Launch of Sundar Health Salt

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Launch of Sundar Health Salt

• A multiple micronutrient fortified cooking salt
  enriched with Vitamin A, Vitamin B12,Folic Acid,
• Iron, Iodine and Zinc

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Background

• Multiple micronutrient deficiencies occur in
  poorer sections of populations in developing
  countries.
• Need to tackle multiple micronutrient
  deficiencies in entire families through the food
  route.
• The multiple micronutrient fortified salt was
  developed to fulfill these concepts.
• The delivery of micronutrients through the use
  of the multiple micronutrient fortified salt was
  tested.

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Nutrient content of Sundar Health Salt
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Stability of the multiple fortified salt during
cooking. Data mean of 6 trials.
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Stability of the multiple fortified salt during
storage. Data given are mean of 8 batches
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Study in school children

• To test the stability of the product during
  cooking and storage
• To test the efficacy and bioavailability of
  nutrients from a multiple micronutrient fortified
  salt on the serum Vitamin A status, iron status
  in the blood and urinary iodine status and
  angular stomatitis status of school children
  through the use of the use of salt enriched with
  vitamin A, B complex vitamins, iron and iodine.
• To test the effect of salt fortified with
  multiple micronutrients on cognition of school
  children in the age group 7-11 years.

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Methods

• The Research Design was a pretest post test
  design with experimental and control groups.
• A school was selected for the study.
• The children residing in the residential school
  constituted the experimental group (n119)
• The children who lived in communities nearby and
  attended the day school constituted the control
  group.
• The fortified salt was used in the kitchen of the
  experimental residential school for a period of
  one year.
• The fortified salt provided 1 RDA of the
  micronutrients to the children of the
  experimental group per day.
• The children in both the experimental and
  control groups were dewormed with 400 mgs
  Albendazole every 6 months
• No intervention other than deworming was done in
  the control group children (n126)

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Methods (continued)

• The experimental and control groups of children
  were selected after establishing their
  homogeneity in terms of age, nutritive intake and
  socioeconomic status.
• A survey was conducted on different schools and
  the school was chosen where
• A) There were minimum instances of outside cooked
  food served to the children as this would
  interfere with the nutritional intervention of
  adding the fortified salt to the food cooked in
  the school kitchen and serving it to the
  children.
• B) There were minimum intervening holidays when
  the children would go home and cause a disruption
  in the study.
• Ethical issues Children in the control group
  whose baseline serum retinol was less than 20
  micrograms per dl and whose baseline hemoglobin
  was less than 8 gms/dl were therapeutically
  treated with vitamin A tablets and iron tablets
  and excluded from the study.

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Methods (continued)

• Biochemical parameters estimated
• For iron estimations Hemoglobin, red cell count
  and hematocrit was done in all the children. Red
  cell count and hematocrit estimations were done
  at baseline and endline. Hemoglobin estimations
  was done every 6 months .
• Urinary iodine at baseline and endline in all the
  children.
• Serum vitamin A only in children clinically
  diagnosed with vitamin A deficiency by Physicians
  by clinical examinations. (n85 in experimental
  group and n78 in control group). This was done
  at baseline and endline by the spectrophotometric
  method.
• Clinical examinations For angular stomatitis (B
  Complex deficiencies), and clinical signs of
  vitamin A deficiency. This was done every 6
  months in all the children.
• The study lasted for one year.
• Validations was done in 10 of the samples for
  serum vitamin A, redcell count, hematocrit and
  urinary iodine .Every hemoglobin was done
  twice,100 validation.

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Methods (continued)

• Tests for cognition Childrens memory tests
  developed standardized by NIMHANS, India.
• Personal information
• Digit span
• Delayed response learning
• Mann-Suiter Visual memory screen for objects
  (picture recall test)
• Benton Visual Retention Test (BVRT)
• Cattells Retentivity Test
• Letter cancellation test
• Ravens coloured progressive matrices

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Overall picture biochemistry Comparison of the
experimental and control group
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• Serum vitamin A shows statistical increase in
  the experimental group, thereby showing vitamin A
  bioavailability. In the control group, there is
  no statistical significance in the change of
  serum vit A
• Urinary Iodine There is a statistically
  significant improvement of urinary iodine in the
  experimental group, showing bioavailability of
  iodine. In the control group there is a
  significant fall in urinary iodine.
• Iron There is a statistically significant
  improvement of hemoglobin and red cells, showing
  bioavailability of iron in the experimental
  group. In the control group there is a
  significant decrease in hemoglobin, hematocrit
  and red cells, probably because the increasing
  demands of iron at the growing age are not met by
  their diets.
• B Complex The angular stomatitis at baseline has
  completely disappeared at end line in the
  experimental group showing bioavailability of B
  complex vitamins. In the control group it
  increased from 3.3 to 24, probably because of
  the seasonal variations in the diets of these
  children.

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Cognitive Increment in Scores overview
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• There is a significant improvement in hemoglobin
  and red cells in the experimental group, whereas
  there is a significant fall in hemoglobin and red
  cells in the control for the children in whom
  tests for cognition was administered.
• There is a significant improvement in the
  increment in scores of 4 memory tests namely in
  the Bentons, Cattells, Picture recall and the
  delayed response memory tests in the experimental
  group when compared to the control.
• There is no significant improvement in the digit
  span and personal information tests.
• There is a significant improvement in the letter
  cancellation test in the experimental group when
  compared to the control.

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Study in a tea plantation using double fortified
salt

• Doublind blind randomised placibo controlled
  study
• 358 subjects in the experimental households
• 408 subjects in the control households
• Finger prick blood analysed for hemoglobin by the
  cyanamethemoglobin method.
• Hemoglobin analysed at baseline ,6months after
  intervention 1 year after intervention.
• The experimental households were given double
  fortified salt for a period of 1 year
• The control households were given unfortified
  salt.

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• 50 of the population in the experimental and
  control groups were dewormed with Albendazole
  400mg.
• average hemoglobin increased from 8.48g/dl to
  10.031g/dl in the women in the experimental
  group.
• Highest increase of 1.48g/dl in the experimental
  dewormed group
• Deworming necessary here because of rampant
  hookworm infestation,which itself causes
  intestinal bleeding and hence anaemia.
• increase in productivity (kg of tea plucked from
  24.8kg/person/day to 26.2kg) in the experimental
  group.
• It takes about 6 months for the increase in
  hemoglobin to translate into an increase in
  picking average.
• Translated to annual increment of 330 tonnes of
  tea in the plantation.
• reduction in absenteeism .Increase in mandays
  from 96034 mandays before the study to 97602
  mandays during the study period of 1 year.
• Subjects who consumed the fortified salt reported
  feeling lesser irritability and fatigue- probably
  due to higher hemoglobin levels.

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Study in communities in 5 states using double
fortified salt conducted by BAIF

• Experimental group given salt fortified with
  iron and iodine
• control group given iodised salt
• A total of 942 persons participated in the
  study, 457 in the Study Group and 485 in the
  Control Group. The majority were in the age group
  16 45 years.
• both groups dewormed.
• statistically significant urinary iodine increase
  from 74mcg/l to 268mcg/l in the experimental
  group
• statistically significant urinary iodine increase
  from 54mcg/l to 205mcg/l in the control group

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