Effectiveness of Intermittent Iron Treatment of Two- to Six-Year-Old Jordanian Children with Iron-Deficiency Anemia Effectiveness of daily and weekly iron supplementation in the prevention of anemia in infants. Daily and weekly iron supplementation and physical growth of school age Indonesian children. Effect of Twice Weekly Versus Daily Iron Treatment in Turkish Children with Iron Deficiency Anemia Weekly iron supplementation is as effective as 5 day per week iron supplementation in Bolivian school children living at high altitude Once-weekly and 5-days a week iron supplementation differentially affect cognitive function but not school performance in Thai children. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Effect of daily or weekly multiple-micronutrient and iron foodlike tablets on body iron stores of Indonesian infants aged 6-12 mo: a double-blind, randomized, placebo-controlled trial. Efficacy of twice-weekly multiple micronutrient supplementation for improving the hemoglobin and micronutrient status of anemic adolescent schoolgirls in Bangladesh. Once weekly is superior to daily iron supplementation on height gain but not on hematological improvement among schoolchildren in Thailand. Evaluation of a gastric delivery system for iron supplementation in pregnancy. Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh. Iron and zinc supplementation promote motor development and exploratory behavior among Bangladeshi infants. Effect of daily vs twice weekly iron supplementation in Indonesian preschool children with low iron status. Effective community intervention to improve hemoglobin status in preschoolers receiving once-weekly iron supplementation. Multiple micronutrient supplementation improves anemia, micronutrient nutrient status, and growth of Vietnamese infants: double-blind, randomized, placebo-controlled trial. School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, growth, and morbidity of Peruvian infants. Weekly iron supplementation does not block increases in serum zinc due to weekly zinc supplementation in Bangladeshi infants. Daily iron supplementation is more efficacious than twice weekly iron supplementation for the treatment of childhood anemia in western Kenya. Simultaneous weekly supplementation of iron and zinc is associated with lower morbidity due to diarrhea and acute lower respiratory infection in Bangladeshi infants. Impact of iron-folic acid supplementation on cognitive abilities of school girls in Vadodara. Efficacy and acceptability of two iron supplementation schedules in adolescent school girls in Lima, Peru. Efficacy of daily vs. weekly supplementation of iron in schoolchildren with low iron status. Low-dose weekly supplementation of iron and/or zinc does not affect growth among Bangladeshi infants Weekly iron supplementation for the prevention of anemia in pre-school children: a randomized, double-blind, placebo-controlled trial. School-administered weekly iron supplementation – Effect on the growth and hemoglobin status of non-anemic Bolivian school-age children
A randomized placebo-controlled trial The effect of weekly iron and vitamin A supplementation on hemoglobin levels and iron status in adolescent schoolgirls in western Kenya Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants [Efficacy of daily and weekly iron supplementation for the control of iron deficiency anaemia in infants in rural Vietnam]. Anemia prophylaxis in adolescent school girls by weekly or daily iron-folate supplementation. 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. Effectiveness of weekly vitamin A (10 000 IU) and iron (60 mg) supplementation for adolescent boys and girls through schools in rural and urban East Java, Indonesia Will iron supplementation given during menstruation improve iron status better than weekly supplementation? Weekly vs daily iron and folic acid supplementation in adolescent Nepalese girls. Weekly High-Dose Folic Acid Supplementation Is Effective in Lowering Serum Homocysteine Concentrations in Women Identification of an appropriate strategy to control anemia in adolescent girls of poor communities. Growth in non-anemic infants supplemented with different prophylactic iron doses. Impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status of anemic infants. Intermittent administration of iron and sulfadoxine-pyrimethamine to control anaemia in Kenyan children: a randomised controlled trial Malarial anemia leads to adequately increased erythropoiesis in asymptomatic Kenyan children. Effects of three different iron supplementations in term healthy infants after 5 months of life. Effectiveness of biweekly versus daily iron-folic acid administration on anaemia status in preschool children. Impact of iron supplementation on schistosomiasis control in Zambian school children in a highly endemic area. The impact of weekly iron supplementation on the iron status and growth of adolescent girls in Tanzania. Iron deficiency anaemia: continuous versus intermittent treatment in anaemic children. Comparison of the effectiveness of weekly and daily iron supplementation in 6- to 24-months-old babies in urban health centers of Sari, Iran. Randomized intervention study comparing several regimens for the treatment of moderate anemia among refugee children in Kigoma Region, Tanzania. Physical work capacity of young underprivileged school girls impact of daily vs intermittent iron folic acid supplementation: a randomized controlled trial. The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial. Effectiveness of nutrition education, iron supplementation or both on iron status in children. A randomised trial in Mali of the effectiveness of weekly iron supplements given by teachers on the haemoglobin concentrations of schoolchildren. Effect of daily and intermittent iron supplementation on iron status of high school girls. Weekly iron supplements given by teachers sustain the haemoglobin concentration of schoolchildren in the Philippines. Greater effectiveness of daily iron supplementation scheme in infants. The impact of iron supplementation on reinfection with intestinal helminths and Schistosoma mansoni in western Kenya. [Effect of daily or once weekly iron supplementation on growth and iron status of preschool children]. Zinc and iron deficiency and their interrelations in low-income African American and Hispanic children in Atlanta. Weekly Iron and Folic Acid Supplementation with Counseling Reduces Anemia in Adolescent Girls: A Large-Scale Effectiveness Study in Uttar Pradesh, India Efficacy of Daily and Weekly Iron Supplementation on Iron Status in Exclusively Breast-Fed Infants Treatment response to iron and folic acid alone is the same as with multivitamins and/or anthelminthics in severely anemic 6- to 24-month-old children.
Background Iron deficiency is a common nutritional problem in young children among vulnerable population s in Jordan . Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status . Such a study has not been carried out in 2- to-6-year-old Jordanian children diagnosed with iron deficiency anemia in a clinical setting . Objective To study the effectiveness of intermittent versus daily iron treatment in a clinical setting in 2- to 6-year-old Jordanian children with iron-deficiency anemia . Methods About 4,400 children aged 2 to 6 years who visited Prince Hashim Military Hospital in Zarqa , Jordan , from August 2000 to June 2001 were screened for age , general health , and birthweight . About 10 % of these children were screened for anemia , using complete blood count ( defined as a hemoglobin level ≤ 10.5 g/dL , and a mean corpuscular volume ≤ 75 fL ) . Anemic children underwent further screening for iron deficiency , defined as serum ferritin level ≤ 12 μ g/L. Children with iron-deficiency anemia , as indicated by hemoglobin ≤ 10.5 g/dL , mean corpuscular volume ≤ 75 fL , and serum ferritin ≤ 12 μ g/L , or as indicated by mean corpuscular volume ≤ 75 fL and hemoglobin ≤ 10.5 g/dL , were enrolled in the study after informed oral consent by their parents . Study children ( n = 134 ) were assigned r and omly to one of three groups . Subjects in group 1 ( n = 45 ) , group 2 ( n = 45 ) , and group 3 ( n = 44 ) received iron treatment daily , weekly , and twice weekly , respectively . Out of 134 children recruited for the study , only 63 ( 39 boys and 24 girls ) completed the 3-month treatment period . All of the children received medicinal iron drops at a dosage of 5 mg elemental iron as ferrous sulfate per kilogram of body weight . The parents also received nutritional counseling . Results At the end of treatment , hemoglobin , serum ferritin , hematocrit , mean corpuscular volume , mean corpuscular hemoglobin , and mean corpuscular hemoglobin concentration increased significantly in all groups with no significant differences between groups . The increases in hemoglobin in groups 1 , 2 , and 3 were 2.47 ± 0.17 , 2.12 ± 0.18 , and 2.18 ± 0.18 g/dL , respectively . Measurements of final serum ferritin concentration were available for only 12 , 12 , and 10 children in groups 1 , 2 , and 3 , respectively . In all children who completed the study , except for one in group 1 , hemoglobin , mean corpuscular volume , and serum ferritin reached normal values in response to iron treatment . Conclusions Weekly and twice-weekly iron therapy with 5 mg elemental iron as ferrous sulfate per kilogram of body weight accompanied by nutritional counseling was as effective as daily iron therapy in correcting iron-deficiency anemia in 2- to 6-year-old children under the clinical conditions of this study OBJECTIVE To evaluate the effectiveness of universal prophylactic targeting with iron sulfate on daily or weekly basis in the prevention of anemia in infants . METHODS R and omized clinical field trial with children between ages six and 12 months seen at primary health care units in the municipality of Rio de Janeiro , Brazil , between 2004 and 2005 . Three concurrent cohorts were compared : daily group ( n=150 ; 12.5 mg Fe/day ) ; weekly group ( n=147 ; 25 mg Fe/week ) and control group . The intervention consisted of universal supplementation with iron sulfate for 24 weeks , combined with educational adherence-promoting measures . OUTCOME mean serum hemoglobin concentration , distribution and prevalence of anemia ( Hb<110.0 g/l ) at age 12 months . Effectiveness was evaluated considering both intent to treat and adherence to protocol , using multiple regression analysis ( linear and Poisson ) . RESULTS Groups were homogeneous in terms of descriptive variables . The intervention was implemented successfully , with high adhesion to protocol in both groups , and no statistical difference between them . After adjustment , only the daily regimen showed a protective effect . Adherence analysis demonstrated an evident dose-response effect on mean Hb and prevalence of anemia only for the daily regimen . No protective effect was detected for the weekly regimen . CONCLUSIONS Universal supplementation with iron sulfate from six to 12 months of age was effective in increasing serum Hb and decreasing risk of anemia