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

• Published in: European journal of clinical nutrition Vol. 67; no. 4; pp. 343 - 347
• Main Authors: Kapil, U, Sachdev, H P S, Dwivedi, S N, Pandey, R M, Upadhyay, A D, Sareen, N
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-04-2013; Nature Publishing Group
• Subjects: 631/154/436/1729; 692/699/1541/13; 692/700/1720; 692/700/459/1994; Acids; Age; Anemia; Anemia, Iron-Deficiency - drug therapy; Anemias. Hemoglobinopathies; Biological and medical sciences; Child, Preschool; Children; Clinical Nutrition; Cluster Analysis; Clusters; Confidence intervals; Dietary Supplements; Diseases of red blood cells; Dosage and administration; Dose-Response Relationship, Drug; Drug dosages; Epidemiology; Feeding. Feeding behavior; Folic acid; Folic Acid - administration & dosage; Food and nutrition; Fundamental and applied biological sciences. Psychology; Health aspects; Hematinics - administration & dosage; Hematologic and hematopoietic diseases; Hemoglobin; Hemoglobins - analysis; Humans; India; Internal Medicine; Iron; Iron - administration & dosage; Iron in the body; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Nutrition; original-article; Preschool children; Public Health; Requirements; Socioeconomic Factors; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin B; India; preschool children; iron supplementation; folate supplementation; anemia; hemoglobin; Human; Preschool age; Anemia; Metabolic diseases; Hemopathy; Iron; Folate; Daily; Randomization; Weekly; Hemoglobin; Supplementation; Child
• ISSN: 0954-3007; 1476-5640
• DOI: 10.1038/ejcn.2013.13

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.