Contact Information:

Renata Limited

Plot - 1, Milk Vita Road,

Section - 7, Mirpur,

Dhaka-1216, Bangladesh

Telephone: +(880-2) 8001450-237

FAQ

1. Can Pushtikona be used to treat anaemia or is it only used to prevent anaemia?

2. Can Pushtikona be used to treat vitamin D deficiency rickets?

3. Should a person with thalassemia trait avoid iron supplements, such as iron-fortified vitamins or Pushtikona?

4. When should Pushtikona use begin and how long should Pushtikona be used?

5. What are appropriate complementary feeding practices?

6. Can Pushtikona be used with fluids like milk or juice?

7. Can Pushtikona be used by Muslims who follow traditional food practices?

8. Why does stool consistency (loose stools or constipation) and color change in infants when they start taking Pushtikona?

9. Isn’t Pushtikona not supposed to change the taste and color of food? Why does this happen?

10. Can Pushtikona be provided to non-anemic infants without producing any toxicity?

11. Is vitamin A toxicity of concern for children, who receive both Pushtikona (containing vitamin A) and high dose vitamin A capsules twice yearly?

12. Why was Pushtikona developed?

13. Who is the manufacturer of Pushtikona?

1. Can Pushtikona be used to treat anaemia or is it only used to prevent anaemia?

Pushtikona can be used both in the treatment and prevention of anaemia.

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2. Can Pushtikona be used to treat vitamin D deficiency rickets?

No. The vitamin D dose in Pushtikona is meant to meet the RDA for vitamin D, rather than provide a therapeutic intervention. Thus, for rickets treatment, the recommended dose of vitamin D is significantly higher than the dose present in Pushtikona. The vitamin D dose in Pushtikona, however, is adequate to prevent rickets.

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3. Should a person with thalassemia trait avoid iron supplements, such as iron-fortified vitamins or Pushtikona?

Thalassemia and iron metabolism are closely linked. Iron deficiency and mild forms of thalassemia (e.g., thalassemia trait) are often confused. Both are associated with mild to moderate anaemia and microcytosis (small red cells). At the other end of the spectrum, severe forms of thalassemia frequently produce iron overload. Excess iron accumulates due to a combination of enhanced iron absorption, repeated blood transfusions or both. People with thalassemia trait (thalassemia minor) are not at greater risk of complications from iron in the diet than anyone else in the general population. In the absence of concomitant iron deficiency, iron supplementation will neither correct nor improve anaemia due to thalassemia. For people with both iron deficiency and thalassemia, iron replacement will lessen the severity of the anaemia until the iron deficiency is corrected. The blood count will then level off and no further improvement will occur.

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4. When should Pushtikona use begin and how long should Pushtikona be used?

The current recommendation from the World Health Organization (WHO) is that exclusive breastfeeding should last until the completion of 6 months of age. Afterwards, along with continued, frequent, on-demand breastfeeding, appropriate complementary feeding begins. Pushtikona can be mixed with complementary foods. One sachet a day will provide children with WHO recommended daily required intake of 15 micronutrients until a variety of mixed foods (containing iron and other micronutrients) are being eaten.For the treatment and prevention of iron deficiency anaemia, infants should receive 60 sachets consumed over 60 – 120 days. The provision of 60 sachets should be repeated every 6 months until a variety of mixed foods (containing iron and other micronutrients) are being eaten.

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5. What are appropriate complementary feeding practices?

Exclusive breastfeeding until the completion of the first six months and continued breastfeeding for two years or beyond is essential for optimal child health. After the completion of six months, along with continued, frequent, on-demand breastfeeding until 2 years of age or beyond, appropriate complementary foods should be introduced. Infants are particularly vulnerable during the transition period when complementary feeding begins. Ensuring that their nutritional needs are met thus requires that complementary foods be:

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6. Can Pushtikona be used with fluids like milk or juice?

Pushtikona should be mixed with cooked, mashed, semi-solid foods and not liquids. Because the iron in Pushtikona is coated with lipid (to mask the metallic taste), it will float to the top of liquids and tend to stick to the side of the cup or glass. As a result, when mixed and taken with liquid, some of the contents of a sachet will not be ingested.

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7. Can Pushtikona be used by Muslims who follow traditional food practices?

Yes. Neither alcohol nor porcine products are used in the production of Pushtikona. They are therefore Halal and may be used as part of a traditional Muslim diet.

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8. Why does stool consistency (loose stools or constipation) and color change in infants when they start taking Pushtikona?