only when administered on a daily basis OBJECTIVE To investigate the effect of 3 months iron supplementation on physical growth among anemic school children given daily and weekly and to know the response based on hemoglobin level . SUBJECT One hundred forty-four children were measured for height , weight and hemoglobin level . Ninety seven children were anemic ( 67.36 % ) with Hb level < 12 g/dl and forty seven children were non anemic . anemic children were divided into 2 subgroups and r and omly assigned to either daily and weekly Fe treatment for 12 weeks . The non anemic group were treated with weekly iron supplementation , which was accepted by the parents . OUTCOME MEASURES Children 's height , weight , and hemoglobin of T1 and T2 food recall method was used to know calorie , protein , vitamin C and iron intake in both daily and weekly subgroups . Three days food recall was performed in the second and third months by a nutritionist . RESULT After iron supplementation , the hemoglobin level in both group increased significantly . The average change of hemoglobin between the 2 groups gave no significant difference . W/A and H/A after iron supplementation showed significantly increased in both groups . The average change of W/A and H/A between the 2 groups gave no significant difference . CONCLUSION Daily and weekly iron supplementation showed no significant difference in increasing of hemoglobin level and physical growth . Further research must be done with appropriate sample size and well design This study was design ed to propose a more practical , effective , safer , inexpensive , and manageable alternative treatment of iron deficiency anemia ( IDA ) for the developing countries . The study involves 94 children between the ages of 5 months and 6 years who had been seen in the authors ' hospital and diagnosed as having iron deficiency anemia . Ninety-four children with IDA were r and omly divided into two groups : 48 children comprised the first group , which was administered conventional treatment , and 46 children comprised the second group , which was administered intermittent treatment involving iron administration 2 days a week . Twenty-three children whose age and gender distribution were compatible with the other groups were included in the study as the control group . Both groups were reevaluated for their initial hematologic parameters at the end of the treatment . When the parameters of both groups were compared with the parameters of the control group after the treatment , there were no differences between hemoglobin , hematocrit , red blood cell , mean corpuscular volume , mean corpuscular hemoglobin concentration , serum iron , and ferritin levels of conventional and intermittent treatment groups . With respect to certain parameters , such as red cell distribution , serum iron binding capacity , transferrin saturation , transferrin receptor , and transferrin receptor/log ferritin , however , intermittent treatment was superior to the conventional treatment method ( p < .05 ) . In IDA , when a conventional treatment method or an intermittent treatment method is used , there are no differences between the hematological parameters . In fact , the intermittent treatment method has been found to be superior in many parameters Objective : To compare the efficacy of a daily and a weekly iron supplementation on the hematological status of anemic children living at high altitude . Design : Double blind iron supplementation trial including a placebo control group . Setting : A socioeconomically disadvantaged district of La Paz , Bolivia ( altitude of 4000 m ) . Subjects : Anemic ( hemoglobin concentration≤144 g/L ) , 3.3–8.3 y old children of both sexes . Intervention : Children received a placebo ( n=57 ) or a dose of 3–4 mg of elemental iron per kg body weight ( FeSO4 tablets ) 1 d per week ( n=58 ) or 5 d per week ( n=58 ) for 16 weeks . Results : Hemoglobin and zinc erythrocyte protoporphyrin concentrations improved significantly in supplemented groups but not in the placebo group . Changes in hemoglobin during the study were not significantly different between supplemented groups ( weekly group : 15.2±6.9 g/L and daily group : 18.6±11.1 g/L ) but were different from the placebo group ( 0.5±7.1 g/L , P<0.001 ) . At the end of the supplementation period , the hemoglobin distribution was Gaussian , and similar in both supplemented groups . Adjusting for the initial hemoglobin concentration , final hemoglobin and its changes were similar in both supplemented groups . Conclusion : Weekly iron supplementation is as efficacious as daily iron supplementation in improving iron status and correcting moderate iron deficiency anemia in Bolivian school children living at high altitude . Sponsorship : Program supported in part by ORSTROM , the French Ministry of Foreign Affairs and the National Secretary 's Office of Health , Bolivia Many studies have reported comparable hemoglobin response in subjects given intermittent and daily iron supplements .  However , the effect of intermittent iron supplementation on impaired cognitive function , one of the serious consequences of iron deficiency among children , has not been studied . We investigated the effects of 1 d/wk ( weekly ) and 5 d/wk ( daily ) iron supplementation on changes in results of intelligence quotient ( IQ ) , Thai language , and mathematics tests among Thai primary schoolchildren . A double-blind , r and omized , placebo-controlled trial was conducted . Primary schoolchildren ( n = 397 ) were r and omly assigned to receive iron supplements daily or weekly or placebo . Ferrous sulfate ( 300 mg ) or placebo tablets were given under direct observation by the research er for 16 wk . Changes in IQ , and Thai language and mathematics scores were then compared . The increases in hemoglobin concentration were comparable in the weekly and daily iron supplementation groups but serum ferritin increased more in the children supplemented daily . Children receiving daily iron supplements , however , had a significantly lower increase in IQ ( 3 + /- 12 points ) than those receiving the supplement weekly ( 6 + /- 12 points ) or placebo ( 6 + /- 12 points ) , whereas the last-mentioned two groups did not differ . Z-scores of Thai language and mathematics test results did not differ among the groups . We conclude that weekly iron supplementation is the regimen of choice in this study community Growth faltering , anemia , and multiple micronutrient deficiency are common during infancy in developing countries . This South African trial was part of a multicenter study aim ed at testing the efficacy of multiple micronutrient supplementation on growth , anemia , micronutrient status , and morbidity during infancy across 4 countries . A total of 265 infants aged 6 - 12 mo were individually r and omized to 1 of 4 intervention groups : a daily multiple micronutrient supplement ( DMM ) , a daily placebo supplement ( P ) ; a multiple micronutrient supplement 1 d of the week and placebo supplement on the other days of the week ( WMM ) , and a daily iron supplement ( DI ) . For 6 mo , the blinded supplements were provided to mothers at monthly health clinic sessions , and consumption was verified during weekly household visits by community health workers , when morbidity was also checked . Weight and height of the infants were measured monthly , and blood sample s were taken at the beginning and at the end for assessing the infants micronutrient status . There were no significant differences in nutritional status of the groups at baseline with 40 % of infants with anemia ( hemoglobin < 110 g/L ) , 16 % vitamin A deficiency ( plasma retinol < 0.7 micromol/L ) , 47 % zinc deficiency ( plasma zinc < 10.7 micromol/L ) , 2 % underweight , and 11 % stunting . There was no difference in growth or morbidity between the micronutrient supplemented groups and the P group during the 6-mo study . The DMM was the most effective intervention tested , not only for improving anemia but also for improving iron , zinc , riboflavin , and tocopherol status BACKGROUND Micronutrient deficiencies remain common in preschool children in developing countries . Interventions focus on single micronutrients and often lack effectiveness . Weekly instead of daily supplementation may improve effectiveness . OBJECTIVE The efficacy of weekly and daily supplementation in reducing anemia prevalence and in improving the zinc , vitamin A , and growth status of 6 - 24-mo-old Vietnamese children was investigated . DESIGN In this double-blind , placebo-controlled trial , the daily group ( n = 55 ) received 8 mg elemental Fe ( as iron sulfate ) , 5 mg elemental Zn ( as zinc sulfate ) , 333 microg retinol , and 20 mg vitamin C 5 d/wk for 3 mo . The weekly group ( n = 54 ) received 20 mg Fe , 17 mg Zn , 1700 microg retinol , and 20 mg vitamin C once a week . A third group ( n = 54 ) received a placebo only .  Venous blood sample s were collected at the start and end of the supplementation period and anthropometric measurements were taken at the start and 3 mo after the end of supplementation . RESULTS At baseline , 45.6 % of subjects had hemoglobin concentrations < 110 g/L , 36.3 % had zinc concentrations < 10.71 micromol/L , and 45.6 % had retinol concentrations < 0.70 micromol/L. Hemoglobin , retinol , and zinc concentrations of both the weekly and daily groups increased similarly compared with the placebo group ( P < 0.001 ) . There was no significant difference in growth between the supplemented groups and the placebo group . However , the height-for-age of subjects stunted at baseline increased with z scores of 0.48 ( P < 0.001 ) and 0.37 ( P < 0.001 ) for the daily and weekly groups , respectively . CONCLUSIONS Weekly and daily supplementation improved hemoglobin , zinc , and retinol concentrations similarly . Neither intervention affected growth of the overall population , but growth of children stunted at baseline was improved through both types of supplementation BACKGROUND There is still uncertainty about the best procedure to alleviate iron deficiency . Additionally more reliable methods are needed to assess the effect of iron intervention . OBJECTIVE We examined the efficacy of daily iron ( 10 mg ) , daily and weekly multiple-micronutrient supplementation ( 10 and 20 mg Fe , respectively ) in improving body iron stores of Indonesian infants . DESIGN Infants aged 6 - 12 mo were r and omly allocated to 1 of 4 groups : daily multiple-micronutrients ( DMM ) foodlike tablets ( foodLETs ) , weekly multiple-micronutrient ( WMM ) foodLETs , daily iron ( DI ) foodLETs , or daily placebo .  