Micronutrient and iron supplementation and effective antimalarial treatment synergistically improve childhood anaemia. Failure of twice-weekly iron supplementation to increase blood haemoglobin and serum ferritin concentrations: results of a randomized controlled trial. Cluster-randomised trial of the impact of school-based deworming and iron supplementation on the cognitive abilities of schoolchildren in Sri Lanka's plantation sector. Iron pre-load for major joint replacement. Effects of iron and multimicronutrient supplementation on geophagy: a two-by-two factorial study among Zambian schoolchildren in Lusaka. Weekly iron supplements given by teachers sustain the haemoglobin concentration of schoolchildren in the Philippines. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren A randomised placebo-controlled trial to determine the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin > or = 13.2 g/dl. Is cooking food in iron pots an appropriate solution for the control of anaemia in developing countries? A randomised clinical trial in Benin. The efficacy of micronutrient supplementation in reducing the prevalence of anaemia and deficiencies of zinc and iron among adolescents in Sri Lanka Behavioural responses of young anaemic Indian children to iron-folic acid supplements. Efficacy of iron supplementation on fatigue and physical capacity in non-anaemic iron-deficient adults: a systematic review of randomised controlled trials Effects of an iron supplementation trial on the Fe status of Thai schoolchildren. Antenatal Iron Supplementation Regimens for Pregnant Women in Rural Vietnam and Subsequent Haemoglobin Concentration and Anaemia among Their Infants Randomised comparison of the effects of Sprinkles and Foodlets with the currently recommended supplement (Drops) on micronutrient status and growth in Iranian children Intravenous versus oral iron therapy for postpartum anaemia. Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study Iron supplementation during pregnancy. Effect on iron status markers, serum erythropoietin and human placental lactogen. A placebo controlled study in 207 Danish women. Effect of iron or multiple micronutrient supplements on the prevalence of anaemia among anaemic young children of a malaria-endemic area: a randomized double-blind trial. Effectiveness of biweekly versus daily iron-folic acid administration on anaemia status in preschool children. Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia Does iron therapy benefit children with severe malaria-associated anaemia? A clinical trial with 12 weeks supplementation of oral iron in young children from the Turiani Division, Tanzania. Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People's Democratic Republic: a randomised trial
The control of childhood anaemia in malaria holoendemic areas is a major public health challenge for which an optimal strategy remains to be determined . Malaria prevention may compromise the development of partial immunity . Regular micronutrient supplementation has been suggested as an alternative but its effectiveness remains unsettled . We therefore conducted a r and omised placebo-controlled intervention trial with 207 Tanzanian children aged 5 months to 3 years on the efficacy of supervised supplementation of low-dose micronutrients including iron ( Poly Vi-Sol with iron ) three times per week , with an average attendance of > /= 90 % . The mean haemoglobin ( Hb ) level increased by 8 g/l more in children on supplement ( 95 % CI 3 - 12 ) during the 5-month study . All age groups benefited from the intervention including severely anaemic subjects . The mean erythrocyte cell volume ( MCV ) increased but Hb in children > /= 24 months improved independently of MCV and no relation was found with hookworm infection . The data therefore suggest that micronutrients other than iron also contributed to Hb improvement . In the supplement group of children who had received sulfadoxine-pyrimethamine ( SP ) treatment , the mean Hb level increased synergistically by 22 g/l ( 95 % CI 13 - 30 ) compared to 7 g/l ( 95 % CI 3 - 10 ) in those without such treatment . Supplementation did not affect malaria incidence . In conclusion , micronutrient supplementation  improves childhood anaemia in malaria holoendemic areas and this effect is synergistically enhanced by temporary clearance of parasitaemia In order to increase the intestinal absorption of iron whilst simultaneously minimising the side-effects and thus increasing compliance , once- or twice-weekly , instead of daily , iron supplementation has been widely recommended . In a r and omized , placebo-controlled , double-blind study in western Kenya , a tablet of ferrous dextran ( containing 60 mg elemental iron ) or an identical-looking placebo tablet was provided twice-weekly for 12 months to each child or adult investigated . At baseline each subject had a moderately low blood concentration of haemoglobin ( Hb ) . Initial Hb and serum ferritin ( SF ) concentrations were determined and each subject was tested for malarial and helminth infection and treated , if necessary , with the appropriate anthelminthic drug(s ) . Overall , 200 children ( aged 4 - 15 years ) and 129 adults ( aged 16 - 63 years ) completed the 12-month study . At baseline , 47.5 % of the children and 58.1 % of the adults were anaemic  , hookworm ( detected in 60.0 % of the children and 69.9 % of the adults ) was the most common helminth infection , and malaria was endemic . The results of bivariate analyses indicated that twice-weekly