This paper presents the results of a cluster randomised trial into the effects on morbidity of the provision of zinc, iron and micronutrients on young Pakistani children. Iron and other micronutrients in powder form are recommended as a strategy to prevent childhood nutritional anaemia and other micronutrient deficiencies. This study focuses on the effects of provision of two micronutrient powder formulations, with or without zinc, administered between 2008 and 2011. It was found that micronutrient powder administration was associated with lower risk of iron-deficiency anaemia at 18 months compared with the control group. Also compared with the control group, children receiving micronutrient powder without zinc gained an extra 0·31 cm between 6 and 18 months of age and children receiving micronutrient powder with zinc an extra 0·56 cm). Strong evidence was found of an increased proportion of days with diarrhoea and increased incidence of bloody diarrhoea) between 6 and 18 months in the two micronutrient powder groups, and reported chest indrawing.

Incidence of fever or admission to hospital for diarrhoea, respiratory problems, or fever did not differ between the three groups. These results suggest that the use of micronutrient powders reduces iron-deficiency anaemia in young children, but that 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.

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