Hemoglobin , ferritin , transferrin receptors , and C-reactive protein data were obtained at baseline and 23 wk . RESULTS Body iron estimated from the ratio of transferrin receptors to ferritin was analyzed for 244 infants . At baseline , mean iron stores ( 0.5 + /- 4.1 mg/kg ) did not differ among the groups , and 45.5 % infants had deficits in tissue iron ( body iron < 0 ) . At week 23 , the group DI had the highest increment in mean body iron ( 4.0 mg/kg ) , followed by the DMM group ( 2.3 mg/kg ; P < 0.001 for both ) . The iron stores in the WMM group did not change , whereas the mean body iron declined in the daily placebo group ( -2.2 mg/kg ; P < 0.001 ) . Compared with the daily placebo group , the DMM group gained 4.55 mg Fe/kg , the DI group gained 6.23 mg Fe/kg ( both P < 0.001 ) , and the WMM group gained 2.54 mg Fe/kg ( P = 0.001 ) . CONCLUSIONS When compliance can be ensured , DI and DMM foodLETs are efficacious in improving and WMM is efficacious in maintaining iron stores among Indonesian infants BACKGROUND Although iron deficiency is a major cause of anemia , other micronutrient deficiencies may also play a role . OBJECTIVE We examined whether multiple micronutrient supplementation is more efficacious than is supplementation with iron and folic acid alone for improving the hemoglobin and iron status of anemic adolescent girls in Bangladesh . DESIGN Anemic ( hemoglobin < 12.0 g/dL ) girls ( n = 197 ) aged 14 - 18 y from rural schools in Dhaka District were entered into a r and omized double-blind trial and received twice-weekly supplements of iron and folic acid ( IFA group ) or multiple micronutrients ( 15 micronutrients , including iron and folic acid ; MMN group ) for 12 wk . RESULTS At recruitment , the characteristics of the girls in the 2 groups were not significantly different , except for family size and body mass index . At the end of the study , although both groups benefited significantly from supplementation , mean changes in hemoglobin and serum ferritin concentrations were not significantly different between groups . Compared with the IFA group , girls in the MMN group had significantly greater increases in mean serum vitamin A , plasma vitamin C , red blood cell folic acid , and riboflavin concentrations ( assessed as erythrocyte glutathione reductase activation coefficient ) . After 12 wk of supplementation , only the prevalence of vitamins A and C and riboflavin deficiencies decreased more significantly in the MMN group than in the IFA group . CONCLUSIONS Twice-weekly MMN supplementation for 12 wk significantly improved the status of the micronutrients assessed but was not more efficacious than was supplementation with iron and folic acid alone in improving the hematologic status of anemic adolescent girls . More frequent doses may be needed to achieve full benefit Intermittent iron supplementation has been suggested as a replacement for daily iron supplements for reducing anemia in developing countries . The effects of once weekly and daily iron supplementation on hemoglobin ( Hb ) , serum ferritin ( SF ) , prevalence of anemia , weight and height are compared in this study . Primary schoolchildren ( n = 397 ) from two selected schools in the Hat Yai rural area , southern Thail and , were recruited in 1999 . All children received Albendazole and then r and omly received ferrous sulfate ( 300 mg/tablet ) either daily or weekly , or a placebo for 16 wk . The average increase in Hb was not significantly different between the daily ( mean + /- SD ; 6.5 + /- 6.0 g/L ) and weekly ( 5.7 + /- 6.3 g/L ) groups . However , the average increase in SF was greater ( P < 0.01 ) in the daily ( mean + /- SD ; 39.8 + /- 30.3 microg/L ) than the weekly ( 13.4 + /- 17.3 microg/L ) group . All cases of iron deficiency anemia were abolished in both daily and weekly groups , whereas no reduction in prevalence occurred in the placebo group . Height gain was greater in children who received weekly ( mean + /- SD ; 2.6 + /- 0.9 cm ) than in those who received daily iron ( mean + /- SD ; 2.3 + /- 0.8 cm ) , ( P < 0.01 ) . Weight gain , weight-for-age and height-for-age were not significantly different among the intervention groups . It is concluded that a weekly iron dose is more effective than a daily dose in height gain but not in hematological improvement over 16 wk of supplementation The present investigation was undertaken to assess the efficacy of oral iron supplementation during pregnancy by using a gastric delivery system ( GDS ) . Three hundred seventy-six pregnant women between 16 and 35 y of age and 14 and 22 wk gestation were selected if mild anemia was present ( hemoglobin concentration 80 - 110 g/L ) . The participants were r and omly assigned to one of three study groups given no iron , two FeSO4 tablets ( 100 mg Fe ) daily , or one GDS capsule ( 50 mg Fe ) daily . Blood was obtained initially and after 6 and 12 wk for measurement of red blood cell and iron indexes , including serum transferrin receptor . There was a significant and comparable improvement in hematologic and iron-status measurements in the two groups of women given iron whereas iron deficiency evolved in women given no iron supplement . We conclude that by eliminating gastrointestinal side effects and reducing the administration frequency of an iron supplement to once daily , a GDS offers significant advantages for iron supplementation of pregnant women BACKGROUND Iron deficiency is the most common micronutrient deficiency and affects > 2 billion persons worldwide , leading to anemia in > 40 % of women of reproductive age in the developing world . OBJECTIVE The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant . DESIGN Participants with a hemoglobin concentration of 80 - 120 g/L were entered into a r and omized , double-blind , placebo-controlled trial and received supplements of placebo , vitamin A , iron + folic acid , or iron + folic acid + vitamin A weekly for 12 wk . The supplements contained 2.42 mg vitamin A ( retinol ) as retinyl palmitate , 120 mg elemental Fe as ferrous sulfate , and 3.5 mg folic acid . RESULTS Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone . There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid , but the additional effect disappeared after adjustment for baseline hemoglobin , serum vitamin A , and ferritin and the number of supplements taken . Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin . Compared with the placebo , iron + folic acid + vitamin A reduced anemia by 92 % , iron deficiency by 90 % , and vitamin A deficiency by 76 % . CONCLUSION There may be significant health benefits from a program that enhances the nutritional status of iron , folate , and vitamin A in poor urban young women before they become pregnant BACKGROUND Iron and zinc deficiency are prevalent during infancy in low-income countries . OBJECTIVES The objectives were to examine whether a weekly supplement of iron , zinc , iron+zinc , or a micronutrient mix ( MM ) of 16 vitamins and minerals would alter infant development and behavior . DESIGN The participants were 221 infants from rural Bangladesh at risk of micronutrient deficiencies .  Development and behavior were evaluated at 6 and 12 mo of age by using the Bayley Scales of Infant Development II and the Home Observation Measurement of Environment ( HOME ) scale . In this double-blind trial , the infants were r and omly assigned to 1 of 5 treatment conditions : iron ( 20 mg ) , zinc ( 20 mg ) , iron+zinc , MM ( 16 vitamins and minerals , including iron and zinc ) , or riboflavin weekly from 6 to 12 mo . Multivariate analyses were conducted to examine the change in development and behavior for each supplementation group , with control for maternal education , HOME score , months breastfed , anemia , growth at 6 mo , and change in growth from 6 to 12 mo . RESULTS Iron and zinc administered together and with other micronutrients had a beneficial effect on infant motor development .  Iron and zinc administered individually and in combination had a beneficial effect on orientation-engagement . Two-thirds of the infants were mildly anemic , no treatment effects on hemoglobin concentration were observed , and hemoglobin was not associated with measures of development or behavior . CONCLUSION The beneficial effects of weekly iron and zinc supplementation on motor development and orientation-engagement suggest that infants benefit from these minerals when administered together The effect of daily vs twice weekly iron supplementation on iron status was studied in preschool children with low iron status in a r and omized double-masked field trial . Subjects ( n = 87 ) were selected on the basis of their hemoglobin concentration being < 111 g/L in finger-prick blood , and were divided into two groups . For 8 wk one group received a daily supplement of 30 mg Fe , while the other group received 30 mg Fe twice per week . A complete data set was obtained from 32 children in the group supplemented daily and from 33 children in the group supplemented twice weekly . Hemoglobin , serum ferritin , and protoporphyrin increased significantly in both groups ( P < 0.001 ) . Changes in hemoglobin and protoporphyrin were correlated with initial hemoglobin concentration ( P < 0.001 ) . The difference in treatment effect between groups was not significant after correction for the initial hemoglobin concentration . It is concluded that in preschool children with low iron status , twice weekly iron supplementation has an effect on iron status similar to that of daily supplementation The effect of weekly iron supplementation with and without deworming on hemoglobin was investigated in a double-masked , placebo-controlled field trial . Subjects were 289 preschoolers who were r and omly divided into three groups . Groups 1 and 2 received 30 mg Fe once weekly and group 3 received a placebo . Group 1 additionally received anthelminthic treatment . Supplements were administered by the mothers , who were educated about iron deficiency beforeh and . In the iron-supplemented groups prevalence of anemia decreased from 37.2 % to 16.2 % ( P < 0.001 ) . Hemoglobin increased by an average of 6.9 + /- 9.8 g/L in the two iron-supplemented groups ( n = 191 ) , which was greater ( P < 0.001 ) than the increase of 1.9 + /- 8.0 g/L in the placebo group . None of the subjects had hookworm , and anthelminthic treatment did not have an additional effect . Iron supplements administered once weekly by mothers reduced anemia without major involvement of health staff A r and omized , double-blind , placebo-controlled trial was performed to assess the efficacy of different micronutrient supplementation regimes for improving micronutrient status , preventing anemia , and growth faltering of Vietnamese infants . A population -based sample of 306 infants aged 6 - 12 mo , split in 4 treatment groups , received daily multiple micronutrient ( DMM ) , daily placebo ( P ) , weekly multiple micronutrient ( WMM ) , or daily iron ( DI ) supplements for 6 mo , 7 d/wk , under supervision . Weight and length were measured monthly , and anemia and plasma levels of ferritin , zinc , riboflavin , retinol , tocopherol , and homocysteine were determined before and after the supplementation . Z-scores for length-for-age and weight-for-age worsened significantly in all groups , but the length-for-age Z-score decreased significantly less in the DMM group ( -0.32 + /- 0.05 ) than in the P and WMM groups ( -0.49 + /- 0.05 and -0.51 + /- 0.05 , respectively , P = 0.001 ) . Hemoglobin levels increased significantly more in the