iron supplementation had no significant effect on blood Hb or SF concentrations , either in the children or the adults investigated . The results were confirmed in multiple linear-regression analyses , which revealed that the predictors of the final Hb concentration in the children investigated were age and infection , after enrollment , with Ascaris lumbricoides . Gender and the serum concentration of alpha-1-antichymotrypsin ( ACT ) at final follow-up were predictors of the final SF concentration in the children . In adults , the predictors of the final Hb concentration were gender and HIV infection , and the predictors of the final SF concentration were age and the serum concentration of ACT at the final follow-up . Twice-weekly iron supplementation did not increase Hb or iron stores in children or adults . Since compliance appeared to be high , this lack of effect may be the result of an inadequate dose of iron or of subjects who have deficiencies in micronutrients other than iron OBJECTIVE To assess the impact of deworming and iron supplementation on the cognitive abilities and educational achievement of school-age children in Sri Lanka . METHODS Prospect i ve , placebo-controlled r and omised study . The treatment group received deworming and weekly iron supplementation for 6 months ; the control group received placebo for both the anthelmintic and iron . A mixed effects regression model was used to answer the main research question . To increase the precision of this study 's estimates , various background variables were controlled for that were not related to treatment but could have some impact on the outcome . RESULTS The prevalence of soil-transmitted helminth ( STH ) infection was reduced in the treatment group ( n = 615 ) , with significant differences between treatment and control groups ( n = 575 ) in the levels of Ascaris and Trichuris . No impact was found on haemoglobin ( Hb ) levels , nor any significant impact on concentration levels or on educational test scores . CONCLUSION Decline in STH prevalence alone , in the absence of improved Hb status , produced no evidence of impact on concentration levels or educational test scores Patients undergoing total hip or knee replacement frequently receive  blood transfusion . Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum . We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery . All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement .  If the haemoglobin concentration ( Hb ) was less than 12 g dL-1 they were given a four week course of ferrous sulphate . If it was greater than or equal to 12 g dL-1 they were r and omized to a control group or given a supplementation course of ferrous sulphate .  One hundred patients were seen . Of these 18 ( 18 % ) had haemoglobin less than 12 g dL-1 and 16 were treated with iron . The mean Hb was 10.8 g dL-1 and mean cell volume ( MCV ) 86 . These patients increased their Hb by a mean 1.1 g dL-1 prior to admission ( P = 0.008 ) . MCV was the best predictor of response ( r = -0.63 , P < 0.02 ) . This group dropped their haemoglobin by a mean 1.4 g dL-1 in the first post-operative week . In the study groups there was no significant preoperative rise in Hb . However , the control group dropped their Hb by a mean 1.3 g dL-1 in the week following surgery compared with 0.4 g dL-1 in the group which had received iron supplements ( P < 0.001 ) . We conclude that at least 18 % of patients attending for hip or knee replacement in this region are frankly anaemic and benefit significantly from preoperative iron supplements over 4 weeks . Iron supplementation in patients without obvious anaemia protects against a fall in Hb during the immediate post-operative period , suggesting a widespread underlying depletion of iron stores in this group despite a normal Hb . Preoperative iron supplements may reduce transfusion requirements as part of a co-ordinated strategy in this group of patients Geophagy has been associated with iron deficiency and anaemia , but no causal relationship has been established . To clarify this , we conducted a two-by-two factorial r and omised , controlled trial on the effect of iron and multimicronutrient supplementation on geophagy in Zambian schoolchildren in Lusaka , from February to December 2001 . Of the 406 children , 212 ( 52.2 % ) were girls and the mean ( range ) age was 10.2 ( 7 - 15 ) years .  Geophagy was reported by 302 ( 74.4 % ) and more often in girls than in boys ( 80.2 vs. 67.7 % , P = 0.007 ) . The mean ( range ) daily earth intake was 25.2 ( 1 - 200 ) g. Geophageous children had more often geophageous relatives than non-geophageous children ( 79.5 vs. 1.9 % , P < 0.001 ) . Geophageous children had lower serum ferritin ( 20.5 vs. 25.0 microg/l , P = 0.032 ) but not haemoglobin ( Hb ) ( 129.2 vs. 130.4 g/l , P = 0.59 ) , than non-geophageous . Among those with Hb < 130 g/l , geophageous children had significantly higher prevalence ( 53.7 vs. 30.6 % , P = 0.024 ) of Ascaris lumbricoides infection than non-geophageous . The prevalence of geophagy ( 74.4 to 51.6 % ) and the intake of earth ( 25.3 to 15.0 g/day ) declined ( P = 0.001 and P < 0.001 , respectively ) among the 220 ( 54.2 % ) children followed-up . In bivariate analysis , non-iron supplementation reduced the prevalence of geophagy more than iron supplementation did , but this was not confirmed in the multiple logistic regression analysis . Multimicronutrients had no effect on either geophagy prevalence or earth intake . Geophagy was prevalent and associated with iron