It's been almost 20 years since Canadian pediatrician Dr. Stanley Zlotkin was approached by UNICEF with a daunting challenge: Could he come up with an inexpensive means of providing iron and other micronutrients to millions of children around the world to prevent anemia?
Back in his office at Toronto's Hospital for Sick Children, following a trip to UNICEF's Copenhagen office, Zlotkin says he thought about the problem "for a long time."
Anemia due to iron deficiency impairs babies' physical and neurological development, weakens immunity that makes them more prone to infections such as pneumonia and, in severe cases, can cause death.
In developing countries, parents make food for their babies from locally available commodities such as rice, maize or wheat, none of which contain sufficient iron, says Zlotkin. While iron drops were available, their strong metallic taste meant most children wouldn't take them, and the mineral turns teeth brown.
That wasn't something Canadian kids had to deal with because baby foods such as infant cereal have long been fortified with iron – and anemia is rare.
So how could parents in other parts of the world fortify their own youngsters' food?
Zlotkin's solution was Sprinkles, a sachet of micronutrients in powdered form that could easily be added to a baby's or toddler's meals, much like shaking a packet of sugar into a cup of coffee.
UNICEF liked the idea but said he had to show the product would prevent and treat anemia, demonstrate that parents would use it, find suppliers to make the product in huge volumes at a very inexpensive price and come up with workable distribution models.
"Over virtually the next 10 years, I spent my research life here at SickKids doing those four things, that is doing research in multiple countries around the world to demonstrate the efficacy of micronutrient powders, or as we call it, Sprinkles," he says.
That research showed that most children who had anemia and took the micronutrient powder became non-anemic. In focus groups around the world, parents said giving Sprinkles to their children wasn't difficult because an edible coating on the iron component masked its nasty taste.
"And because there was nobody to make the product, we actually made the product in the hospital kitchen for the first couple of years," he recalls. "I would go in at night when there was no one using the kitchen and we would blend up the powder and we would send it to a local co-packer to put into little packages."
Once the team began doing large-scale research projects in countries such as India, Pakistan and Bangladesh, they were able to contract several local companies to mass-produce Sprinkles at a cost of two to three cents per packet.
Zlotkin found that distribution could best be handled through local ministries of health and programs such as UNICEF, the World Food Program and the UN High Commission on Refugees.
With all its concerns met, UNICEF officially embraced the product and began global distribution of Sprinkles, which began with five or six essential minerals and vitamins to address anemia and then expanded to 17 micronutrients to further support children's physical and neurological development threatened by malnutrition.
"So over the last five years, it went from 10 countries to 20 countries and according to UNICEF in 2014, the micronutrient powders were being distributed in 62 countries and reaching, from their estimate, around 20 million children," he says.
Zlotkin, chief of Global Child Health at SickKids, was recently awarded the inaugural Mining4Life chair in mineral nutrition to continue the work of improving the health of children around the world.
Mining4Life is a charitable initiative supported by dozens of global mining companies. Established in 2010, Mining4Life holds an annual fundraiser which has raised more than $15-million for the Hospital for Sick Children and its research centre, as well as helping fund the new BC Children's Hospital in Vancouver, expected to open next year.
Global health programs such as Sprinkles are delivered to children in regions where the mining industry has a major presence, said Aaron Regent, founding partner of Magris Resources and a former CEO of Barrick Gold and Falconbridge.
"As an industry, we see firsthand the working environment in these developing countries and the challenges that communities and governments face, and child health and malnutrition is an issue that we see," he said. "So this kind of directly links into us trying to support the communities where we operate around the world."
Zlotkin, who gave the Sprinkles patent to the public domain several years ago and has never personally profited from it, has been tweaking the formulation, adding five other micronutrients aimed at promoting development in low-birth-weight babies to prevent stunted growth and other health effects.
With the help of UNICEF and other UN agencies, as well as charitable agencies such as Save the Children, World Vision, Care and Plan, he hopes Sprinkles will have a far greater reach.
"Part of my goal is to expand the distribution of micronutrient powders to greater than 20 million children because the estimate is that there are at least 500 million children still in the world who have deficiencies of minerals."