DMM group [ mean ( 95%CI ) : 16.4 g/L ( 12.4 - 20.4 ) ] than in the P group [ 8.6 g/L ( 5.0 - 12.2 ) , P = 0.04 ) , with intermediate nonsignificant increases in the WMM [ 15.0 g/L ( 11.5 - 18.5 ) ] and the DI [ 12.9 g/L ( 8.4 - 17.3 ) ] groups . Ferritin changes were significantly greater in DMM ( 12.1 microg/L ) and DI ( 9.5 microg/L ) than in P ( -14.7 microg/L ) and WMM groups ( -9.7 microg/L ) . Of the other micronutrients , only tocopherol showed a significantly greater level in the DMM group compared with P. Anemia still affected a quarter and zinc deficiency affected a third of infants although there was no iron deficiency after 6 mo of supplementation with DMM , suggesting that multiple factors are causing anemia and that the dose of zinc is too small BACKGROUND Iron deficiency and its consequent anemia constitute the commonest micronutrient deficiency in the world . OBJECTIVE We investigated whether long-term , weekly iron-folate supplements administered at school would improve hemoglobin and ferritin concentrations in adolescent girls , including those with mild-to-moderate anemia and hemoglobin concentrations indicating borderline anemia . DESIGN Subjects were 266 girls with hemoglobin concentrations of 80 - 119.9 g/L ( group A ) and 358 girls with hemoglobin concentrations of 120 - 130 g/L ( group B ) who were otherwise healthy . Two hundred sixty-six girls in group A and 268 girls in group B were r and omly assigned to receive either 60 or 120 mg Fe plus 3.5 mg folic acid weekly for 22 wk . Ninety of the girls in group B were r and omly assigned to receive only 5 mg folic acid weekly . Capillary hemoglobin and plasma ferritin were measured at baseline and after 12 and 22 wk of supplementation . RESULTS By the end of the study , 2 % of the girls had dropped out and > 96 % had taken > or = 20 of the 22 tablets ; side effects were minimal . Mean plasma ferritin increased significantly in all iron-supplemented groups , independently of initial hemoglobin values and iron doses . Ferritin concentrations decreased in the girls supplemented with folic acid only . As expected , hemoglobin responses to iron were higher in group A than in group B and increases were positively correlated with initial plasma ferritin . Hemoglobin failed to respond to folate supplementation if initial plasma ferritin concentrations were low . Mean hemoglobin increased significantly and consistently in relation to the length of treatment . CONCLUSION Long-term , weekly iron-folate supplementation was found to be a practical , safe , effective , and inexpensive method for improving iron nutrition in adolescent schoolgirls Anemia , micronutrient deficiencies , and growth faltering are still common in Peru . The study objective was to determine the efficacy of different micronutrient supplements in preventing growth failure , anemia , and  micronutrient deficiencies  in Peruvian infants . Three hundred and thirteen infants aged 6 to 12 mo participated in a double-blind , masked , controlled trial in which they were r and omly assigned to receive either a daily dose of iron ( DI ) , a daily dose of multiple micronutrients ( DMM ) , a weekly dose of multiple micronutrients , or a placebo ( P ) for 6 mo . None of the supplements tested prevented growth faltering or the morbidities common during infancy . Anemia and plasma homocysteine concentrations fell significantly in all groups during the study , but the mean change of plasma homocysteine during the trial period was significantly smaller in the DI group than in other groups , and the increase in hemoglobin concentrations was smaller in the P group than the micronutrient treatment groups . Plasma ferritin concentrations decreased least in the groups taking daily micronutrient supplements containing iron ( DI and DMM ) . There were no significant differences among groups in mean final values or changes in plasma zinc , retinol , tocopherol , or riboflavin . Although the DMM intervention was the most efficacious for preventing anemia , iron , and zinc deficiencies , 15 % , 20 % , and 50 % of this group still remained anemic , zinc deficient , and iron deficient , respectively , at the end of the study . Further research thus should investigate whether higher doses of iron and zinc , together with infection control measures , are more efficacious Because infants and young children in many developing countries are deficient in both iron and zinc , and zinc can affect iron metabolism , evaluation of optimum strategies to simultaneously supplement iron and zinc is an important public health priority . This study evaluated the efficacy of weekly supplementation of iron or zinc or both on iron , zinc , and copper status in Bangladeshi infants . In a double-blind , r and omized , controlled community trial , 6-mo-old infants were assigned to receive weekly supplements of 1 mg riboflavin ( control , n = 82 ) or 1 mg riboflavin + 20 mg iron ( n = 83 ) , 20 mg zinc ( n = 83 ) , or both ( n = 85 ) for 6 mo . Hemoglobin , serum ferritin , transferrin receptor , zinc , and copper concentrations were measured at baseline and at the end of intervention . Serum Zn increased in both groups receiving zinc ; the increase was greatest among children with low baseline serum zinc concentration . Iron status indicators did not differ among the groups before or after 6 mo of supplementation . Supplementation with either zinc or iron decreased serum copper after 6 mo . Joint supplementation did not alter the individual effects of iron or zinc supplementation in these Bangladeshi children . However , the dosing regimen may not have been adequate to achieve the desired biochemical effects A recent meta- analysis of 14 clinical trials indicated that daily compared with intermittent iron supplementation result ed in significantly greater hematological improvement in pregnant women . No such definitive beneficial effect was demonstrated in preschool children . We compared the efficacy of daily and twice weekly iron supplementation for 6 wk under supervised and unsupervised conditions in the treatment of mild and moderate anemia [ hemoglobin ( Hb ) 50 - 109 g/L ] in children aged 2 - 59 mo living in a malaria-endemic area of western Kenya . The study was a cluster-r and omized trial using a factorial design ; participants were aware of the treatment assigned . All children ( n = 1049 ) were administered a single dose of sulfadoxine-pyrimethamine at enrollment followed by 6 wk of daily supervised iron supplementation [ 3 - 6 mg/(kg.d ) ] , twice weekly supervised iron supplementation [ 6 - 12 mg/(kg.wk ) ] , daily unsupervised iron supplementation , or twice weekly unsupervised iron supplementation . In the supervised groups , Hb concentrations at 6 and 12 wk ( 6 wk postsupplementation ) were significantly higher in children given iron daily rather than twice weekly [ mean ( 95 % CI ) difference at 6-wk : 4.2 g/L ( 2.1 , 6.4 ) ; 12-wk : 4.4 g/L ( 1.8 , 7.0 ) ] . Among the unsupervised groups , Hb concentrations were not different at 6 wk [ mean ( 95 % CI ) difference : 0.86 g/L ( -1.4 , 3.1 ) ] , but significantly higher at 12 wk for those assigned daily iron [ mean ( 95 % CI ) difference : 3.4 g/L ( 0.79 , 6.0 ) , P = 0.02 ] . In this malarious area and after initial antimalarial treatment , 6 wk of daily iron supplementation results in better hematological responses than twice weekly iron supplementation in the treatment of anemia in preschool children , regardless of whether adherence can be ensured Given the high prevalence of micronutrient deficiencies and infectious diseases in infants in developing countries , an evaluation of the efficacy of different micronutrient formulations on infant morbidity is a priority . The efficacy of weekly supplementation of four different micronutrient formulations on  diarrhea and acute lower respiratory infection ( ALRI ) morbidity  was evaluated in Bangladeshi infants . In a double-blind , r and omized , controlled community trial , 799 infants aged 6 mo were r and omly assigned to one of the following 5 groups : 1 ) 20 mg elemental iron with 1 mg riboflavin , 2 ) 20 mg elemental zinc with 1 mg riboflavin , 3 ) 20 mg iron and 20 mg zinc with 1 mg riboflavin , 4 ) a micronutrient mix ( MM ) containing 20 mg iron , 20 mg zinc , 1 mg riboflavin along with other minerals and vitamins and 5 ) a control treatment , 1 mg riboflavin only . Health workers visited each infant weekly until age 12 mo to feed the supplement and to collect data on diarrhea and ALRI morbidity . Hemoglobin , serum ferritin and serum zinc levels of a sample of infants were measured at 6 and 12 mo . Compared with the control group , at 12 mo , serum ferritin levels were higher in the iron + zinc group , and serum zinc levels were higher in the zinc and iron + zinc groups . Simultaneous supplementation with iron + zinc was associated with lower risk of severe diarrhea , 19 % lower in all infants and 30 % lower in less well-nourished infants with weight-for-age Z-score below -1 . Iron + zinc supplementation was also associated with 40 % lower risk of severe ALRI in less well-nourished infants . MM supplementation was associated with a 15 % higher risk of diarrhea in all infants and 22 % higher risk in less well-nourished infants . Intermittent simultaneous supplementation with iron + zinc seems promising ; it will be useful to determine whether higher doses would provide greater benefits OBJECTIVES To assess impact of daily and intermittent iron-folate ( IFA ) supplementation on cognition of underprivileged primary schoolgirls in Vadodara . DESIGN Experimental-control longitudinal study . SETTING Municipal primary schools . PARTICIPANTS Schoolgirls ( n=161 ) in the age group of 9 - 13 years . INTERVENTION Participants at three r and omly selected schools were given IFA tablets ( 100 mg elemental iron + 0.5 mg folic acid ) either once weekly or twice weekly or daily for one year . The fourth was the control school . OUTCOME MEASURES Digit span , maze test , visual memory test , and clerical task scores . RESULTS IFA supplementation given daily and twice-weekly significantly improved cognition in most tests ; the effect was not seen in once-weekly or control groups . In daily and twice weekly IFA groups , positive change in cognition test scores was relatively higher in girls with good compliance ( < 70 % dose ) vs. poor compliance ; in anemic ( hemoglobin < 11 g/dL ) vs non-anemic girls and in those with higher hemoglobin ( Hb ) gain ( < 1g/dL ) vs. lower Hb gain . CONCLUSION Twice weekly IFA supplementation is comparable to daily IFA in terms of beneficial effects on cognition in young adolescent girls To assess the efficacy and acceptability of a daily and intermittent iron supplementation , a double-blind , placebo-controlled trial was conducted in a public school located in periurban Lima , Peru . Adolescent girls ( n = 312 ) , 12 - 18 y old , were r and omly assigned to one of the following three groups : 1 ) 60 mg iron as ferrous sulfate daily from Monday to Friday ; 2 ) 60 mg iron as ferrous sulfate 2 d/wk and 3 d placebo ( intermittent ) ; 3 ) placebo , from Monday to Friday . Field workers gave the girls supplements during school hours for 17 wk ; 296 girls completed the trial . Girls took 94 % of the expected dose of 85 pills . Few side effects were reported . Postintervention , hemoglobin ( Hb ) , serum ferritin ( SF ) and free erythrocyte protoporphyrin ( FEP ) were improved significantly in the iron-supplemented groups compared with placebo ( P<0.05 ) . Daily supplements led to higher Hb increases than intermittent supplements ( P<0.05 ) , but SF and FEP were similar between the two groups . Thus , both iron supplementation schedules were efficacious in preventing iron deficiency in adolescent girls through the school system , and the daily schedule was better than the intermittent schedule at increasing Hb values and reducing anemia Iron deficiency anemia ( IDA ) is still a major nutritional and public health problem in developing countries . The prevalence among young children and pregnant women is particularly high . Daily oral supplementation with medicinal iron is considered an effective strategy for reducing the incidence of IDA but non-compliance is a major problem with this strategy . We undertook this study to compare the results of once-weekly vs. daily oral iron supplementation in schoolchildren . Sixty children ranging between 5 and 10 years with iron deficiency anemia were selected from a school in Karachi , Pakistan and were divided into two equal groups , i.e. , daily and weekly supplementation groups . Hemoglobin ( Hb ) , hematocrit ( Hct ) , serum iron , total iron binding capacity ( TIBC ) , and serum ferritin were determined before the start of the study . Ferrous sulfate ( 200 mg ) was given daily to the daily supplementation group and once-weekly to the weekly supplementation group for 2 months . When post-supplementation values of the above-mentioned parameters were determined , a significant improvement was observed in all parameters in both groups . It is concluded that once-weekly iron supplementation is as effective as daily supplementation for the treatment of iron deficiency anemia . Moreover , weekly iron supplementation is cost effective and has no or fewer side-effects Objectives : To determine the effect of low-dose weekly supplementation with iron , zinc or both on growth of infants from 6 to 12 months of age . Subjects/ Methods : A total of 645 breastfed infants age 6 months who were not severely anemic ( Hb⩾90 g l−1 ) or severely malnourished ( weight-for-age ⩾60 % median ) were r and omized to receive 20 mg iron and 1 mg riboflavin ; 20 mg zinc and 1 mg riboflavin ; 20 mg iron , 20 mg zinc and 1 mg riboflavin ; or riboflavin alone ( control ) weekly for 6 months . Results : Baseline characteristics were similar among the four supplementation groups . Weight , length and mid-upper arm circumference were assessed at baseline , 8 , 10 and 12 months of age . There was no interaction of iron and zinc when given in a combined supplement on either weight or length ( P>0.05 ) . There were no effects of either iron or zinc on the rate of length or weight gain for all infants or when stratified by baseline Hb concentration . Conclusions : Weekly supplementation of 20 mg Fe , 20 mg Zn , or both does not benefit growth among infants 6–12 months of age in rural Bangladesh , a region with high rates of anemia and zinc deficiency OBJECTIVE This study analyses the impact of weekly iron supplementation with ferrous sulphate heptahydrate ( FeSO4 ) in 5-year-olds compared with placebo , on hemoglobin ( Hb ) and hematocrit ( Ht ) values and anemia . DESIGN The study concerns a cluster-r and omized , placebo-controlled double-blind trial . Intervention participants received 50 mg elemental iron for 14 weeks . SETTING The study population comprised pre-school children ( n = 135 ) from one r and omly chosen public school in the northeast of Brazil . SUBJECTS Participants were 5-year-old students from a public school . RESULTS Mean Hb and Ht values increased after iron supplementation , with p < 0.0001 . There was no statistically significant increase in the placebo group . After intervention , anemia prevalence reduced only in the intervention group , from 48.0 % to 26.0 % . CONCLUSIONS Weekly iron supplementation was effective in reducing anemia in 5-year-olds Summary Background Recent data suggest that daily iron supplementation of iron-replete children could impair their growth . If verified for weekly iron supplementation these results would markedly complicate targeting and implementing school-based weekly iron supplementation programs . Aim of the study To ascertain the effect of weekly iron supplementation on the growth and hemoglobin status of non-anemic school-age children . Subjects and methods 73 Bolivian non-anemic school-age children r and omly assigned to the treatment group ( n=37 ; receiving supplements containing FeSO4 during 18 weeks ) or the control group ( n=36 ; receiving a placebo during the same period ) . Hemoglobin concentration and anthropometric measures were determined for each child at the beginning ( T0 ) and the end ( T18 ) of the study . Results The treatment group did not show any significant variation in hemoglobin concentration between T0 and T18 ( −1.6±10.4 g/L ; P=0.40 ) whereas the control group showed a significant decrease in hemoglobin concentration ( −4.6±10.9 g/L ; P=0.03 ) . Anthropometric changes were not significantly different between the treatment and the control groups for weight , ( 1.63±1,11 kg vs 1.88±0.79 kg ; P=0.30 ) , height ( 2.35±0.94 cm vs 2.11±1.03 cm ; P=0.34 ) or mid-upper arm circumference ( 0.29±0.57 cm vs 0.22±0.54 cm ; P=0.64 ) . Conclusion In our study , weekly iron supplementation of non-anemic school-age children had no negative effect on their growth while having a positive effect in preventing significant decreases in hemoglobin concentration . These results suggest that in regions where iron deficiency anemia ( IDA ) is prevalent , a simple and cost-effective way to control IDA in school-age children is to give weekly iron supplements to all children at school Background / Objectives : Iron deficiency anemia is a major public health problem in developing countries and may affect school performance and physical work capacity in nonpregnant adolescents , and may increase the risk of anemia during subsequent teenage pregnancies . We assessed the effect of weekly iron ( 120 mg elemental iron ) and vitamin A ( 25 000 IU ) supplementation on hemoglobin , iron status and malaria and nonmalaria morbidity in adolescent schoolgirls . Subjects/ Methods : A total of 279 schoolgirls aged 12–18 years from public primary schools in Kisumu , western Kenya . Double-blind r and omized placebo-controlled trial using a factorial design . Results : Five months of iron supplementation was associated with a 0.52 g dl−1 ( 0.21 , 0.82 ) greater increase in hemoglobin relative to iron placebo . The effect was only observed in girls with iron deficiency on enrollment ( 1.34 g dl−1 ( 0.79 , 1.88 ) ) , but not in iron-replete girls ( −0.20 g dl−1 ( −0.59 , 0.18 ) ) . Similar differences in treatment effect were seen between menstruating and nonmenstruating girls . The effect of iron was independent of vitamin A. The baseline prevalence of vitamin A deficiency was low ( 6.7 % ) and no sustained increase in hemoglobin was seen with weekly vitamin A ( −0.07 g dl−1 ( −0.38 , 0.25 ) ) . Incidence of malaria parasitemia was higher in the iron than iron-placebo groups ( Rate ratio 1.33 ( 0.94 , 1.88 ) ) . Conclusions : Weekly iron supplementation results in substantial increases in hemoglobin concentration in adolescent schoolgirls in western Kenya , which may outweigh possible risks caused by malaria , but only in iron-deficient or menstruating girls and not in iron-replete and nonmenstruating girls BACKGROUND Malaria and anaemia , especially that due to iron deficiency , are two leading causes of morbidity worldwide . Little is known about the relative contribution of Plasmodium falciparum infection and iron deficiency to the aetiology of anaemia in malaria-endemic areas . We undertook a r and omised comparison of different strategies for control of anaemia and malaria in infants , including an assessment of the effect of iron supplementation on malaria susceptibility . METHODS 832 infants born at one hospital in a malaria-hyperendemic area of Tanzania between January and October , 1995 , were r and omly assigned to group DI , receiving daily oral iron ( 2 mg/kg daily ) plus weekly Deltaprim ( 3.125 mg pyrimethamine plus 25 mg dapsone ) ; group IP , receiving iron plus weekly placebo ; group DP , receiving daily placebo plus weekly Deltaprim ; or group PP . supplementation was given from 8 to 24 weeks of age , and the weekly chemoprophylaxis from 8 to 48 weeks . The frequency of severe anaemia ( packed-cell volume < 25 % ) and malaria episodes was assessed through a combination of passive case detection and cross-sectional surveys . FINDINGS The groups that received iron supplementation had a lower frequency of severe anaemia than those that did not receive iron ( 0.62 vs 0.87 cases per person-year ; protective efficacy 28.8 % [ 95 % CI 6.3 - 45.8 ) . Iron supplementation had no effect on the frequency of malaria ( 0.87 vs 1.00 cases per person-year ; protective efficacy 12.8 % [ -12.8 to 32.5 ] ) . The groups that received malaria prophylaxis had lower frequencies of both severe anaemia ( 0.45 vs 1.04 episodes per person-year ; protective efficacy 57.3 % [ 43.0 - 67.9 ] ) and malaria ( 0.53 vs 1.34 episodes per person-year ; protective efficacy 60.5 % [ 48.2 - 69.9 ] ) than the groups that did not receive prophylaxis . After the end of the intervention period , children who had received malaria chemoprophylaxis had higher rates of severe anaemia and malaria than non-chemoprophylaxis groups ( relative risks 2.2 [ 1.3 - 3.7 ] and 1.8 [ 1.3 - 2.6 ] ) . INTERPRETATION Malaria chemoprophylaxis during the first year of life was effective in prevention of malaria and anaemia but apparently impaired the development of natural immunity . Iron supplementation was effective in preventing severe anaemia without increasing susceptibility to malaria . Our findings support iron supplementation of infants to prevent iron-deficiency anaemia , even in malaria-endemic areas In Vietnam the high prevalence of iron deficiency anaemia in infants and young children speaks for implementing early interventions . This study aim ed to evaluate the efficacy of the daily iron supplementation in infants given by their mothers and of the weekly iron supplementation .  