Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa

Abstract

This current pilot trial assessed the feasibility of implementing a point-of-use (PoU) micronutrient fortification in preschool settings. Preschool children (n = 151) aged 36–79 months were randomized into intervention (n = 76) and control (n = 75) groups, both receiving breakfast maize-porridge with added micronutrient or placebo powder for 52 school days. Process evaluation and early childhood development indicators were used to assess trial feasibility. Process evaluation results showed that the implementation components were feasible and could be delivered with high fidelity. The improvement in hemoglobin concentration in intervention and control groups were not significantly different (P = 0.250). There was medium likelihood for practical significance for the two global cognitive scores assessed: non-verbal index (intervention effects: 7.20; 95% confidence interval: 2.60, 11.81; P = 0.002, effect size: 0.55) and mental processing index (intervention effects: 2.73; 95% confidence interval: 0.25, 5.70; P = 0.072, effect size: 0.36) on the Kaufman Assessment Battery for Children, Second Edition. The lessons from this trial could help in planning/implementing future PoU micronutrient fortification trial among South African preschool children.

Keywords::

• Micronutrient
• point-of-use
• fortification
• preschool
• pilot
• feasibility

Acknowledgements

The authors would like to thank the children, caregivers and preschool principals who participated in this study. We are also grateful to the National Research Foundation, South Africa for their financial support and the DSM Nutritional Products South Africa (Pty) Ltd for providing the micronutrient powder.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.