Relative efficacy of weekly and two differing doses of daily iron-folate supplementation in improving hemoglobin in mild and moderately anemic children between 3 and 5 years of age: a cluster randomized trial.
Study Goal
The researchers aimed to compare the hemoglobin response in children with mild or moderate anemia using two daily dosages and one weekly dosage of iron and folic acid (IFA) supplementation.
Results Summary
At 100 days, daily IFA supplementation (both standard and double doses) was equally effective and superior to weekly supplementation in improving hemoglobin levels. Anemia reduction was higher in the daily dose groups (18.8% and 18.4%) compared to the weekly group (10.9%).
Population
Children aged 3-5 years with mild or moderate anemia (hemoglobin 7-10 g/dl) in India.
Effective Dosage
Daily (20 mg iron + 100 μg folic acid or 40 mg iron + 200 μg folic acid) and weekly (40 mg iron + 200 μg folic acid).
Duration
100 days.
Interactions
None mentioned.
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
20 mg iron and 100 μg folic acid (IFA) supplementation for 100 days/year | no change | anemia prevalence | children <5 years of age in India | high | anemia prevalence has remained high | #1 |
daily IFA supplementation (20 mg iron and 100 μg folic acid) | neutral | hemoglobin | children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl) | - | hemoglobin response | #2 |
daily IFA supplementation (40 mg iron and 200 μg folic acid) | neutral | hemoglobin | children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl) | - | hemoglobin response | #3 |
weekly IFA supplementation (40 mg iron and 200 μg folic acid) | neutral | hemoglobin | children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl) | - | hemoglobin response | #4 |
IFA supplementation | no change | hemoglobin | enrolled participants | - | no differences | #5 |
weekly supplementation | decrease | hemoglobin | available subjects | - | adjusted hemoglobin was lowered | #6 |
NNACP daily dose (A) | decrease | anemia | available subjects | 18.8% | anemia reduction | #7 |
daily dose doubled (B) | decrease | anemia | available subjects | 18.4% | anemia reduction | #8 |
weekly dose (C) | decrease | anemia | available subjects | 10.9% | anemia reduction | #9 |
Directly supervised IFA supplementation at the NNACP or double dose | increase | efficacy | children of 3-5 years of age with mild or moderate anemia | - | equally efficacious but superior to weekly regimen | #10 |
BACKGROUND/OBJECTIVES: In India, 75% of children <5 years of age have anemia. The National Nutritional Anemia Control Program (NNACP) recommends 20 mg iron and 100 μg folic acid (IFA) supplementation for 100 days/year, but still anemia prevalence has remained high. To accelerate the progress, suggestions include increase in IFA to therapeutic dose or supervised weekly supplementation to improve compliance. The objectives of this study was to compare the hemoglobin response with two dosages of daily (20 mg iron and 100 μg folic acid, or 40 mg iron and 200 μg folic acid) and weekly (40 mg iron and 200 μg folic acid) IFA supplementation in children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl). SUBJECTS/METHODS: Community-based cluster randomized control trial in nine adjoining Anganwadi Centers. Four hundred twenty six enrolled participants received directly supervised IFA tablet supplementation as per the above three groups. After 100 days, the number of available subjects in the NNACP daily dose (A), daily dose doubled (B) and weekly dose (C) groups were 112, 114 and 110, respectively. Hemoglobin was estimated at baseline, 50 and 100 days by the Cynmeth hemoglobin method. RESULTS: At 50 days, there were no differences between the three groups, but at 100 days, adjusted hemoglobin was lowered with weekly supplementation. The mean (95% confidence interval) hemoglobin (g/dl) differences were: (i) A-B: -0.05 (-0.17, 0.05), (ii) A-C: -0.38 (-0.50, -0.27) and (iii) B-C: -0.33, (-0.45, -0.21). Anemia reduction was 18.8%, 18.4% and 10.9%, respectively, in the three groups. CONCLUSION: Directly supervised IFA supplementation at the NNACP or double dose is equally efficacious but superior to weekly regimen.