Abstract

Nutritional anemias, the majority of which are due to iron deficiency are very prevalent in both developing and developed countries and contribute significantly to the global burden of illness, at a level equivalent with vitamin A deficiency. Iron deficiency with or without anemia results in impairments in mental development and work performance. The most affected groups are small children, pubertal children, and women throughout their reproductive years. The prevalence of iron deficiency in Mali is estimated to be comparable to that in West Africa, at 43%. Iron supplementation is one strategy that is currently being used in treatment. However, iron supplementation, which is normally taken daily, has had problems with compliance due to unpleasant gastrointestinal side effects. As well there is some indication that iron repleteness may unmask underlying infections such as malaria and tuberculosis. A recent study has indicated that weekly supplementation has the benefit of greater fractional absorption of the administered dose with no apparent side effects. This project will test the effectiveness and safety of daily versus weekly iron supplementation in school children at risk for iron deficiency anemia. The sample will include 510 children from age 6 to 16 years with hemoglobin greater than 80 g/L from schools in Bamako. Hematologic parameters will be measured at selected intervals, and side effects including malaria, respiratory infections, diarrhea, and constipation will be monitored daily.

Post-Project Summary

A population of 350 children ages 5 to 17 was divided into three groups, each of which was stratified by age and sex. The first group (G1) received daily supplements of 60 mg iron and 250 g folic acid; the second group (G2) received a weekly supplement of 60 mg iron and a daily supplement of 250 g folic acid; the third group (G3) received just the daily supplement of 250 g folic acid. The average levels of hemoglobin (Hb), hematocrit (Ht), erythrocyte protoporphyrin (EP) and serum ferritin (SF) for each group were calculated at the start of the study, and at 3 months, 6 months and 10 months (4 months after the end of the intervention). The results of each measurement are tabulated in the final report. In brief, the children in G1 showed a significant increase in Hb, Ht and SF levels, a significant decrease in EP levels, and a correction of iron deficiency anemia. Weekly supplementation, however, had no apparent impact on the iron status parameters: in the third month, the children in G2 were no different from those in the control group in terms of Hb or Ht levels, but they did have significantly higher SF levels. At that time, and unlike the control group, no children were observed in this group with ferritinemia below 20 g/l. Between the start of the study and the third month, the number of anemic children declined for G1, remained stable for G2, and increased slightly for G3. However, between the third and sixth months, an upward trend in the number of cases of anemia was observed, particularly in G2 and G3. This phenomenon suggests the existence of a common anemia-causing factor such as a nutritional deficit. The plasmodic indices (plasmodium infestation) observed in the third and sixth months for each group did not differ significantly. Four months after the end of supplementation, the prevalence of anemia was 55.7% in G1, 58.8% in G2 and 54.7% in G3, versus 37.08%, 29.56% and 28.95% at the time supplementation was ended. It was concluded that daily iron supplementation is more effective than weekly supplementation in the treatment of iron deficiency anemia, but that weekly supplementation may have a role to play in prevention.

Recipient Institution(s)