Two hundred and seventy infants aged 5 to 12 months , were divided into four groups . Group 1 received a placebo daily and group 2 a daily dose of 15 mg iron ( 2.0 + /- 0.3 mg iron/day/kg body weight ) which was given by their mothers for three months . Group 3 received a daily dose of 15 mg iron and group 4 a weekly dose of 15 mg iron given during 6 months by health auxiliaries . The hemoglobin concentration ( Hb ) was measured before the intervention and after 3 months of supplementation in all groups , and again after 6 months of supplementation in groups 3 and 4 . After 3 months of iron supplementation , the hemoglobin concentration increased significantly by 21.6 + /- 12.3 g/l and the prevalence of anaemia decreased from 81.3 % to less than 9 % in group 2 . The weekly iron supplementation was significantly less effective than the daily supplementation : after 3 months , Hb increased by 15.4 + /- 13.3 g/l in group 3 and by 11.2 + /- 10.2 g/l in group 4 ( p = 0.04 ) and the prevalence of anaemia was 17.9 % and 41.5 % in groups 3 and 4 , respectively . After 6 months of supplementation , changes in Hb were not significantly different between group 3 ( 22.0 + /- 12.1 g/l ) and group 4 ( 20.0 + /- 10.0 g/l , p = 0.30 ) . However , the final hemoglobin concentration was significantly lower in group 4 ( 120.5 + /- 7.2 g/l ) than in group 3 ( 123.6 + /- 7.8 , p = 0.02 ) . Moreover , nearly 8 % of the children were still anemic in group 4 versus 0 % in group 3 . Since the early developmental period , when the brain and other specific organs are especially sensitive to iron deficiency , is critical , 3-month daily iron supplementation of infants from the age of 6 months has to be recommended , followed by a weekly iron supplementation until the age of 15 months . The community approach , where mothers informed on the importance of iron deficiency anaemia and on the consequences for the health of their infants gave the iron supplements , was shown to be effective . However , its sustainability would depend on the availability of low-cost iron supplements affordable by population s with limited economic re sources . Other interventions , such as iron supplementation of women during fertile age , especially during pregnancy and lactation periods , and the use of complementary food to breast milk , fortified with micronutrients , should be associated OBJECTIVE To examine the benefits of anemia prophylaxis in adolescent school.girls by weekly or daily iron-folate supplementation . DESIGN Prospect i ve study . SETTING Government girl schools of northeast Delhi . SUBJECTS 2088 subjects ( with hemoglobin greater than 7.9 g/dL ) , including 702 on daily and 695 on weekly iron-folate administration ; 691 girls served as controls .  RESULTS About 85 % girls were iron deficient out of which 49.3 % were anemic . Weekly administration took longer time to raise hemoglobin but was effective as well as practical . Plasma ferritin estimation in girls showed rise in level in both the treated groups . CONCLUSION Weekly administration of iron-folate was a practical and effective strategy for anemia prophylaxis in adolescent school girls 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 : High prevalences of vitamin A deficiency and anaemia among adolescents warrant interventions . This study evaluated the effectiveness of school-based supplementation to reduce anaemia and improve vitamin A status . Design : School-based , grade -r and omized , intervention . Subjects and setting : In all , 1757 girls and 1859 boys , aged 12–15 y , in 24 Junior High Schools . Interventions : Weekly supplementation for 14 weeks with 60 mg iron and 250 μg folate ( Fe group ; n=978 ) , 10 000 IU vitamin A ( VA group ; n=970 ) or both ( VAFe group ; n=1042 ) to subjects in 15 schools , compared to subjects in nine other schools not receiving supplements  ( control ; n=626 ) . Results : The baseline anaemia prevalence ( Hb < 120 g/l ) in girls was 20 % ( prepubertal ) and 26 % ( pubertal ) , and in boys 24 % ( pre-pubertal ) and 11 % ( pubertal ) . Serum retinol concentrations were low ( < 1.05 μmol/l ) in 41 % of boys and 45 % of girls . The interventions did not increase haemoglobin concentrations . Serum retinol concentration of boys , but not girls , in the VA group increased ( 0.33 vs 0.07 μmol/l in controls ; P<0.01 ) . The risk factors for low serum retinol concentration were lower baseline serum retinol concentration ( OR 0.02–0.03 ) with , for girls , nightblindness at baseline ( OR 5.88 ) , and for boys , not receiving vitamin A ( OR control : 1.00 ; VA : 0.37 ; Fe : 0.77 ; VAFe : 0.34 ) and maternal illiteracy ( OR mother never attended school 1.00 , mother received any formal education 0.17–0.33 ) . Conclusions : Supplementation with vitamin A increased serum retinol concentration of boys . Iron supplementation did not change Hb . This appeared to be due to poor compliance , and partly related to side effects . Sponsorship : This study was funded by USAID through the OMNI Project To investigate the efficacy of two different iron supplements administered either on a weekly basis or during menstruation , a 16-week community experimental study was carried out among postmenarcheal female adolescent students in Kupang , East Nusa Tenggara , Indonesia . Forty eight students received a placebo tablet  weekly , 48 other students got an iron tablet weekly and 41 students took an iron tablet for four consecutive days during their menstruation cycle . All subjects were given deworming tablets before supplementation . Haemoglobin , serum ferritin , height , weight , mid-upper arm circumference and dietary intake were assessed before and after intervention . The supplementation contributed to a significant improvement in the iron status of the intervention groups compared to the placebo group ( P < 0.05 ) . In the menstruation group , the haemoglobin concentrations of the anaemic subjects improved significantly ( P < 0.05 ) while for the non-anaemic subjects , serum ferritin concentrations also increased significantly ( P < 0.05 ) . In the weekly group for anaemic and nonanaemic subjects , there was a significant increase in both haemoglobin and serum ferritin concentrations ( P < 0.05 ) . This study revealed that weekly supplementation of iron tablets continued for 16 weeks contributed a higher improvement to haemoglobin concentration , compared with supplementing iron tablets for four consecutive days during menstruation for four menstrual cycles . This suggests that weekly iron supplementation is preferable OBJECTIVE To compare the effectiveness of weekly vs daily iron and folic acid supplementation for control of anemia in adolescent Nepalese girls . DESIGN R and omized controlled trial . SETTING A Government Girl School in Dharan , Nepal , an urban foothill town that is 305 m above sea level . SUBJECTS Consecutive healthy adolescent girls ( n = 209 , median age 15 years ) r and omized to 3 groups matched for age , anthropometry , and personal and sociodemographic characteristics . Of 209 subjects , 181 completed the trial . Two girls had adverse reactions to treatment and were excluded . INTERVENTION Group A ( n = 70 ) received a 350-mg ferrous sulfate and 1.5-mg folic acid combination once daily for 90 to 100 days . Group B ( n = 67 ) received the tablet under supervision once a week for 14 weeks . Group C ( n = 72 ) did not receive any drugs . OUTCOME VARIABLE Presupplementation and postsupplementation differences in prevalence of anemia and change in hematocrit . RESULTS Prevalence of anemia ( defined as hematocrit < 36 % ) declined from 68.6 % and 70.1 % in groups A and B to 20 % and 13.4 % , respectively , postsupplementation ( P<.001 ) , whereas the prevalence in group C changed little ( 68.1 % to 65.3 % , P = .81 ) . There was a significant rise in the mean hematocrit of both supplemented groups ( group A , 32.9 % + /- 3.5 % to 41.0 % + /- 5.6 % , P<.001 ; group B , 33.2 % + /- 3.6 % to 40.4 % + /- 4.9 % , P<.001 ) but no appreciable change in controls ( 34.2 % + /- 2.9 % to 34.1 % + /- 3.3 % , P = .91 ) . Net change in mean hematocrit in both the supplementation groups was comparable ( P = .57 ) . CONCLUSIONS The prevalence of anemia in adolescent Nepalese girls is high . Supervised iron and folic acid therapy once a week is an effective alternative to daily administration and helps lower the prevalence of anemia in adolescent girls Aims : To compare the efficacy of a weekly high-dose ( 2,800 µg ) folic acid supplement with a daily ( 400 µg ) folic acid supplement in lowering homocysteine concentrations in healthy women of childbearing age . Methods : Free-living healthy women of childbearing age ( n = 138 ) were r and omized to receive a weekly ( 2,800 µg ) , a daily ( 400 µg ) folic acid supplement , or placebo .  Blood sample s were collected at baseline and at 12 weeks and analyzed for serum homocysteine and erythrocyte folate . Results : At 12 weeks the mean ( 95 % CI ) serum homocysteine concentrations declined significantly ( p < 0.05 ) in women receiving the daily [ week 12 – baseline : –1.4 ( –2.0 , –0.70 ) µmol/l ] and the weekly supplement [ –1.3 ( –2.1 , –0.5 ) µmol/l ] versus placebo [ 0.0 ( –0.5 , 0.5 ) µmol/l ] . There was no significant difference between the two folate-treated groups ( p > 0.05 ) . At 12 weeks the mean erythrocyte folate concentration increased significantly in both supplemented groups versus placebo ( p < 0.001 ) . The increase in erythrocyte folate was significantly greater ( p < 0.001 ) in the daily group than in the weekly group [ 451 ( 380 , 521 ) vs. 288 ( 240 , 335 ) nmol/l ] . Conclusion : A weekly high-dose folic acid supplement was as effective as a daily supplement in lowering homocysteine concentrations in healthy women of childbearing age . Further study is needed to determine if weekly folic acid supplementation is effective in lowering homocysteine concentrations in population s with high homocysteine OBJECTIVES To obtain baseline data on hemoglobin ( Hb ) levels of adolescent girls belonging to the low-socio-economic groups ; investigate the comparative efficacy of once ' weekly ' and ' daily ' administration of iron-folate tablets with respect to impact on the Hb levels ; and find out the effect of added ascorbic acid supplementation on the efficacy of iron-folate administration with respect to increment in Hb levels . DESIGN R and omized experimental . SETTING Adolescent girls of poor communities in urban areas of Delhi and rural parts of Bharatpur ( Rajasthan ) . METHODS The baseline investigations included measurements of height , weight , and Hb levels . The Hb levels of the participating subjects were measured again after 3 months and 6 months of supplementation . RESULTS 61.9 % of the subjects in the urban and 85.4 % in the rural area were anemic . The response of Hb levels to daily iron/folate supplementation was better in comparison to once-weekly supplementation . The increment in Hb levels of subjects due to addition of vitamin C to iron/folate supplementation was more than that with supplementation of iron/folate alone . CONCLUSIONS Considering compliance , feasibility and cost-factors , a public-health approach consisting of once-weekly distribution of iron/folate supplementation through schools and welfare centers is better and can be recommended as an appropriate strategy for combating anemia in adolescent girls of poor communities in developing countries like India OBJECTIVE To compare the effects of different prophylactic iron doses on the growth and nutritional status of non-anemic infants . METHODS Prospect i ve