Preventing childhood anemia in India: iron supplementation and beyond.
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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.