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Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control



Despite repeated public commitments and availability of various forms of iron supplements, rates of anaemia in developing countries remain high. A major reason for this lack of success has been poor adherence. The objective of this study was to compare the effectiveness of daily and flexible administration of micronutrient Sprinkles on adherence, acceptability and haematological status among young children in rural Bangladesh.


A sample of 362 children (haemoglobin (Hb)70 g l−1) aged 6–24 months were cluster-randomized to receive 60 sachets of Sprinkles either (i) daily over 2 months; (ii) flexibly over 3 months; or (iii) flexibly over 4 months. With a flexible regimen, mothers/caregivers decided how frequently to use Sprinkles without exceeding one sachet per day. Adherence was assessed monthly by counting the number of sachets used and acceptability was evaluated through focus group discussions. Haemoglobin was measured at baseline, at the end of each intervention period and 6 months post-intervention.


Mean percent adherence was significantly higher in the flexible-4-month group (98%) compared to the flexible-3-month (93%) and daily-2-month (88%) groups (P<0.01). Most mothers found flexible administration to be more acceptable than daily due to perceived benefits of use. Hb at the end of intervention was significantly higher in the flexible-4-month group compared to the daily group (P=0.03). Anaemia prevalence decreased by 65% in the flexible-4-month group compared to 54% in the flexible-3-month and 51% in the daily-2-month groups. Percent of cured children who maintained a non-anaemic status 6 months post-intervention was significantly higher in the flexible-4-month (82%) and flexible-3-month (80%) groups than the daily-2-month (53%) group (P<0.05).


The adherence, acceptability and haematological response to flexible administration over 4 months were found preferable to daily.

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We thank and acknowledge the colleagues at BRAC including Fazlul Karim, Nuzhat Choudhury, Mizanur Rahman, Late MG Sattar and Imran Matin for their support. We thank Mélody Tondeur for her contribution in reviewing the manuscript. Finally, we thank the mothers and the community at large without whom this research project would not have been successfully completed. This study was funded by the Hospital for Sick Children through a generous grant from the HJ Heinz Company Foundation, Pittsburg, USA.

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Correspondence to S H Zlotkin.

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Ip, H., Hyder, S., Haseen, F. et al. Improved adherence and anaemia cure rates with flexible administration of micronutrient Sprinkles: a new public health approach to anaemia control. Eur J Clin Nutr 63, 165–172 (2009).

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