60 Sprinkles sachets over 120 days (Group 3). A flexible dosing schedule means that mothers would be told to use a given amount of Sprinkles sachets (60 sachets, each containing 12.5mg Fe) over a specified period of time, but 'How often' they give Sprinkles to their infant during the intervention period is their own choice provided that no more than one sachet is used per day. Hemoglobin concentration is the primary outcome and monthly monitoring visits will assess compliance by counting the number of unused and used sachets. An acceptability survey and focus group discussions will be conducted at the end of intervention to assess mothers' acceptance, attitudes and preferences towards the different models of use.

National Workshop on Sprinkles

A consensus-building workshop was jointly organized by BRAC and IPHN on February 11, 2004 in Dhaka entitled, "Home Fortification of Weaning Food with Sprinkles: A New Strategy to Control Iron Deficiency Anemia among Infants and Young Children". The workshop was sponsored by the Micronutrient Initiative (MI) in Dhaka and HSC. The objectives of the workshop were to review the interventions for controlling IDA among infants, to share experiences of on-going Sprinkles activities and to formulate a strategy of home-fortification to improve the iron and other micronutrient content of weaning foods in Bangladesh. The workshop was attended by 51 participants representing governmental, non-governmental, UN and international agencies in Bangladesh. Special guests and key note speakers included Mr. FH Abed (Founder and Chairman of BRAC), Prof. Mizanur Rahman (Director General of Health Services in Bangladesh), Dr. Selina Ahsan (Joint Secretary, WHO and Public Health, Ministry of Health and Family Welfare) and Dr. Stanley Zlotkin (Professor and Department Head of GI/Nutrition, HSC). The workshop was important to introduce Sprinkles to the Bangladesh health and nutrition community and to mobilize support for nation-wide Sprinkles program development. Future scaling-up activities on Sprinkles will include the partnership and support of MI and IPHN (Institute of Public Health Nutrition).

Formative Research

Extensive formative research was initiated by BRAC and HSC in December 2003 with the key objective of developing an effective distribution model, proper communication strategy and culturally appropriate social marketing method and message for Sprinkles in Bangladesh. The formative research will identify the target audience, barriers and facilitators to the intervention and the social messages that should be conveyed. It consists of several stages and includes nine district areas throughout Bangladesh, which are representative of the diverse communities that exist throughout the country. A thorough understanding of the operational issues such as the perceptions, beliefs and factors that may influence Sprinkles acceptance and use, will be gained through a mainly qualitative approach which involves conducting household surveys, in-house observations, in-depth interviews with key informants, two 'trial improved practice' stages (TIPS1 and TIPS2) and focus group discussions (FGDs). These ongoing activities will provide an overall assessment of community child feeding practices, mothers' nutritional knowledge and health seeking behavior. Mothers and key community members including health workers (Shatho Shebikas), nutritionists, religious leaders, rural medical practitioners, manufacturers and retailers will be asked about their attitudes and opinions towards Sprinkles' use, mode of distribution and social marketing plan. A communication package for Sprinkles will be developed and mothers will be given a two-month daily Sprinkles intervention to try. Ongoing continuous in-depth interviews with mothers will reveal key issues for the improvement of the Sprinkles program and communication package at each stage so that the implementation of Sprinkles will be available to all infants and young children and widely received by mothers, policy makers, health officials, community leaders and the general population.

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Canadian International Development Agency (CIDA) |  Centers for Disease Control and Prevention (CDC) |  Food and Agriculture Organization (FAO) |  Health Canada |  The Hospital for Sick Children |  The Hunger Site, Sight and Life |  The International Development Research Center (IDRC) |  International Life Sciences Institute (ILSI)  |  Micronutrient Initiative (MI) |  The Pan American Health Organization (PAHO) |  United Nations Children’s Fund (UNICEF) |  University of Toronto |  U.S. Agency for International Development (USAID) |  World Health Organization (WHO) |  Canadian Institutes of Health Research. | 


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