Research News

New safety concerns over supplement powders for infants in Pakistan

BMJ 2013; 346 doi: (Published 24 April 2013) Cite this as: BMJ 2013;346:f2604

Infants and young children given micronutrient powders had more bloody diarrhoea and more respiratory symptoms than controls in a recent trial from Pakistan, and the authors have called for a closer look at safety before distribution is scaled up. The World Health Organization already recommends the powders to help control iron deficiency anaemia in vulnerable children. The new trial tested sachets that contained iron; folic acid; and vitamins A, C, and D, with or without additional zinc.

Children given daily powders mixed with weaning food between 6 and 18 months of age grew slightly but significantly more than controls who had no supplements (an extra 0.31 cm, 95% CI 0.03 to 0.59 for children given micronutrients without zinc; an extra 0.56 cm, 0.29 to 0.84 for those given micronutrients with zinc). They also had a lower prevalence of iron deficiency at 18 months (22.9% and 26.5% v 57%). However, mothers reported a significantly higher incidence of bloody diarrhoea in children receiving supplements, which corresponded to roughly one extra episode a year for every 12-13 children treated. Mothers of children in both treated groups also reported significantly more “chest indrawing” than mothers of controls. The micronutrient powders didn’t increase the incidence of fever or hospital admissions for pneumonia.

Researchers randomised 256 clusters of children in urban and rural areas of Pakistan. The children were poorly nourished at baseline, with high rates of stunting, wasting, diarrhoea, and respiratory infections. Fewer than half the participating families had piped drinking water. The researchers say the extra morbidity associated with micronutrient powders is new, worrying, and may not be worth the limited benefits.


Cite this as: BMJ 2013;346:f2604