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Experiences providing multivitamins to children 6-59 months

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Anonymous 2812

Children's Nutrition Program of Haiti

Normal user

6 Feb 2015, 16:09

I am curious as to what people's experiences are to providing multivitamin supplements to children 6-59 months. Do you provide them for daily use or give three months on three months off? What are the risks associated with overdosing?

Jacky Knowles

Public Nutrition Consultant

Frequent user

17 Mar 2015, 21:52

Hi Taryn, Answers to these questions and a lot of other related programme advice is provided by the Home Fortification Technical Advisory Group (HF TAG), see hftag.org site - in particular the FAQs for MNPs. In brief, multi-micronutrients are provided in the form of powders (MNPs) to children this age. Regarding dosing, from HF-TAG document: "Sachets should be made available throughout the year for the target groups, and be no less than 60 / 6 months and no more than 180 / 6 months (no more than one sachet per day). A target of 90 sachets per six months period (equivalent to 15 per month, or 3-4 per week), which thus provides an additional intake of 50% RNI/d for each micronutrient, is likely reasonable for most situations." The same document provides advice that MNPs can be safely provided at the above doses along with twice yearly vitamin A supplementation and the use of iodised salt and other fortified foods. They should generally not be given however when other higher dose supplementary foods for the treatment of malnutrition are being provided. This is detailed in the document that you can access here: http://www.hftag.org/resource/hf-tag_program-brief-dec-2011-pdf/ There are also WHO guidelines from 2011 with similar advice: http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_mnp_infants_children/en/ I don't know where you are working so do have to mention a paper by Soofi et al (Lancet 2013) that has generated a lot of discussion. It investigated the use of MNPs in a community with a high burden of malnutrition, that concluded: "Use of micronutrient powders reduces iron-deficiency anaemia in young children. However, the excess burden of diarrhoea and respiratory morbidities associated with micronutrient powder use and the very small effect on growth recorded suggest that a careful assessment of risks and benefits must be done in populations with malnourished children and high diarrhoea burdens." The HF TAG group responded that this was not a typical finding in other places using MNPs and may be related to the high levels of malnutrition in the study area.

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