deficiency , but iron supplementation had no effects on geophageous behaviour . Geophagy could be a copied behaviour and the association between geophagy and iron deficiency due to impaired iron absorption following earth eating OBJECTIVES To examine the effectiveness of weekly iron supplements given for 10 weeks by teachers to children in rural schools in the Philippines . METHODS Forty-nine rural primary schools took part in the study and were r and omly assigned to two groups : children in 25 schools received a weekly tablet providing 108 mg iron while children in 24 schools acted as controls . All children were dewormed before the start of the iron supplementation . The haemoglobin concentration of a systematic sample of one in three children in two classes in each school was estimated before and 5 - 17 weeks after the end of the iron supplementation . RESULTS A total of 1510 children aged 7 - 12 years were studied at both surveys . The mean haemoglobin concentration of children in the intervention group did not change significantly ; in the untreated group it fell by 3.8 g/l and the prevalence of anaemia rose from 14.3 % to 25.6 % . The difference between study groups was significantly larger amongst the younger children ( 7 - 8 years ) , and was observed in both anaemic and non-anaemic children . CONCLUSION Even where anaemia is only a mild public health problem , weekly iron supplements given by teachers may prevent a fall in the haemoglobin concentration , and can benefit both anaemic and non-anaemic children The effect of iron fortification is generally assumed to be less than iron supplementation ; however , the magnitude of difference in effects is not known . The present study aims to compare the efficacy of these two strategies on anaemia and iron status . After screening on low Hb , 425 anaemic children in six primary schools in Tam Nong district of Phu Tho province were included in a r and omized , placebo-controlled trial comparing two groups receiving iron fortified instant noodles or iron supplementation for 6 months and a control group , with children in all groups having been dewormed .  Blood sample s were collected before and after intervention for haemoglobin , serum ferritin ( SF ) , serum transferrin receptor ( TfR ) , C-reactive protein ( CRP ) , and haemoglobinopathies analysis . Regression analysis was used to assess the effect of iron fortification and iron supplementation on haemoglobin concentration , SF , TfR , body iron , and anaemic status as outcome variables . The improvement of haemoglobin , SF , and body iron level in the group receiving iron fortification was 42 % ( 2.6 g/L versus 6.2 g/L ) , 20 % ( 23.5 μg/L versus 117.3 μg/L ) , and 31.3 % ( 1.4 mg/kg versus 4.4 mg/kg ) of that in the iron supplementation group . The prevalence of anaemia dropped to 15.1 % in the control group , with an additional reduction of anaemia of 8.5 % in the iron supplementation group . The additional reduction due to iron fortification was 5.4 % , which amounts to well over 50 % of the impact of supplementation . In conclusion , the efficacy of iron fortification based on reduction of prevalence of anaemia , and on the change in haemoglobin level , is about half of the maximum impact of supplementation in case of optimal compliance . Thus , in a population of anaemic children with mild iron deficiency , iron fortification should be the preferred strategy to combat anaemia OBJECTIVE To study the effect of iron supplementation on pregnancy outcome in pregnant women with haemoglobin ( Hb ) > or = 13.2 g/dl . DESIGN A r and omised , double-blind , placebo-controlled trial . SETTING Routine health services . POPULATION Seven hundred and twenty-seven pregnant women with Hb > or = 13.2 g/dl in the early stage of the second trimester . METHODS Each woman took one ferrous sulphate [ DOSAGE ERROR CORRECTED ] tablet ( 150 g tablet , containing 50 mg of elemental iron ) [ DOSAGE ERROR CORRECTED ] daily in the case group ( n = 370 ) or placebo in the control group ( n = 357 ) throughout pregnancy . MAIN OUTCOME MEASURES Pregnancy outcome . RESULTS While there were no significant differences in demographic and obstetric characteristics between the two groups before any intervention , small-for-gestational-age birth rate and the number of women with hypertension disorder increased significantly in the case group in comparison with the control group ( 57 [ 15.7 % ] versus 36 [ 10.3 % ] , P = 0.035 , 10 [ 2.7 % ] versus 3 [ 8 % ] , P = 0.05 , respectively ) . CONCLUSIONS Our finding proves that routine iron supplementation in nonanaemic women is not rational and may be harmful OBJECTIVE To evaluate the effect of two types of iron pots on haemoglobin ( Hb ) and serum ferritin ( SF ) concentrations in young children ( 6 - 24 months ) , adolescent girls ( 11 - 15 years ) and women of reproductive age ( 15 - 44 years ) , whose households were provided with  iron pots  for cooking food over a period of 6 months , compared with controls . DESIGN AND METHODS We r and omly assigned 161 households including 339 individuals from the three subgroups to cast iron pots , blue steel pots or oral iron supplements ( control ) . In the control group , children received micronutrient Sprinkles , and adolescent girls and women received iron tablets daily for 6 months . We measured Hb , SF and C-reactive protein concentrations at baseline and 6 months , and compared groups using regression models . RESULTS Anaemia prevalence ( Hb < 110 g l(-1 ) in infants , Hb < 120 g l(-1 ) in girls