Comparative Efficacy of Weekly Once Iron with and without Vitamin C Supplementation in Anaemic Adolescent Girls

INTRODUCTION: Nutritional deficiency disorders constitute a major health problem in India. In addition to direct implications for morbidity and mortality, undernutrition predisposes children and adults to various infections. Three micronutrients – vitamin A, iron and iodine are among the most important of all the nutrients needed by the body because they are vital for developing normal learning and cognitive functions, immune defence mechanism, work capacity and reproductive health1. Deficiency of these three micronutrients is known to have devastating effects on health. Anemia resulting from lack of sufficient iron for the synthesis of hemoglobin is the most common hematological disease of infancy and childhood21. It is estimated that 30% of the global population suffers from iron deficiency anemia; most of those affected live in developing countries21. Iron deficiency anemia occurs when iron absorption cannot compensate iron requirements and losses. Requirements are especially high in pregnant women, infants, young children and adolescents. The consequences of iron deficiency anemia are many and serious, affecting not only individual health but also the development of societies and countries.46 In India, the prevalence of anaemia among adolescent girls is high. Adolescent girls are particularly vulnerable group as their requirements of iron as well as its losses from the body are high. And the bioavailability of iron is also low in predominantly cereal based diets because of their high phytate content. Anemia is likely to compromise physical work capacity and cognitive functions of girls in the pubertal phase of development43. Anemia during adolescence limits growth and delays the onset of menarche, which inturn may later lead to cephalopelvic disproportion. It results in increased maternal mortality and decreased child survival, as supplementation during pregnancy fails to restore the iron status. AIM OF THE STUDY: To compare the efficacy of the weekly oral iron/folate versus weekly oral iron/folate with Vitamin C supplementation in anemic adolescent school girls aged 10 to 14 years DISCUSSION: Iron deficiency anemia is the significant problem in adolescent girls studying in the schools. A study on adolescents by Mehtha52 revealed that 63.8% girls were anemic39, another study by Shaw NS40 showed iron deficiency was more prevalent in teenage girls, and another study by Cai MQ, Yan WY39 showed 61.8% anemia prevalence in adolescent girls. Our study showed about 68.3% of young adolescent girls were anemic and the prevalence is comparable. In that49.4% of the girls were mildly anemic, 18.9% were moderate and 1.2% were severely anemic. In order to improve the compliance and reduce the intestinal oxidative stress, schedules administering hematinics less than once daily have been tried. This strategy is based on intestinal mucosal turnover time. It has been suggested that saturation of iron binding protein, apoferritin, in the mucosal cells is the rate limiting step of the absorption of iron (mucosal block theory)35. Since the mucosal removal time in humans is 5-6 days, the strategy of weekly iron supplementation has been strongly suggested by some worker 11,13 and it also has been done in our study. Compliance is one of the important problem in iron supplementation, it is better and side effects are less in twice weekly supplementation schedule done by Shoba S and Sharda D in adolescent school girls in India44. In our study both groups showed better compliance and no major side effects were noticed. Many studies revealed that weekly iron supplementation in adolescent girls had a reasonable increase in hemoglobin concentration. Mehta et al.52 reported an increase in the mean haemoglobin level from 10.45±1.21 g/dl to 11.99±1.19 g/dl and the halving of the prevalence of anaemia from 63.8% after weekly supplementations of iron and folic acid for 25 weeks, which were comparable with daily supplementation. A study done by Cai MQ, Yan WY39 showed that weekly supplementation of iron improved hemoglobin concentration in adolescent girls. A study done by Kotecha et al.41 showed that weekly iron supplementation in adolescent girls had improvement in both hemoglobin and serum ferritin levels. In our study weekly once IFA supplementation showed comparable results with a mean Hb% increase from 10.29±1.14 to 11.8±0.93 g/dl at the end of 24 weeks. SUMMARY: 1. We followed 220 anemic adolescent school girls aged 10-14 years with Hb% level of 7-12gm/dl and were divided into two groups. 2. 110 girls in Group A with weekly once Iron/Folate and 110 girls in Group B with weekly Iron/Folate with Vitamin C 100mg were supplemented for 24 consecutive weeks. With the baseline Hb%, height and weight it was again recorded at 12 and 24 weeks results were analysed for 105 children in each group. 3. Awareness questionnaire before the study and quality data before and after the study were taken. 4. Study revealed that mean hemoglobin increase noticed in both groups but there is statistically significant increase in mean hemoglobin noticed in the girls who had supplemented with weekly once iron folic acid with Vitamin C. Also the rate of rise in hemoglobin and decrease in severity and prevalence of anemia were significant in that group. 5. There is no difference in weight and height gain and BMI in both groups. Awareness about anemia was poor and the quality data showed better response in both groups and this is subjective improvement, it may be influenced by various other factors also. CONCLUSION: 1. Both weekly supplementation of Fe/Folate and Fe/Folate with Vitamin C group showed increase in mean hemoglobin levels in the anemic children. 2. Increment in Hb levels of subjects with addition of Vitamin C to weekly iron/folate supplementation was more effective than that with supplementation of iron/folate alone at the end of 12 and 24 weeks. 3. Prevalence of mild and moderate anemia decreased in both groups but Fe/Folate with Vitamin C showed dramatic response. 4. There is a gain in height in both groups but there is slightly increased gain noticed in added Vitamin C group at the end of 12 weeks. 5. Weight gain showed no difference in between groups. 6. Compliance is better in both groups and side effects are also minimal. 7. Nutrition education and IEC about anemia in schools is a must and to be integrated in these approaches to reduce the anemia effectively. 8. Weekly once Fe/Folate with Vitamin C supplementation showed better hemoglobin increment in short duration in the anemic children. 9. Suggested that a public health approach consisting of once weekly distribution of iron/folate with added Vitamin C through schools under supervision may be a better strategy than giving weekly iron/folate alone in adolescent girls to combat anemia.