Background: Few studies have evaluated iron-rich plant-based foods, such as amaranth grain, to reduce anaemia. Amaranth is rich in micro- and macro-nutrients, but possesses a high level of phytate, which decreases nutrient absorption.The objective of this trial was to evaluate the efficacy of processed amaranth grain-containing bread in the treatment of anaemia prevalence, and changes in C-reactive protein (CRP) adjusted ferritin and haemoglobin levels, among two-to-five-year-old children in Southern Ethiopia diagnosed with anaemia. Method: Anaemic (haemoglobin less than 11 g/dl) children (N=100) were identified in a community survey using simple random sampling and enrolled in a 1:1 cluster-randomized controlled trial for six months, with clusters in each arm. In the amaranth arm (N=50), 150 g bread, containing 70% amaranth and 30% chickpea, was given daily. The amaranth was processed, which in this case involved soaking, germinating, and fermenting. In the maize arm (N=50), 150 g bread, containing processed maize, was given daily. The bread was given daily under direct supervision in the mornings in both arms. Haemoglobin, ferritin, and CRP were measured using standard methods at baseline and after the end of the intervention. We also collected information about socioeconomic and dietary data. Descriptive statistics, linear generalized estimating equation (GEE), binary logistic regression, and linear multilevel mixed effect models were used to analyse the data. Result: Post-intervention anaemia prevalence was lower in the amaranth 32% (16 of 50 children) than in the maize 56% (28 of 50 children) arm [adjusted risk ratios, aRR: 0.51 (0.31-0.86)]. The mean within arm difference of haemoglobin level was 1.3 g/dl (95%CI 0.9-1.7) in the amaranth arm compared to 0.7 g/dl (95%CI 0.3-1.1) in the maize arm, with a statistically significant difference between the arms [aβ 0.8 (0.3-1.3)]. There was no significant difference between arms [aβ 3.1 (-3.9; 10.2)] regarding ferritin level. Conclusion: Processed amaranth bread increased haemoglobin levels in anaemic children.

Trial registry number: PACTR201705002283263

Keywords: anaemia; amaranth; haemoglobin; ferritin; c-reactive protein; randomized controlled trial.