Multiple Micronutrients Including Iron Are Not More Effective Than Iron Alone for Improving Hemoglobin and Iron Status of Malian School Children ,

Abstract

Iron deficiency and anemia remain among the most important global public health problems facing school children. Helminth infections often peak at school age and aggravate nutritional risks. We conducted a 12-wk randomized controlled trial in 406 Malian anemic schoolchildren infected with Schistosoma hematobium to examine the effects of 2 doses of praziquantel (P) (40 mg/kg body weight), P + 60 mg/d iron (Fe), and/or a multiple micronutrient supplement (MM) that included 18 mg/d Fe. Supplements were administered to the children each school day (5 d/wk) throughout the study. Changes in hemoglobin (Hb), serum ferritin (SF), and serum transferrin receptors (s-TfR) were followed. We also examined interactions between Fe and MM supplements on Hb and SF concentrations and malaria incidence. The effects of Fe on Hb and SF concentrations were greater than the effects of P alone and MM with or without added Fe at 6 and 12 wk (P < 0.001). In all groups, s-TfR decreased at 6 and 12 wk compared with baseline. The decrease was most pronounced in the P + Fe group compared with the other 3 groups at wk 6 (P = 0.05). Fe and MM interacted negatively at wk 6 and 12 to affect Hb (beta = -0.43, 95% CI = -0.77, -0.09; P = 0.01 and beta = -0.47, 95% CI = -0.83, -0.11; P = 0.01, respectively) and SF (beta = -0.42, 95% CI = -25.60, 12.31; P < 0.001, and beta = -0.37, 95% CI = -0.63, -0.12; P = 0.004, respectively). Malaria incidence was higher in the groups treated with added Fe (relative risk: 1.66; 95% CI: 0.75, 3.67). In this context, MM with added iron were not more effective than Fe without MM. Fe supplementation of schoolchildren with 60 mg/d for anemia control should be considered carefully.

Point-of-use micronutrient fortification: lessons learned in implementing a preschool-based pilot trial in South Africa

“…The lack of significant intervention effect on Hb concentration in the study was surprising. Evidence from other studies within similar age groups showed that the use of multiple micronutrient intervention led to improvement in Hb concentration in some (Lopriore et al 2004, Ayoya et al 2009) but not in all , Sharieff et al 2006, Wegmuller et al 2006. However, it is very difficult to explain the observed difference in Hb concentration in the experimental and control groups.…”

Oral iron supplements for children in malaria-endemic areas

“…Severe malaria, as defined per protocol, was reported in a single trial and its substudy that reported on cerebral malaria (Sazawal 2006 (C)a; Sazawal 2006 (C)b). Five trials reported clinical malaria with high-grade parasitaemia (Smith 1989 (C); Adam 1997 (C); Massaga 2003; Ayoya 2009; Zlotkin 2013 (C)). Twelve trials reported only or mostly (over 80%) on P. falciparum malaria (Table 4).…”

Effects of daily iron supplementation in primary-school–aged children: systematic review and meta-analysis of randomized controlled trials

“…17,18 Data from 2 other studies could not be included because global cognitive scores were not presented.…”

“…17,18,57,58 Iron supplementation reduced the prevalence of anemia (RR 0.12, 95% CI 0.02 to 0.66; p = 0.01, 334 children).…”