or women ) was 47 % ( cast iron group ) , 50 % ( blue steel group ) and 50 % ( control ) at baseline . At 6 months , there were no significant differences in Hb concentrations among groups ; however , differences in SF concentrations were significant ( P < 0.0001)--the control group had higher SF concentrations compared with the groups using iron pots . Also , differences in the prevalence of iron-deficiency anaemia ( IDA ; anaemia plus SF < 15 microg l(-1 ) ) were almost significant between cast iron and control groups ( P = 0.08 ) , and blue steel and control groups ( P = 0.05 ) . CONCLUSION There is no evidence that iron cooking pots are effective against IDA . Further research is warranted to determine whether the iron leached from the pots is bioavailable Objective : To determine the effectiveness of combined iron and zinc over the iron or zinc-only supplementation in correcting deficiency and possible interactive effects in a group of adolescent school children . Subjects and methods : Schoolchildren ( n=821 ) of 12–16 years of age were r and omized into four groups and supplemented with iron ( 50 mg/day ) , zinc ( 14 mg/day ) , iron+zinc or placebo capsules 5 days per week for 24 weeks . Anthropometry , and haemoglobin ( Hb ) , serum zinc ( SZn ) and serum ferritin ( SF ) concentrations were determined before and after the intervention . Results : There were no significant effects between-groups in their weight , height and Hb concentrations with the intervention when compared with the placebo group . Iron-only and combination-supplemented groups had reached mean SF concentrations of 55.1 μg/l with no difference between them ( P=0.99 ) . The zinc-only group had a mean change of 4.3 μmol//l whereas the combine-supplemented group had a mean change of 4.0 μmol/l ( P=0.82 ) . The prevalence of anaemia was found to be 70.3 % in the iron group at baseline ; this was reduced to 14.5 % after the supplementation . In the combine-supplemented group anaemia , prevalence was reduced from 64.8 to 19.3 % . Conclusions : Zinc alone or in combination with iron has not shown a significant improvement in growth in adolescence . Severe and moderate forms of anaemia were successfully treated in children who received iron supplementation . Initial high prevalence of low SZn and iron stores was significantly improved with micronutrient supplementation 1 . Behavioural responses of young anaemic Indian children to iron-folic acid supplements were assessed in two separate studies using the Indian adaptation of Wechsler 's ( 1967 ) intelligence scale for children ( WISC ) . 2 . The first study was an exploratory study in which the cognitive behaviour of 5 - 8-year-old children of both sexes was assessed before and after supplementation with 20 mg elemental Fe and 0.1 mg folic acid given daily for a period of 60 d. 3 . The supplemented children showed a significant improvement in haemoglobin ( Hb ) as well as the WISC scores while the control children who did not receive any supplements failed to show an improvement either in Hb or in the WISC scores . However , within the supplemented group when the initially-anaemic children were compared with the initially-non-anaemic ones , only the 7-year-old anaemic children performed significantly poor in the tests than the non-anaemic group of the same age . The study raised the possibility that in addition to increasing the blood Hb levels , Fe-folic acid supplements may have additional benefits in improving the cognitive performance of children . 4 . In the second study , cognitive behaviour of fourteen matched pairs of anaemic children in the age-range of 5 - 6 years was assessed before and after supplementation with 40 mg Fe and 0.2 mg folic acid given daily in two divided doses or sugar placebos for a period of 60 d. The tester did not know the groups to which each child belonged . 5 . The supplemented children showed a significant improvement in Hb as well as in the verbal and performance IQ of WISC . The control children showed no improvement in Hb but their verbal IQ improved significantly . However , there was no significant improvement in their performance IQ . 6 . The results indicated that Fe-folic acid supplements to anaemic children not only raised Hb levels but also improved intelligence test results , particularly in the performance section Objective Iron supplementation in iron-deficiency anaemia is st and ard practice , but the benefits of iron supplementation in iron-deficient non-anaemic ( IDNA ) individuals remains controversial . Our objective is to identify the effects of iron therapy on fatigue and physical capacity in IDNA adults . Design Systematic review and meta- analysis of r and omised controlled trials ( RCTs ) . Setting Primary care . Participants Adults ( ≥18 years ) who were iron deficient but non-anaemic . Interventions Oral , intramuscular or intravenous iron supplementation ; all therapy doses , frequencies and duration s were included . Comparators Placebo or active therapy . Results We identified RCTs in Medline , Embase , Cochrane Central Register of Controlled Trials , Cumulative Index of Nursing and Allied Health , SportD iscus and CAB Abstract s from inception to 31 October 2016 . We search ed the WHO ’s International Clinical Trials Registry Platform for relevant ongoing trials and performed forward search es of included trials and relevant review s in Web of Science . We assessed internal validity of included trials using the Cochrane Risk of Bias tool and the external validity using the Grading of