Anemia, typically the result of iron deficiency, is a major cause of disability and nonreversible developmental delay among infants. At-risk groups include women of child-bearing age, pregnant women, and rapidly growing infants, children, and adolescents. Many foods for children in developed nations, such as cereals, are commercially fortified with iron and other essential nutrients to ensure healthy growth. But in developing nations this process is expensive and unpractical as most foods come straight from the farm and do not go through factories.
Dr. Stanley Zlotkin is a research scientist, professor, and has worked at The Hospital for Sick Children since 1980 where he is now Chief of Global Child Health. His decades of research focusing on nutrient deficiency in infants and children led him to develop an inexpensive food fortification product used at home called Sprinkles that would provide an effective remedy for vitamin and mineral deficiency in developing countries.
Sprinkles are sachets, like small packets of sugar, that contain a blend of micronutrients in powder form that can be sprinkled onto any food prepared at home. The product was originally designed for children between 6-24 months of age but new formulations have been developed for women and older children. A single packet contains the right amount of minerals and vitamins a child needs per day and costs approximately $0.035 USD each to make. Being lightweight and having a long shelf life (2 years) also make it a winning innovation.
A large number of mothers in the developing world did not go to school and cannot read and write. But one can be illiterate and still use Sprinkles. It simply requires tearing open the package and sprinkling it onto any food that is prepared. The design specifically took into consideration that it is very hard to change someone’s diet, so it is made in a way that can be used in any type of food. It dissolves right in and doesn’t alter the taste, colour, or texture of the food.
“The children don’t object to using it and the parents find it very easy to use. Parents like using it because they really do feel that they’re contributing to the health of their children. So the simplicity of it is probably one of the major secrets of the success,” said Zlotkin.
A decade ago, UNICEF had consulted with Zlotkin to see whether the organization should do something about iron deficiency in young children globally. Nothing they were doing at the time was working to prevent or treat the problem. So he was presented with a challenge to find a solution. Zlotkin thought hard about the challenge and came up with a home fortification solution in a packet. When he presented the idea to UNICEF, they told him to meet four specific criteria:
1) Show that it works.
2) Show that people will use it.
3) Find someone who will make this product at a very low price in huge volumes.
4) Come up with a model of distribution.
Zlotkin describes one of the biggest challenges to designing the product was in the research. He “naively thought” that doing one large randomized controlled trial in a single country could help him prove that a child with anemia no longer had it at the end of the intervention period, or that a child at the risk of anemia didn’t get it, and that this was enough to convince the international community.
“I was totally wrong,” said Zlotkin. “Although I had done the first studies, for example in Ghana in West Africa, even in the other African countries that border on Ghana, they would say ‘Well it may be fine for the children in Ghana, but my children here in Nigeria, or my children here in Sierra Leone are quite different.’”
He sees the same trend in India, Pakistan, and Bangladesh. The science may have been enough to prove a solution but still, he had to navigate this barrier by repeating the study in multiple countries around the world.
A second challenge was to ramp up production from ten thousand to ten million when the team realized they needed more. With no experience working with the private sector, he needed to find the right partner to make the individual packages and convince them that they couldn’t make money – at least initially – but ultimately if the packets were a success, it would be a legitimate source of revenue.
Zlotkin calls himself a pediatrician but he has no training in advocacy or business. He had no knowledge of how to deliver a product nor did he have experience working in the developing world. Furthermore he had no idea how to deal with large UN agencies or governments. But he took a chance and was not willing to take no for an answer. Luckily, he worked in an environment that allowed him to have the flexibility to do novel research and make mistakes. Sprinkles’ original funding for research came from The HJ Heinz Company Foundation and USAID.
To date, 15 million children around the world received packages of powder minerals and vitamins. He believes it’s a good start but only a start since there are 600-700 million children needing help. What will ultimately make this project a success is wide scale, sustainable delivery. Sprinkles Global Health Initiative, the organization that Zlotkin now heads, currently consults with government, UN agencies, large NGOs, and the private sector to discuss how Sprinkles should be used, distributed, and scaled up. In the end he learned more about the different sectors and realized that “no one organization can do everything”.
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