r and omized study . Infants aged 5.0 to 6.9 months who met the inclusion criteria and showed capillary hemoglobin > or= 11 g/dL were r and omly allocated into three groups who received the following prophylactic doses of iron supplement ( ferrous sulfate ) : 1 mg/kg/day ( n = 39 ) ; 2 mg/kg/day ( n = 36 ) ; and 25 mg/week ( n = 39 ) . This supplementation was given during 16 weeks . Both weight and length were measured . The nutritional status was evaluated by comparing z scores for weight/age , length/age and weight/length based on the World Health Organization ( 2006 ) references . Morbidity information was collected during monthly visits . RESULTS The groups showed similar nutritional status before supplementation . There were no differences in daily nutrient intake among groups . During the study , weight and length gain , and increments in anthropometric indices did not differ statistically among supplemented groups . The occurrence and duration of morbidity episodes did not differ statistically among groups . In general , improvements were observed in both weight/age and weight/length indices in the population under study , whereas length/age showed no differences before and after supplementation . CONCLUSION Different prophylactic iron doses had no different effects on the growth and nutritional status of non-anemic infants OBJECTIVE To evaluate the impact of weekly treatment with ferrous sulfate on hemoglobin level , morbidity and nutritional status in a sample of anemic infants from Zona da Mata Meridional in the state of Pernambuco , Brazil . METHODS A controlled , community-based intervention was carried out with 378 infants who were followed-up for 18 months .  Hemoglobin level was measured at 12 months in a total of 245 children r and omly selected . Participating infants were divided into three groups : two received 45 mg of elemental iron weekly , from 12 to 18 months of life ( 69 children with moderate/severe anemia , and 111 with mild anemia ) ; the third group was composed of 65 non-anemic children , who received no intervention . The remaining 133 children constituted the control group , for comparisons on nutritional status and morbidity . RESULTS The prevalence of anemia was 73.5 % at 12 months of life . After 6 months of treatment , 42.3 % of anemic children reached hemoglobin levels > or= 11.0 g/dL. The mean increase was 1.6 g/dL , being higher ( 2.5 g/dL ) in the group with lower levels of hemoglobin at baseline . Children without anemia at baseline received no treatment , and 40.3 % of them became anemic at the end of follow-up , with a mean decrease of 0.5 g/dL in hemoglobin levels . A significantly greater weight gain was observed in the two treated groups , while no significant improvements were seen in linear growth and duration of diarrhea . CONCLUSIONS The fact that less than half the children receiving ferrous sulfate recovered from anemia at the end of follow-up , along with the development of anemia in many untreated , previously non-anemic infants , suggests the need for effective control strategies BACKGROUND Iron supplementation is recommended for children at high risk of anaemia , but its benefits may not outweigh the associated risk of malaria in areas of seasonal transmission . We investigated the effect on haemoglobin concentrations of intermittent administration of iron supplements and sulfadoxine-pyrimethamine in symptom-free children under intense health surveillance . METHODS In a trial of two by two factorial design , 328 anaemic Kenyan children were r and omly assigned either iron or placebo and sulfadoxine-pyrimethamine or placebo ( 82 to each group ) . Primary outcomes were haemological indicators of iron status and inflammation at the end of the follow-up , and occurrence of malaria attacks . Morbidity surveillance consisted of medical examinations every 4 weeks , continuous passive case detection , and visits twice a week to community health-workers . Analyses were by intention to treat . FINDINGS After 12 weeks , the groups assigned iron plus sulfadoxine-pyrimethamine , iron alone , or sulfadoxine-pyrimethamine alone had higher haemoglobin concentrations than the group assigned placebo ( treatment effect adjusted for prognostic factors at baseline : 11.1 g/L [ 95 % CI 7.5 to 14.7 ] ; 10.7 g/L [ 7.1 to 14.3 ] ; and 3.1 g/L [ -0.5 to 6.7 ] ) . Administration of iron plus sulfadoxine-pyrimethamine also lowered the proportion with anaemia from 100 % at baseline to 36 % at 12 weeks , and of iron deficiency from 66 % at baseline to 8 % at 12 weeks . Survival analysis showed no evidence of substantially increased risk of malaria after iron supplementation . INTERPRETATION Iron supplementation gives substantial health benefits , which may outweigh possible inherent risks caused by malaria . A larger study than ours is needed to assess benefits and risks of intermittent administration of sulfadoxine-pyrimethamine in reducing the incidence of malaria attacks in areas of seasonal malaria transmission Malarial anemia is associated with a shift in iron distribution from functional to storage compartments . This suggests a relative deficit in erythropoietin production or action similar to that observed in other infections . Our study in Kenyan children with asymptomatic malaria aim ed at investigating whether malaria causes increased erythropoiesis , and whether the erythropoietic response appeared appropriate for the degree of result ing anemia . Longitudinal and baseline data were used from a trial with a 2 x 2 factorial design , in which 328 anemic Kenyan children were r and omly assigned to receive either iron or placebo , and sulfadoxine-pyrimethamine or placebo .  Erythropoiesis was evaluated by serum concentrations of erythropoietin and soluble transferrin receptor . Prospect ively collected data showed that malarial infection result ed in decreased hemoglobin concentrations , and increased serum concentrations of erythropoietin and transferrin receptor . Conversely , disappearance of malarial antigenemia result ed in increased hemoglobin concentrations , and decreased concentrations of these serum indicators . Additionally , our baseline data showed that current or recent malarial infection is associated with increased serum concentrations of erythropoietin and transferrin receptor , and that these were as high as or perhaps even higher than values of children without malarial infection and without inflammation . Our findings indicate that in asymptomatic malaria , the erythropoietic response is adequate for the degree of anemia , and that inflammation probably plays no or only a minor role in the pathogenesis of the result ing anemia . Further research is needed to demonstrate the role of deficient erythropoietin production or action in the pathogenesis of the anemia of symptomatic malaria The aim of this study was to investigate the effects of different doses of iron on haematological status of breastfed infants . One hundred and thirteen infants were r and omized into four groups at 5 months of age .  Iron supplementation was given at doses of 1 mg/kg/day , 2 mg/kg/day , and 2 mg/kg/every other day in the first three study groups , respectively , and the last group received placebo . The hematological values , except hemoglobin , were higher in the group supplemented with iron at a dose of 2 mg/kg/day , and ferritin values were statistically higher in the group supplemented with iron at a dose of 2 mg/kg/every other day than in the group supplemented with iron at a dose of 1 mg/kg/day . We suggest that intermittent iron supplementation is more effective than a daily regimen in equal dosages 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 AIM To study impact of once weekly iron supplementation on praziquantel cure rate , Schistosoma haematobium reinfection , and haematological parameters in pupils aged between 9 and 15 years of age in Nchelenge district , Zambia . METHODS Pupils in the intervention group received once weekly dose of ferrous sulphate at 200 mg while those in the control received once weekly vitamin C at 100 mg for up to 9 months . Both study groups received a single dose of praziquantel at baseline . RESULTS S haematobium reinfection intensity was significantly lower in boys in the intervention group than in boys in the control group at 6 months ( P < 0.001 ) and 9 months ( P < 0.001 ) of supplementation . Significantly lower S haematobium reinfection intensity was found in girls in the intervention group than in girls in the control group only at 6 months of supplementation ( P = 0.018 ) . Boys in the intervention group were 42 % ( Adjusted Risk Ratio = 0.58 , 95 % confidence interval 0.39 , 0.86 ) less likely to be reinfected with S haematobium than in the control group at 6 months follow up . CONCLUSION Once weekly iron supplementation can decrease S haematobium reinfection after 6 months and should be incorporated into school based schistosomiasis control programs in highly endemic areas We evaluated the effect of weekly doses of 400 mg of ferrous sulphate for 4 months on the iron status of adolescent girls in a controlled trial in Tanga , Tanzania . Supplementation led to a significantly greater increase in serum ferritin compared with the control group ( + 15.6 microg/l vs. 8.6 microg/l ) ( P = 0.002 ) but there was no significant difference in change in haemoglobin . Children given iron showed a significantly greater weight gain than controls ( + 2.4 kg vs. + 1.4 kg ) ( P = 0.03 ) . Weekly iron supplementation may be an effective means of increasing iron stores and growth in children vulnerable to iron deficiency Iron deficiency anaemia is a common disorder among paediatric population . Traditionally , oral iron is given for treatment on daily basis . We undertook this study to compare the results of intermittent with continuous oral iron therapy in children . The study was conducted at Combined Military Hospital ( CMH ) , Lahore . Children ( aged 1 to 6 ) with iron deficiency anaemia ( Hb 11 g/dl ) were allocated at r and om into two groups , A ( n = 27 ) and B ( n = 28 ) . The mean Hb of group A , before treatment , was 8.56 ( + /- 1.51 ) g/dl and that of group B was 8.32 ( + /- 1.68 ) g/dl . Group A was given daily oral dosage of 6 mg/kg of elementAL iron whereas group B was given the same dosage of iron but only 3 days a week . After 2 months of treatment the Hb of group A rose to a mean of 11.06 ( + /- 0.72 ) g/dl and that of group B was increased to 11.3 ( + /- 0.90 ) g/dl , respectively . The difference , in the rise of Hb of two groups , was not statistically significant . It was concluded that in our sample of population , the results of intermittent and continuous oral iron therapy , for iron deficiency anaemia in children aged 1 to 6 years , were identical The aim of this study was to compare the effectiveness of weekly and daily iron supplementation in 6 to 24 months infants . One-hundred Infants enrolled into this r and omized controlled field trail . Fifteen drops was prescribed for the group who received daily supplementation of iron and 30 drops was prescribed for the group who was set up to receive weekly supplementation of iron .  