Recommendations Assessment , Development and Evaluation methodology . From 11 580 citations , we included 18 unique trials and 2 companion papers enrolling 1170 patients . Using a Mantel-Haenszel r and om-effects model , iron supplementation was associated with reduced self-reported fatigue ( st and ardised mean difference ( SMD ) −0.38 ; 95 % CI −0.52 to −0.23 ; I2 0 % ; 4 trials ; 714 participants ) but was not associated with differences in objective measures of physical capacity , including maximal oxygen consumption ( SMD 0.11 ; 95 % CI −0.15 to 0.37 ; I2 0 % ; 9 trials ; 235 participants ) and timed methods of exercise testing  . Iron supplementation significantly increased serum haemoglobin concentration ( MD 4.01 g/L ; 95 % CI 1.22 to 6.81 ; I2 48 % ; 12 trials ; 298 participants ) and serum ferritin ( MD 9.23 µmol/L ; 95 % CI 6.48 to 11.97 ; I2 58 % ; 14 trials ; 616 participants ) . Conclusion In IDNA adults , iron supplementation is associated with reduced subjective measures of fatigue but not with objective improvements in physical capacity . Given the global prevalence of both iron deficiency and fatigue , patients and practitioners could consider consumption of iron-rich foods or iron supplementation to improve symptoms of fatigue in the absence of documented anaemia . PROSPERO registration number CRD42014007085 A double-blind clinical trial was conducted among 9- to 11-year-old children in sixteen schools in the Chon Buri province of Thail and to assess the effects of an iron supplement combined with an anthelminthic agent ( i.e. albendazole ) . In addition to the albendazole , Fe or placebo tablets were distributed to 2268 children enrolled in grade s three to five without knowledge of the Fe status of the children . Criteria for case inclusion were : ( a ) absence of A E Bart 's or haemoglobin ( Hb ) H disease , ( b ) absence of abnormal Hb EE , and ( c ) age , 108 - 144 months . The results showed a significant improvement in the Fe status of the children after 16 weeks of treatment . The increments were : Hb from 124 to 128 g/l , serum ferritin from 34.54 to 104.72 micrograms/l , transferrin saturation from 24.09 to 35.05 % ; free erythrocyte protoporphyrin decreased from 444.7 to 281.4 micrograms/l erythrocytes . These changes were significantly greater than in the control group that received only the anthelminthic agent . However , the administration of albendazole only also result ed in significant changes in the same Fe indicators Background Little evidence about the effects of antenatal iron supplementation on infant anaemia is available . The aim was to compare effects on  six-month-old infants ’ Haemoglobin ( Hb ) concentration and anaemia of daily iron – folic acid ( IFA ) , twice-weekly IFA with or without other micronutrients ( MMN ) and usual antenatal care in rural Vietnam . Methods and Findings Secondary data analysis from : a prospect i ve population -based observational study ( OS ) which examined effects of antenatal psychosocial factors , anaemia and iron deficiency on infant development and health ; and a three-arm cluster r and omised trial ( CRT ) of different antenatal iron supplementation regimens . In the OS 497 women ( < 20 weeks gestation ) from 50 r and omly-selected communes participated , and in the CRT 1,258 pregnant women ( < 16 weeks gestation ) in 104 communes were allocated r and omly to trial arms . The main outcome was six-month-old infant Hb concentration . Baseline data included women ’s socio-demographic characteristics , reproductive health , Hb and serum ferritin . Mean differences in infant Hb and odds ratios of infant anaemia between CRT arms and OS were calculated by multivariable regression models , controlling for baseline differences and clustering , using robust st and ard errors . Infant anaemia prevalence was 68.6 % in the OS , 47.2 % daily IFA , 53.5 % weekly IFA , and 50.3 % MMN conditions . After adjustment , mean infant haemoglobin levels in daily IFA ( mean difference = 0.95 g/dL ; 95%CI 0.7 - 11.18 ) ; weekly IFA ( 0.91 ; 95%CI 0.69 - 1.12 ) and MMN ( 1.04 ; 95%CI 0.8 - 1.27 ) were higher than in the OS . After adjustment there were lower odds ratios of anaemia among infants in the daily IFA ( OR = 0.31 ; 95 % CI 0.22 - 0.43 ) , weekly IFA ( 0.38 ; 95%CI 0.26 - 0.54 ) and MMN ( 0.33 ; 95%CI 0.23 - 0.48 ) groups than in the OS . Conclusions Infant anaemia is a public health problem in Vietnam and other re source -constrained countries . All supplementation regimens could have clinical ly significant benefits for Hb and reduce anaemia risk among six-month-old infants . Universal provision of free intermittent iron supplements is warranted Background / Objectives : Multiple micronutrient supplementation with Sprinkles powder and crushable Foodlets tablets may be effective means of controlling micronutrient deficiencies in infants . Their efficacy has not been tested in countries like Iran where wheat as the staple food may affect nutrient bioavailability . This study aim ed to compare the efficacy of Sprinkles , Foodlets and the current supplement ( Drops ) for improving micronutrient status and growth among Iranian infants . Subjects/ Methods : Infants of 6–18 months of age , living in an urban district of Iran were r and omised to receive daily Sprinkles ( n=120 ) , Foodlets ( n=121 ) or Drops ( n=121 ) for 4 months . Haemoglobin ( Hb ) , serum ferritin , serum retinol , serum zinc , 25(OH ) D concentration and anthropometry were assessed at baseline and at 4 months . Results : Iron status