Measured endogenous creatinine clearance (requiring 24-hour urine collection) was compared to estimated (calculated) creatinine clearance obtained by 2 formulas and a nomogram (without urine collection), in 26 elderly nursing home residents. All were clinically stable and had adequate intakes of food and fluid. Of the 26 subjects, 23 had a "normal" value for serum creatinine concentration (0.7-1.5 mg/dl) with a mean of 1.1 mg/dl. Measured creatinine clearance (Cer) was reduced in all patients despite a "normal" serum creatinine level. The mean Cer was 47.2 ml/min, with values as low as 21.6 ml/min. Measured Cer findings compared well with estimated (calculated) findings, the correlation coefficients being highly significant in all instances. If it is difficult or impossible to collect a 24-hour urine specimen, a fairly accurate assessment of renal function may be obtained by using a simple formula (or nomogram) for estimating creatinine clearance on the basis of the patient's age, weight (height) and serum creatinine level.

A weekly iron/folate supplement was compared with a standard daily iron/folate supplement in pregnant women living in rural Malawi. Women were enrolled as they attended the local antenatal clinic, stratified by grade of anaemia and then randomized to receive either 60 mg iron/0.25 mg folate per day (n = 211) or 120 mg iron/0.50 mg folate once a week (n = 202). Supplementation was continued for a minimum of 8 weeks (10 weeks on average) and was self administered by the women at home. Initial haemoglobin values for the daily (mu = 105.7 g/l) and weekly (mu = 104.4 g/l) groups as well as final haemoglobin values (107.5 g/l and 105.6 g/l, respectively) did not differ significantly between the two groups. Haemoglobin values increased by similar levels in both groups with the subset of anaemic women increasing by an average of 6.3 g/l in the daily group (n = 70) and 5.9 g/l in the weekly group (n = 66) for all women. For compliant, anaemic women, the increases were 7.4 g/l and 6.6 g/l for the daily and weekly groups, respectively. Compliance, as indicated by self reporting and by regular counts of remaining tablets, was significantly higher in the weekly group (76% compared with 60%, P < 0.05), however compliance was identical in both groups when assessed by a stool test for elemental iron. Reported side effects were significantly reduced in the weekly group (6% compared with 17%, P < 0.05). We conclude that a weekly iron supplement given to pregnant women in rural Malawi has similar haematologic effects, and an improved side effect profile, in comparison with a standard daily supplement when administered through an existing primary healthcare programme, although both regimens are relatively unsuccessful in the reduction of anaemia prevalence during pregnancy.

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