(P07-045-25) Effects of Multiple Micronutrient-Fortified Bouillon Cube on Morbidity in Children 2–5 Y and Women 15–49 Y in Northern Ghana: A Randomized Controlled Trial

Objectives: Investigate the impact of household use of multiple micronutrient (MN)-fortified bouillon cubes (vitamins A, B9 and B12, iron, zinc and iodine) vs. control bouillon cubes (iodine) on morbidity and inflammation among nonpregnant and nonlactating women 15-49 y (WRA) and children 2-5 y.

Methods: 769 WRA and 670 children were randomized and followed for 9 mo. Household bouillon consumption, and morbidity symptoms (e.g., diarrhea, dysentery, fever, vomiting, respiratory symptoms), medication use (e.g., antimalarials, antibiotics) and health care visits were ascertained at biweekly home visits. Anemia and MN status, inflammation (C-reactive protein, CRP, α-1-acid glycoprotein, AGP, and fecal calprotectin concentrations) and malaria (rapid diagnostic test, RDT) were assessed at two endline visits (intervention wks 35 and 38). Longitudinal outcomes were assessed via negative binomial models. Endline continuous and dichotomous outcomes were assessed via repeated measures ANCOVA and modified Poisson regression, respectively.

Results: Reported longitudinal prevalence of morbidity symptoms, medication usage and visits to health care providers was low (e.g., < 1% of days with symptoms), and there were no group-wise differences. At endline, neither CRP nor AGP differed between groups (P > 0.05). However, the prevalence of asymptomatic malaria antigenemia differed by intervention group among children, but not WRA. Children in the intervention group were more likely to have a positive malaria RDT (19.1% wk35, 11.8% wk38) compared to children in the control group (11.9% wk35, 7.6% wk38) (P = 0.036). This effect was modified by baseline anemia status (P = 0.067), but not baseline iron or folate status. Children in the intervention group who were not anemic at baseline were 1.9 (95% CI 1.2, 3.1) times more likely to have malaria at endline compared to non-anemic children in the control group (P = 0.008).

Conclusions: In this population, there was no overall impact of multiple MN-fortified bouillon cubes on morbidity symptoms (including fever) or systemic inflammation. However, the increase in asymptomatic malaria antigenemia is concerning and warrants further exploration.

Funding Sources: Helen Keller Intl, through the Bill & Melinda Gates Foundation