improved with all treatments . Drops showed significantly greater changes in Hb and serum ferritin , though changes in anaemia prevalence were not different across groups . Infants having Foodlets and Sprinkles had significantly greater reductions in proportion of children with zinc deficiency compared with Drops . No significant differences in treatment effects were observed for mean serum 25(OH ) D and retinol , or for growth of infants across groups . Conclusion : The study was the first efficacy trial with Sprinkles and Foodlets in the Middle East where wheat or rice is the principal complementary foods . Differences across treatment groups were largely consistent with supplement micronutrient composition for iron and zinc , with no benefit in this population for serum retinol , 25(OH ) D , growth or anthropometric status . The trial identified trade-offs in combining multiple micronutrients in a single delivery mechanism OBJECTIVE Postpartum iron deficiency anaemia ( IDA ) is common in women . Most women are treated with either oral iron supplementation or blood transfusion . Hence , the aim of our study was to compare the effect of treatment with either oral ferrous sulphate or intravenous ferrous sucrose on postpartum IDA . DESIGN A single centre , prospect i ve r and omised controlled trial . SETTING Women 's Centre , John Radcliffe Hospital , Oxford , UK . POPULATION Forty-four women with haemoglobin ( Hb ) of < 9 g/dl and ferritin of < 15 microgram/l at 24 - 48 hours postdelivery . METHODS Women were r and omised to receive either oral ferrous sulphate 200 mg twice daily for 6 weeks ( group O ) or intravenous ferrous sucrose 200 mg ( Venofer ; Vifor International Ltd , St Gallen , Switzerl and ) , two doses given on days 2 and 4 following recruitment ( group I ) . RESULTS were analysed by the Students t-test , chi-square test and analysis of variance . MAIN OUTCOME MEASURES Hb , haematocrit , red cell indices , ferritin and serum iron levels were measured on days 0 , 5 , 14 and 40 . Results By day 5 , the Hb level in women treated with intravenous iron had risen from 7.3 + /- 0.9 to 9.9 + /- 0.7 g/dl , while there was no change in those treated with oral iron . Women treated with intravenous iron had significantly higher Hb levels on days 5 and 14 ( P < 0.01 ) than those treated with oral iron ; although by day 40 , there was no significant difference between the two groups . Throughout the study , ferritin levels rose rapidly in those treated with intravenous iron and remained significantly higher than in those treated with oral iron ( P < 0.01 ) . CONCLUSIONS Intravenous iron sucrose increases the Hb level more rapidly than oral ferrous sulphate in women with postpartum IDA . It also appears to replenish iron stores more rapidly . However , this study was not large enough to address the safety of this strategy Abstract Objective : To measure the effects of iron supplementation and anthelmintic treatment on iron status , anaemia , growth , morbidity , and development of children aged 6–59 months . Design : Double blind , placebo controlled r and omised factorial trial of iron supplementation and anthelmintic treatment . Setting : Community in Pemba Isl and , Zanzibar . Participants : 614 preschool children aged 6–59 months . Main outcome measures : Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups . Results : Before intervention , anaemia was prevalent and severe , and geohelminth infections were prevalent and light — Plasmodium falciparum infection was nearly universal . Iron supplementation significantly improved iron status , but not haemoglobin status . Iron supplementation improved language development by 0.8 ( 95 % confidence interval 0.2 to 1.4 ) points on the 20 point scale . Iron supplementation also improved motor development , but this effect was modified by baseline haemoglobin concentrations ( P=0.015 for interaction term ) and was apparent only in children with baseline haemoglobin concentrations < 90 g/l . In children with a baseline haemoglobin concentration of 68 g/l ( one st and ard deviation below the mean value ) , iron treatment increased scores by 1.1 ( 0.1 to 2.1 ) points on the 18 point motor scale . Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura , but not by hookworms . Mebendazole  increased development scores by 0.4 ( −0.3 to 1.1 ) points on the motor scale and 0.3 ( −0.3 to 0.9 ) points on the language scale . Conclusions : Iron supplementation improved motor and language development of preschool children in rural Africa . The effects of iron on motor development were limited to children with more severe anaemia ( baseline haemoglobin concentration < 90 g/l ) . Mebendazole had a positive effect on motor and language development , but this was not statistically significant . What is already known on this topic Iron is needed for development and functioning of the human brain Anaemic children show developmental delays , but it is not yet clear whether iron deficiency causes these deficits or whether iron supplementation can reverse them Helminth infections in schoolchildren are associated with cognitive deficits , but few studies have been made of helminth infection and early child development What this study adds Low doses of oral iron supplementation given daily improved language development in children aged 1–4 years in Zanzibar Iron supplementation improved motor development , but only in children with initial haemoglobin concentrations below 90 g/l The effects of routine anthelmintic treatment on motor and language milestones were positive , but non-significant , with our sample The effect of iron supplementation , 66 mg elemental iron daily , from the 16th week of gestation to delivery , on iron status markers during uncomplicated pregnancies was assessed in a r and omised , double-blind , placebo controlled study of 207 healthy women ( 100 iron treated , 107 placebo treated ) and their newborn babies .  