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Preventing childhood anemia in India: iron supplementation and beyond.

European journal of clinical nutrition
May 1, 2013
H P S Sachdev et al. (2 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the potential role of double (iron-folate)-fortified salt in addressing childhood anemia, particularly in the context of mid-day meal programs.

Results Summary

The abstract suggests that double-fortified salt could be a viable intervention for childhood anemia, warranting pilot studies in mid-day meal programs, but does not provide specific efficacy data.

Population

Children aged 6-59 months, with a focus on those in India.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (14)
InterventionDirectionEndpointPopulationDosageImpactClaim #
iron-folate supplements
no change
program implementation
preschoolers
3.8-4.7%
only 3.8-4.7% of preschoolers receive
#1
increased iron intake
decrease
anemia burden
-
up to half
may yield maximum benefit but will only address up to half the burden
#2
directly supervised intermittent supplementation (biweekly; ~100 days per year)
decrease
anemia
6-59 months old children
-
merits consideration
#3
Multiple micronutrient powders for home fortification of foods
no change
anemia
6-23 months old infants
-
do not appear viable
#4
delayed cord clamping
decrease
anemia
-
-
additional intervention
#5
earlier supplementation
decrease
anemia
low birth weight infants
-
additional intervention
#6
appropriate infant and young child feeding guidelines
decrease
anemia
-
-
additional intervention
#7
intermittent supervised supplementation
decrease
anemia
children and adolescents
-
additional intervention
#8
Use of double (iron-folate)-fortified salt in mid-day meal programs
decrease
anemia
-
-
deserves piloting
#9
targeted deworming
decrease
anemia
-
-
area-specific, non-iron intervention
#10
prevention and treatment of hemoglobinopathies
decrease
anemia
-
-
area-specific, non-iron intervention
#11
prevention and treatment of malaria
decrease
anemia
-
-
area-specific, non-iron intervention
#12
prevention and treatment of other common infections
decrease
anemia
-
-
area-specific, non-iron intervention
#13
Routine addition of multi-micronutrients to iron-folate supplementation
no change
anemia
-
-
appears unjustified currently
#14
Abstract

Childhood anemia has major adverse consequences for health and development. It's prevalence in India continues to range from 70 to 90%. Although anemia is multifactorial in etiology, preventative efforts have predominantly focused on increasing iron intake, primarily through supplementation in pregnant and lactating women. Policy thrust for childhood anemia is only recent. However, program implementation is dismal; only 3.8-4.7% of preschoolers receive iron-folate supplements. There is an urgent need for effective governance and implementation. Policy makers must distinguish anemia from iron deficiency, and introduce additional area-specific interventions as an integrated package.Increased iron intake may yield maximum benefit but will only address up to half the burden. In 6-59 months old children, instead of 100 days' continuous dosing with iron-folate syrup in a year, a directly supervised intermittent supplementation (biweekly; ~100 days per year) merits consideration. Multiple micronutrient powders for home fortification of foods in 6-23 months old infants do not appear viable. Additional interventions include delayed cord clamping, earlier supplementation in low birth weight infants, appropriate infant and young child feeding guidelines, and intermittent supervised supplementation in children and adolescents through school health programs. Use of double (iron-folate)-fortified salt in mid-day meal programs deserves piloting.Important area-specific, non-iron interventions include targeted deworming, and prevention and treatment of hemoglobinopathies, malaria and other common infections. Routine addition of multi-micronutrients to iron-folate supplementation appears unjustified currently. There is a pressing need to conduct relevant research, especially to inform etiology, additional interventions and implementation issues.

Medical Subject Headings (MeSH)
AnemiaAnemia, Iron-DeficiencyChildComorbidityDietDietary SupplementsFemaleFolic AcidHumansIndiaIronIron DeficienciesMicronutrientsPregnancy
Study Links
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality80/10
Citation Metrics
Total Citations24
Citations/Year2.0
Relative Citation Ratio1.04
NIH Percentile51.7%
Research Impact Scores
APT Score0.75
Weight Score1.54
Normalized Score0.64
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