Systematic review and meta‐analysis of home fortification of complementary foods

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Abstract
We reviewed the efficacy and effectiveness of home fortification of complementary foods with micronutrient powders (e.g. Sprinkles®), crushable tablets and lipid‐based or soy‐based products. Sixteen studies (5 anaemia treatment trials, 11 prevention trials) met the inclusion criteria. The treatment trials indicate that Sprinkles were as effective as iron drops, and were better accepted and had fewer side effects. In the prevention trials, the risk of anaemia was cut in half. The effect of home fortification with multiple micronutrients on plasma zinc and vitamin A levels was mixed. The impact on child growth of home fortification using only micronutrients was not significant. However, with products containing both micronutrients and a small amount of energy (including fat and protein), the pooled data from two efficacy trials in Africa suggest an effect size of ∼0.4 for both weight and height. Home fortification with products that include some energy also showed positive effects on indices of child development in two studies. There was a beneficial impact of home fortification on morbidity in high‐risk populations in some studies, but most showed no significant impact. Acceptability of home fortification by caregivers and young children is high, and side effects are rare. The safety of home fortification using ‘bolus’ doses of iron, particularly in malarial areas, needs further investigation. In one study of Sprinkles in a low‐income country, the estimates of cost per disability‐adjusted life year regained compared favourably with other approaches, but more data on operational and cost considerations for the various home fortification products are needed.