Haemoglobin ( Hb ) and serum ( S- ) human placental lactogen ( HPL ) were measured in all 207 females , while transferrin saturation , S-ferritin and S-erythropoietin ( EPO ) were measured in 120 females at monthly intervals . Hb : from 27th week of gestation to eight weeks post partum , the placebo treated group had significantly lower Hb levels than the iron treated group ( p less than 0.001 ) . Iron status markers : in the placebo group ( n = 57 ) , 92 % developed exhausted iron stores ( i.e. S-ferritin less than or equal to 20 micrograms/l ) , 65 % latent iron deficiency ( i.e. S-ferritin less than or equal to 20 micrograms/l and transferrin saturation less than 15 % ) , and 18 % iron deficiency anaemia ( i.e. S-ferritin less than or equal to 20 micrograms/l , transferrin saturation less than 15 % and Hb less than 110 g/l ) . In the iron treated group ( n = 63 ) , 54 % developed exhausted iron stores , 6 % latent iron deficiency , and none iron deficiency anaemia . S-EPO : the placebo group had significantly higher values than the iron treated group from the 27th week of gestation to one week post partum ( p less than 0.01 ) . S-HPL : levels were identical in placebo and iron treated females . Babies of iron treated mothers had higher S-ferritin than babies of placebo treated mothers ( p less than 0.02 ) . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE To assess the effect of supplementation with iron or multiple micronutrients ( MM ) on the prevalence of anaemia in a malaria-endemic area . METHODS A community-based r and omized double-blind trial was conducted in rural Burkina Faso , including children aged 6 - 23 months with haemoglobin ( Hb ) concentrations of 70 - 109 g/l who were r and omized into an iron group ( Fe , n = 96 ) , an iron and zinc group ( IZ , n = 100 ) or an MM group ( MM , n = 100 ) , 5 days/week for 6 months . All children were provided with insecticide-treated bednets ; those who had a Plasmodium falciparum ( PF ) positive-smear at baseline and /or at each monthly checking received antimalarial therapy . RESULTS The mean ( SD ) endpoint Hb concentration was higher in the MM group [ 113.2 ( 13.6 ) g/l ] than in the IZ group [ 106.3 ( 15.6 ) g/l ] and the Fe group [ 107.1 ( 12.9 ) g/l ] ( P = 0.001 ) . Children in the MM group were more likely to recover from anaemia than those in the Fe group [ prevalence rate ratios , PRR ( 95 % confidence interval , CI ) = 1.62 ( 1.22 - 2.15 ) , P < 0.001 ] . The IZ group did not differ from the Fe group [ PRR ( 95 % CI ) = 0.94 ( 0.65 - 1.35 ) , P = 0.72 ] . None of the interactions on the effect of supplementation of baseline age ( 0.13 ) , or baseline height-for-age z-score ( P = 0.33 ) , or incident PF parasitemia ( P = 0.99 ) , was significant . CONCLUSION In this malaria-endemic area , in combination with malaria management , the MM supplement was more efficacious than the Fe supplement and the IZ supplement for reducing anaemia . Further investigation into limiting factors and amounts of micronutrients that would be more efficacious for reducing anaemia is recommended Three-quarters of preschool children in India are anaemic . With the aim of identifying a cost-effective strategy for iron supplementation , the study objective was to assess the effectiveness of daily versus biweekly iron-folic acid ( IFA : 20 mg elemental iron and 0.1 mg folic acid/tablet ) on change in haemoglobin ( Hb ) levels of preschool children ( 3 - 6 years ) . This was a rural community-based effectiveness study in Uttar Pradesh , North India .  IFA was given in two schedules : biweekly ( 2 tablets/dose ) and daily ( 1 tablet/dose ) for 1 year with fortnightly monitoring for adherence . A total of 400 and 403 children were enrolled in daily and biweekly regimes , respectively , of which 57.32 per cent and 50.25 per cent were anaemic ( Hb < 11 g/dl ) in each group . Adherence in biweekly and daily regimes was 89.05 per cent vs. 63.5 per cent . After 1 year , the mean Hb rise in daily and biweekly regime was 1.063 g/dl ( SD : 1.6 ; p = 0.000 ) and 1.053 g/dl ( SD : 1.73 ; p = 0.001 ) , respectively . Reduction in point prevalence of anaemia was 65.7 per cent daily vs. 56.1 per cent in biweekly regimen ( p = 0.0047 ) . We conclude that biweekly as well as daily IFA administration is effective in raising Hb levels and decreasing community prevalence of anaemia significantly . However , since there is better adherence and lower drug costs associated with biweekly IFA administration , this can be considered for programme use Objectives : To examine the effect of low birth weight ( LBW ) and fetal anaemia ( FA ) on haemoglobin ( Hb ) patterns in infancy . To study the additional contribution of other risk factors known at birth . To examine the effect of iron supplementation during infancy on Hb levels . Methods : A stratified cohort of infants in Malawi ( 83 with LBW ( < 2500 g ) , 111 with FA ( cord Hb < 125 g/l ) , 31 with both LBW and FA , and 176 controls ) was followed during infancy . Hb levels were measured at about 2 , 4 , 6 , 9 , and 12 months of age . Repeated measures models were used to describe the changes in Hb