To the Editor: We read with great interest article entitled “Delivering sprinkles plus through the Integrated Child Development Services (ICDS) to reduce anemia in preschool children in India” [1]. The authors have concluded that following micronutrient powder supplementation; a reduction in anemia by 50– 30 % was achieved in children.

It would have been more scientifically informative if the authors could have mentioned the increase in hemoglobin (Hb) amongst the children at different levels of Hb. Generally children with mild anemia show improvement in Hb and they become non anemic. This is reported as success of intervention in reduction of anemia.

The authors have not mentioned the side effects associated with micronutrient powder. A recent largest intervention trial carried out till date on supplementation of micronutrient powder with zinc (10 mg) and without zinc has reported a strong evidence of an increase in proportion of days with diarrhea (p = 0.001), increase in incidence of bloody diarrhea (p = 0.003) and increase in rates of lower respiratory tract infection or pneumonia. The study also documented the compliance rate was 50 %. The lead investigator who is author of Lancet Nutrition series 2013 has requested for a detailed scientific review and discussion on benefits and potential harm of micronutrient powder supplementation [2].

The readers of Indian Journal of Pediatrics (IJP) would have been benefited if authors had provided more data on i) compliance, ii) respiratory infection and iii) bloody diarrhea associated with micronutrient powder use in their study population.

The validity of the results reported on reduction of anemia is questionable. As the method utilized for hemoglobin estimation i.e. , HemoCue does not provide correct estimation of hemoglobin [3–5].

The cost effectiveness of micronutrient supplementation vs. Iron Folic Acid syrup is an important issue for consideration. Comments from the authors would help the policy makers in India to make an objective decision on inclusion of micronutrient powder for combating anemia.