{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T11:25:19Z","timestamp":1777807519406,"version":"3.51.4"},"posted":{"date-parts":[[2026,4,27]]},"group-title":"Nutrition","reference-count":31,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Affecting 40% of infants and young children worldwide, anaemia in sub-Saharan Africa hampers cognitive and physical development, often in ways that cannot be reversed. Iron-based micronutrient powders (MNPs) are recommended to combat anaemia, but concerns remain about their safety and effectiveness in malaria-endemic areas. We evaluated the impact of iron-based MNPs on growth measurements and malaria-related anaemia among preschool children in Ghana.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a secondary analysis of a cluster-randomized, double-blind, placebo-controlled trial in the Bono Region, Ghana. Children aged 6\u201335 months (n=1,958) received daily MNP containing 12\u00b75mg elemental iron or placebo for five months. Anthropometric indices, haemoglobin, and malaria parasitaemia were assessed at baseline and endline. Adjusted analysis of covariance (ANCOVA) models estimated effects on height-for-age (HAZ), weight-for-age (WAZ), and weight-for-height (WHZ) z scores. Binomial regression with identity link estimated risk differences for malaria-induced anaemia. Cluster-robust standard errors were applied at the compound level, and intracluster correlation coefficients (ICCs) were estimated.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1,815 (92\u00b77%) children completed the endline survey, but 1,806 were included in the final analysis. Baseline characteristics were balanced between groups. Iron-containing MNP had no significant effect on endline HAZ (\u03b2=0\u00b7026, p=0\u00b7609), WAZ (\u03b2=\u20130\u00b7015, p=0\u00b7719), or WHZ (\u03b2=\u20130\u00b7035, p=0\u00b7463). However, the intervention reduced the risk of malaria-induced anaemia (risk difference 0\u00b7050, 95% CI 0\u00b7004\u20130\u00b7096; p=0\u00b7032). Female sex was associated with higher HAZ (\u03b2=0\u00b7149, p=0\u00b7005).<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Iron-containing MNP did not improve short-term growth but was associated with a modest reduction in malaria-induced anaemia. These findings support the safe use of iron fortification in malaria-endemic settings while underscoring the need for integrated strategies to address persistent growth faltering and gender specificity.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>TRIAL REGISTRATION clinicaltrials.gov Identifier<\/jats:title>\n                  <jats:p>\n                    NCT01001871. Registered 27\/10\/2009,\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.ClinicalTrials.gov\/NCT01001871\">http:\/\/www.ClinicalTrials.gov\/NCT01001871<\/jats:ext-link>\n                    .\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.04.24.26351649","type":"posted-content","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T21:50:19Z","timestamp":1777326619000},"source":"Crossref","is-referenced-by-count":0,"title":["Effect of Iron-Containing Micronutrient Powders on Growth and Malaria-Induced Anaemia Among Preschool Children in Ghana: A Cluster-Randomized, Double-Blind, Placebo-Controlled Trial"],"prefix":"10.64898","author":[{"given":"Emmanuel Kwesi Yeboah","family":"Tchum","sequence":"first","affiliation":[{"name":"Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Legon, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joana Edem","family":"Koto","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre (KHRC), Ghana Health Service, Kintampo-North, Bono East Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fred","family":"Kanyoke","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre (KHRC), Ghana Health Service, Kintampo-North, Bono East Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ophelia","family":"Opoku","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre (KHRC), Ghana Health Service, Kintampo-North, Bono East Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Ussher","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Science, Koforidua Technical University, Koforidua, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1880-5507","authenticated-orcid":false,"given":"Slyvester Donnie","family":"Dassah","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Upper East Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Amoani","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4800-1769","authenticated-orcid":false,"given":"Samuel Kofi","family":"Tchum","sequence":"additional","affiliation":[{"name":"Kintampo Health Research Centre (KHRC), Ghana Health Service, Kintampo-North, Bono East Region, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1666-7489","authenticated-orcid":false,"given":"Eric","family":"Nyarko","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, School of Physical and Mathematical Sciences, University of Ghana, Legon, Accra, Ghana"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026042913501802000_2026.04.24.26351649v1.1","doi-asserted-by":"crossref","first-page":"1474664","DOI":"10.3389\/fnut.2024.1474664","article-title":"Global burden of anemia and cause among children under five years 1990\u20132019: findings from the global burden of disease study 2019","volume":"11","year":"2024","journal-title":"Frontiers in Nutrition"},{"issue":"5","key":"2026042913501802000_2026.04.24.26351649v1.2","doi-asserted-by":"crossref","first-page":"e627","DOI":"10.1016\/S2214-109X(22)00084-5","article-title":"National, regional, and global estimates of anaemia by severity in women and children for 2000\u201319: a pooled analysis of population-representative data","volume":"10","year":"2022","journal-title":"The Lancet Global Health"},{"key":"2026042913501802000_2026.04.24.26351649v1.3","doi-asserted-by":"crossref","unstructured":"Obasohan PE. 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