levels over time . Results : The mean Hb concentration in the control group was 95.5 g/l ( 95 % confidence interval ( CI ) 92.5 to 98.5 ) at 2 months , 86.9 g/l ( 95 % CI 84.4 to 89.4 ) at 9 months , and 898 g/l ( 95 % CI 874 to 92.2 ) at 12 months . Differences between LBW infants and controls increased over time ( difference at 12 months : 5.5 g/l ( 95 % CI 1.3 to 9.7 ) ) . Infants with FA had borderline significantly lower Hb at 2 months ( p = 0.07 ) , but at 6 months their levels were similar to those of controls . The LBW infants and those with FA had the lowest Hb levels ( difference from controls at 12 months 7.9 g/l ) . Parity , placental and maternal malaria at delivery , and sex significantly affected Hb levels after adjustment for LBW and FA . After iron supplementation , Hb significantly increased . Conclusions : Antimalarial control and iron supplementation throughout pregnancy should be increased to reduce the incidence of infant anaemia and improve child development and survival Oral iron supplementation is often routinely given to children with malaria-associated anaemia , but its contribution to recovery is controversial . A r and omized clinical trial , evaluating such routine , was carried out among 100 children , who had a haemoglobin of < or = 5 g/dl and a positive blood smear for malaria parasites . All children received malaria therapy ( chloroquin + fansidar ) and were r and omly allocated to two groups , one receiving additional oral iron treatment , the other being the control . In the 12-week follow-up period the haemoglobin level and malaria indices were measured at 2 , 4 , 8 , and 12 weeks . There was a 100 per cent compliance during the follow-up period . In each group 20 children ( 40 per cent ) required a blood transfusion . In the remaining 60 children , after 2 weeks the haemoglobin had risen 3.7 g/dl in the ferrous-supplemented group compared to 3.5 g/dl in the non-ferrous group . Thereafter , the increase in haemoglobin in both groups was steady . At follow-up measurements , the groups did not differ for haemoglobin levels . The mean haemoglobin at 12 weeks was 9.2 and 9.0 g/dl , respectively . It was concluded that iron supplementation did not have any effect on the rate of parasitaemia and on parasite density during the 12 weeks . However , the iron-supplemented group had a significantly increased morbidity from other causes than malaria . It appears that iron does not have an effect on the recovery of haemoglobin level in children with malaria-associated anaemia . This study provides no evidence supporting routine iron supplementation to these children Background Multiple micronutrient deficiencies , in particular iron deficiency anaemia ( IDA ) is a severe public health problem in Lao People 's Democratic Republic ( Lao PDR ) . Because of the practical difficulties encountered in improving the nutritional adequacy of traditional complementary foods and the limitations associated with the use of liquid iron supplementation for the treatment and prevention of IDA in infants and young children , recently , home-fortification with multivitamins and minerals sprinkles was recommended . This study aims to compare the effect of twice weekly versus daily supplementation with multivitamins and minerals powder ( MMP ) on anaemia prevalence , haemoglobin concentration , and growth in infants and young children in a rural community in Lao PDR . Methods A r and omized trial was conducted in six rural communities . Children aged 6 to 52 months ( n = 336 ) were r and omly assigned to a control group ( n = 110 ) or to one of two intervention groups receiving either two sachets per week ( n = 115 ) or a daily sachet ( n = 111 ) of MMP for 24 weeks ; 331 children completed the study . A finger prick of blood was taken at baseline , at week 12 , and again at week 24 to determine haemoglobin concentration . Anthropometric measurements were taken every 4 weeks . The McNemar test was used to assess within group differences at three time points in the study subjects with anaemia and one-way ANOVA was used to assess changes in mean haemoglobin concentration in the treatment groups . Results MMP supplementation result ed in significant improvements in haemoglobin concentration and in the reduction of anaemia prevalence in the two treatment groups compared with the control group ( p < 0.001 ) . The severely to moderately anaemic children ( Hb < 100 g/L ) on daily supplementation recovered faster than those on twice weekly supplementation . MMP was well accepted and compliance was high in both treatment groups . Overall , the improvement in the weight for age Z-score was very small and not statistically significant across the three study groups . Conclusions MMP supplementation had positive effects in reduction of anaemia prevalence and in improving haemoglobin concentration . For severely to moderately anaemic children , daily MMP supplementation was more effective in improving haemoglobin concentration and reducing anaemia prevalence . A longer intervention period is probably needed to have a positive effect on growth
This systematic review indicates that iron supplementation increases  Hb levels in children significantly but modestly .
The increase is greater in subjects who are anaemic at the start of the trial and lower in malarial hyperendemic areas and in those consuming iron-fortified food .
OBJECTIVE To evaluate the effect of iron supplementation on  haemoglobin ( Hb ) in children through a systematic review of r and omised controlled trials .