Stool consistency does not change in the majority of infants and children receiving Pushtikona. Stool color, however, changes to a dark or black color in all infants receiving Pushtikona on a regular basis. Iron itself is dark in color. When some quantities are left unabsorbed, the iron is excreted in the stool and causes the change in color. Some very young infants, who have not previously been exposed to any complementary foods containing micronutrients (i.e. who are exclusively breast-fed) may develop loose stools or even mild diarrhea. The diarrhea does not lead to dehydration, but is a valid concern to parents and health care providers. The diarrhea lasts for approximately one week and then will not recur. Parents have reported that diarrhea quickly disappears in these young infants, into whose diet complementary feeding has been introduced, if 1/3 - 1/2 of a Pushtikona sachet is used.

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9. Isn’t Pushtikona not supposed to change the taste and color of food? Why does this happen?

In order to mask the strong metallic taste of the iron, the iron in the Pushtikona is coated or encapsulated with a thin coat of a soy lipid. The melting temperature for the lipid is around 60ºC. If Pushtikona is added to food hotter than 60ºC, the lipid coating around the iron will melt and the food will be exposed to the iron. The iron can then change the color of the food and will certainly have a strong taste. To prevent changes in the taste and color of food to which Pushtikona is added, we recommend that Pushtikona be added to food after it is cooled to a temperature below 60ºC.

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10. Can Pushtikona be provided to non-anemic infants without producing any toxicity?

Yes. The amount of micronutrients in the Pushtikona sachets is high enough to meet the needs of infants with micronutrient deficiencies (e.g. iron deficiency anaemia) but not too high for those who do not have deficiencies. SGHI has completed a research study in China with 400 preschool children, a majority of whom were non-anemic (95%). Pushtikona prevented anaemia (when provided for 4 months) with absolutely no evidence of excessive iron stores.Serum ferritin values remained within the normal range in 100% of infants included in the study. Thus, Pushtikona are safe to use, even in infants without micronutrient deficiencies. In fact, Pushtikona was originally designed to prevent malnutrition in non-deficient children at risk of micronutrient deficiencies.

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11. Is vitamin A toxicity of concern for children, who receive both Pushtikona (containing vitamin A) and high dose vitamin A capsules twice yearly?

There is no risk of toxicity. Pushtikona containing vitamin A is formulated to help children meet their daily vitamin A requirement (the Recommended Daily Allowance or RDA). It is safe to use the two supplements together because Pushtikona use is complementary to high dose vitamin A capsules and not competitive. With the distribution of high dose capsules, the WHO recommends an age-appropriate diet which would contain all micronutrients, including vitamin A.

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12. Why was Pushtikona developed?

In 1996, a group of UNICEF consultants determined that the standard iron drops were not effective, as adherence to treatment remained poor. They called for a simple, inexpensive and potentially viable new method to provide micronutrients (including iron) to populations at risk. The Sprinkles (5-micronutrient predecessor to Pushtikona) concept was based on two observations from the 'West' where micronutrient deficiencies are rare: (a) fortification of commercially available food provides essential micronutrients and (b) no change in the color, texture or taste of the food ensures compliance. Responding to the challenge, the Sprinkles Global Health Initiative at The Hospital for Sick Children, University of Toronto, developed Sprinkles utilizing encapsulated iron that could be added directly to food. In Bangladesh, the 15 micro-nutrient Sprinkles is known as Pushtikona.

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13. Who is the manufacturer of Pushtikona?

Pushtikona is manufactured in Bangladesh by Renata Limited. To contact Renata please submit your query on the ‘Contact Us’ section on this website or send an email to .(JavaScript must be enabled to view this email address)

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The Importance of Breastfeeding and Appropriate Complementary Feeding Practices

Exclusive breastfeeding until the completion of the first six months and continued breastfeeding for two years or beyond is essential for optimal child health.

After the completion of six months, along with continued, frequent, on-demand breastfeeding until 2 years of age or beyond, appropriate complementary foods should be introduced.

Infants are particularly vulnerable during the transition period when complementary feeding begins. Ensuring that their nutritional needs are met thus requires that complementary foods be:

  • timely – meaning that they are introduced when the need for energy and nutrients exceeds what can be provided through exclusive and frequent breastfeeding;
  • adequate – meaning that they provide sufficient energy, protein, fat and micronutrients to meet a growing child’s nutritional needs;
  • safe – meaning that they are hygienically stored and prepared, and fed with clean hands using clean utensils and not bottles and teats;
  • properly fed – meaning that they are given consistent with a child’s signals of appetite and satiety, and that meal frequency and feeding method – Actively encourage the child, even during illness, to consume sufficient food using fingers, spoon or self-feeding.Feed infants directly and assist older children when they feed themselves.

Watch: The Importance of Breastfeeding – Public Service Announcement

Watch: The Importance of Breastfeeding – Public Service Announcement