Introduction
Humanitarian efforts are underway in the Asian
countries affected by the massive earthquake and resulting tsunamis that
devastated the region on December 26, 2004. Relief operations initiated by international
and regional groups are acting urgently to prevent further tragedy and loss of
life of the hundreds and thousands of survivors that will be vulnerable to the
next wave of infectious disease and malnutrition. The World Food Program of the United Nations
has endorsed an emergency approach to provide supplementation with
micronutrients in disaster situations as a cost-effective way to save lives and
prevent disease where food is limited and sanitation poor. Supplementation with micronutrients (SUM)
offers a unique set of advantages as a first-line response in emergency aid:
(1) high impact, (2) low cost, (3) minimum storage needs, (4) little if no
preparation, (5) easily transportable and (6) a gateway to communities and
individuals for assessment and implementation of other interventions. Micronutrient
Sprinkles for use in relief aid offers a clinically proven intervention and
convenient method to deliver micronutrients to vulnerable populations.
What
are Sprinkles?
lang=”EN-CA”>Micronutrient Sprinkles were developed at
the Hospital for Sick Children in Toronto as a food-based strategy to control anemia and other micronutrient
deficiencies. Sprinkles, containing
encapsulated iron, vitamin A, zinc and other micronutrients, are mixed with
food to increase the micronutrient content without causing any appreciable change
in the color, texture or taste of the food.
They are packed in single serving sachets, and to
use them, one is instructed to sprinkle the entire contents on to any
semi-solid food right before serving. A
number of community-based trials have been conducted to assess the efficacy,
safety, bioavailability and acceptability of Sprinkles to improve hemoglobin
concentrations and iron status in young children. Field studies were completed in Asia (China, Indonesia,
Bangladesh, Pakistan and India), Africa (Ghana) and Latin American (Bolivia
and Haiti). Overall, Sprinkles have been successful in the treatment and
prevention of anemia in children and were demonstrated to be well-tolerated,
safe and acceptable to caregivers. Cure rates from anemia when using Sprinkles
have ranged from 55-90%. Sprinkles have been used successfully in a relief
mission in Haiti in cooperation with ACF (Action Contre la Faim).
Sprinkles
for relief aid
Sprinkles are a home-based food
fortification strategy that can contribute largely to improving the nutritional
quality of food aid and rations offered in emergency situations. They were specifically developed for young
children and pregnant and lactating mothers, the most vulnerable groups. The
use of Sprinkles ensures that independent of the type or quality of food provided, adequate amounts of essential micronutrients will
be consumed. Supplementation with micronutrients may play a significant role in
disease control and prevention in humanitarian aid interventions because of the
important role vitamins and minerals play in the immune system response to
disease. For example, both zinc and
vitamin A have been shown to effectively boost the immune system and reduce
child mortality related to infectious diseases including diarrhea. In addition
iron is essential in controlling anemia, a major cause of morbidity and
mortality in over two thirds of children and women in the developing world.
Sprinkles offer many advantages and can be easily integrated into relief aid
situations. The single dose sachets are
convenient and easy to use and do not require special measuring or literacy of
the beneficiaries. They are lightweight for easy commodity transportation,
distribution and storage and thus offer a cost-effective approach to deliver
micronutrient to vulnerable populations.
Composition
of Sprinkles
Sprinkles
for young children: Each sachet contains: 12.5 mg
of iron (as Ferrous Fumarate), 300 µg of vitamin A (Retinol Acetate USP), 5 mg
of zinc (Zinc Gluconate USP), 30 mg of vitamin C (Ascorbic Acid USP-FCC) and
160 µg of folic acid (Folic Acid USP).
Sprinkles
for pregnant and lactating women: Each sachet
contains: 60 mg of iron (as Ferrous Fumarate), 5 mg of zinc (Zinc Gluconate
USP), 30 mg of vitamin C (Ascorbic Acid USP-FCC) and 400 µg of folic acid
(Folic Acid USP).
Recommended
Use
Sprinkles for young children: WHO and UNICEF recommend 12.5 mg of elemental iron daily per child
aged 6-24 months if the prevalence of anemia is
40% or higher. Based on clinical evidence demonstrating the
efficacy of flexible and intermittent dosing, we recommend the provision of 60
Sprinkles sachets
over a period of 120 days (4 months)
to children after 6 months of age. No more than one sachet per day should be
used. A hemoglobin response is
expected within 21 days.
Sprinkles for pregnant and
lactating women: WHO recommends 60 mg of elemental
iron daily per pregnant or lactating woman where the overall
prevalence of anemia is 40% or higher, starting as early as possible
during pregnancy and continuing up to 3 months post- partum. We recommend
daily Sprinkles
starting as early as possible during pregnancy and continuing until 3 months
post partum. For lactating mothers, we recommend daily
Sprinkles daily for 3-6 months.
Cost
of Sprinkles per Beneficiary
The cost varies depending on the site of
production, the content and the volume ordered. The range is between $0.015 to
$0.035 USD per
Sprinkles sachet.
Average
cost of Sprinkles per child: $0.025 x 60 days =
$1.50 USD
Average
cost per pregnant woman: $0.025 x 40 weeks
including 3 months post-partum period (280 days) = $7.00 USD
Average
cost per lactating woman: $0.025 x 24 weeks or 6
months during lactation (168 days) = $4.20 USD
Instructions
for home fortification with Sprinkles
- Tear open the top of the sachet
- Allow cooked food to cool slightly before adding Sprinkles
- Pour entire contents into semi-solid food (e.g. porridge or
thick soup) after cooking and mix well. - Mix Sprinkles with an amount of food that can be consumed
during a single meal