Hemoglobin and serum ferritin was measured after 12 weeks . After 12 weeks results showed that both weekly and daily supplementation significantly increased hemoglobin but for serum ferritin daily supplementation was only significant . However , there was no significant difference between two groups , so the weekly supplementation is recommended . According to the results and more tendencies to the weekly regimen , we recommended weekly regimen versus daily Iron supplementation Anemia-specific mortality was markedly elevated among refugee children < 5 years of age in Tanzania . In a r and omized , double-blind study , 215 anemic children were initially treated for malaria and helminth infection and then received 12 weeks of thrice-weekly oral iron and folic acid . Group I received placebo and chloroquine treatment for symptomatic malaria infection ( i.e. , no presumptive anti-malarial treatment given ) . Group II received placebo and monthly presumptive treatment with sulfamethoxazole-pyrimethamine ( SP ) . Group III also received monthly SP and thrice-weekly vitamins A and C ( VAC ) .  Mean hemoglobin concentration increased from 6.6 to 10.2 g/dL , with no significant differences among groups . Group II had lower mean serum transferrin receptor levels ( TfR ) than group I [ P = 0.023 ] . A greater proportion of participants in group III had normal iron stores ( TfR < 8.5 microg/ mL ) than in group II [ P = 0.012 ] . Initial helminth and malaria treatment , followed by thrice-weekly iron and folic acid supplements result ed in increased hemoglobin levels . Monthly SP and thrice-weekly VAC contributed to improve iron stores . Monthly SP may have a role in situations where asymptomatic disease is prevalent or where access to care is limited . Because administration of VAC also hastened recovery of iron stores over administration of monthly SP alone , health care personnel could add VAC to the treatment for moderate anemia if maximum recovery of iron stores is desired OBJECTIVES To assess impact of daily and intermittent iron-folate ( IFA ) supplementation on physical work capacity of underprivileged schoolgirls in Vadodara . DESIGN R and omized controlled trial . SETTING Municipal Primary schools . PARTICIPANTS Schoolgirls ( n=163 ) in the age group of 9 - 13 years . INTERVENTION Three r and omly selected schools were given IFA tablets ( 100 mg elemental iron + 0.5 mg folic acid ) either once weekly or twice weekly or daily for one year . The fourth was the control school . OUTCOME MEASURES Hemoglobin , modified Harvards Step test for physical work capacity . RESULTS All three IFA supplemented groups showed significant improvement in number of steps climbed and recovery time compared to controls ; with impact being relatively better in girls with higher Hb gain ( > 1 g/dL ) vs. lower Hb gain . Similarly , higher the frequency of dosing better was the impact- it being the best in daily IFA group . Twice weekly IFA was as good as daily IFA under conditions of good compliance . CONCLUSION Twice weekly IFA supplementation is comparable to daily IFA in terms of beneficial effects on physical work capacity in young girls A r and omized controlled trial in KwaZulu-Natal ( South Africa ) of 428 primary -school pupils ( stratified into 6 groups by age , sex and intervention ) measured the effect of different anthelmintic treatments and iron supplementation regimens provided twice at 6-monthly intervals for 1 year ( 1996/97 ) . Half the pupils received iron supplementation ( ferrous fumarate 200 mg weekly for 10 weeks ) . Pupils received 2 anthelmintic regimens , either ( i ) albendazole 400 mg plus praziquantel 40 mg/kg or ( ii ) albendazole 400 mg on 3 consecutive days plus praziquantel 40 mg/kg or ( iii ) placebo . Baseline prevalences of Ascaris 55.9 % , Trichuris 83.6 % , hookworm spp . 59.4 % , were reduced after 12 months for single-dose albendazole treatment to Ascaris 17.4 % ( P < 0.005 ) , Trichuris 61.5 % ( NS ) , hookworm spp . 0 % ( P < 0.005 ) , and for triple-dose albendazole treatment to Ascaris 14.8 % ( P < 0.005 ) , Trichuris 25.0 % ( P < 0.01 ) , hookworm 0 % ( P < 0.005 ) . Schistosoma haematobium 43.4 % was reduced among treated groups to 8.3 % ( P < 0.005 ) . There were no significant changes in the anthropometry of the different treatment groups at either 6 or 12 months post treatment . Twelve months after treatment there was a significant increase in haemoglobin levels ( P = 0.02 ) among pupils receiving triple-dose albendazole , praziquantel and ferrous fumarate ; pupils receiving no anthelmintic treatment showed a significant decrease as did pupils who received triple-dose albendazole and praziquantel but no iron . Regular 6-monthly anthelmintic treatment significantly reduced the prevalence of Ascaris , hookworm spp . and S. haematobium infections ( P < 0.05 ) . Triple-dose treatment for Trichuris was significantly more effective than a single dose of albendazole 400 mg ( P = 0.002 ) . In areas with schistosomiasis , hookworm infection and high prevalence of Trichuris infection , combination treatment with praziquantel , triple-dose albendazole , plus iron supplementation , is likely to improve pupils ' health and haemoglobin levels OBJECTIVE A community-based , r and omized trial was design ed to compare the effect of nutrition education and /or iron supplementation ( weekly ) on iron status of children in an urban slum in Delhi . METHODS Four hundred and fifty one children , 9 - 36 months of age and their caretakers ( mothers ) , assigned to one of the following groups were included in the cohort . Group 1 , nutrition education . Group 2 , supplementation ( with 20 mg elemental iron ) . Group 3 , nutrition education with supplementation ( with 20 mg elemental iron ) and Group 4 , control given placebo . The intervention program was of four months duration , with a treatment phase of 8 wk followed by 8 wk of no treatment . RESULTS Post intervention , at 8 wk and at 16 wk , the hemoglobin change in the nutrition education , supplementation , nutrition education with supplementation and control groups was 2.9 , 1.9 , 3.8 and -5.9 % , respectively and 2.1 , -1.9 , 0 and -9.3 % , respectively ( as compared to initial values ) . There was no significant effect of any of the intervention at 8 weeks . At 16 wk , there was significant positive effect of nutrition education group ( p less than 0.05 ) . The percent change in serum ferritin value at 16 wk in the nutrition education , supplementation , nutrition education with supplementation and control groups was 5.7 , -2.3 , -3.4 and -40 % , respectively . Serum ferritin values were significantly higher for the nutrition education group ( p < 0.001 ) as compared to the control . At 16 wk , the nutrition education group mothers showed significantly higher nutrition knowledge and the dietary iron intake of children was significantly higher than their control group counterparts ( p < 0.0001 ) . CONCLUSION The study suggests that nutrition education did have a positive effect on the iron status possibly by improving the dietary iron intake OBJECTIVE To assess the effect on the haemoglobin concentrations of schoolchildren of weekly iron tablets administered by teachers . DESIGN Sixty schools were r and omly assigned to two groups : in 30 schools children were given weekly for 10 weeks a tablet providing 65 mg of iron and 0.25 mg of folic acid ; in the other 30 schools  no iron tablets were given . All children were dewormed and given vitamin A before the study began . The haemoglobin concentration of up to 20 r and omly selected children in each school was estimated before and 2 weeks after the end of treatment . SETTING Rural community schools in Kolondieba district of Mali . SUBJECTS Some 1113 schoolchildren aged 6 - 19 years with a mean of 11.4 years . RESULTS The haemoglobin concentration of treated children rose on average by 1.8 g l(-1 ) and the prevalence of anaemia fell by 8.2 % ; in untreated children the haemoglobin concentration fell by an average of -2.7 g l(-1 ) and the prevalence of anaemia rose by 9.4 % . The fall in haemoglobin concentration among untreated girls of -4.0 g l(-1 ) was greater than in untreated boys ( -0.3 g l(-1 ) ) . CONCLUSIONS Weekly iron tablets given by teachers prevented a general fall in the haemoglobin concentrations of untreated children , and led to a small but statistically significant rise among treated children . Young children benefited more than children aged > or=12 years , and girls benefited more than boys This experimental study was design ed to investigate the effects of daily versus intermittent iron supplementation on iron status of high school girls in Zahedan and Rasht cities in 1996 - 1997 . The subjects were selected r and omly from among students of grade s 1 - 3 of four high schools in each city .  Anemia was determined by measuring hematological indices . 260 anemic and a similar number of non-anemic subjects of 4 high schools were selected and allocated r and omly to 4 treatment groups . During a 3-month period , the test groups were given 150 mg ferrous sulfate tablets ( 50 mg Fe ) . Subjects in group 1 received a daily dose , groups 2 & 3 received twice or once weekly doses respectively . The control group received no iron supplement . For these subjects , in addition to hematological indices biochemical iron indices were measured in the beginning and at the end of the study . The increases in hemoglobin concentration in anemic subjects were not significantly different among supplemented groups but were different from the control group ( p < 0.00001 ) . Among anemic subjects , changes in serum ferritin levels in 3 supplemented groups were significantly different from the control group . Serum ferritin in Group 1 was also increased to a greater extent than groups 2 and 3 ( P < 0.00001 ) . It is concluded that over the study period a weekly iron dose was as effective as a daily dose in treating anemia but the daily dose was more effective in improving iron stores than a weekly dose in the short run 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 OBJECTIVE To assess the effectiveness of weekly and daily schemes of preventive supplementation with supplementary iron to prevent iron deficiency anemia in non-anemic infants . METHODS A prospect i ve population study with a quantitative approach and preventive intervention was performed in the city of Viçosa , Southeastern Brazil , in 2007 - 8 . A total of 103 non-anemic children , aged between six and 18 months of age , were selected , corresponding to 20.2 % of the children registered with and cared for by Equipes de Saúde da Família ( Family Health Teams ) . Children were divided into two supplementation groups : daily dosage recommended by the Sociedade Brasileira de Pediatria ( Brazilian Society of Pediatrics ) ( group 1 , n=34 ) and weekly dosage recommended by the Brazilian Ministry of Health ( group 2 , n=69 ) . Assessment s were made in the beginning of the study and after six months , with hemoglobin dosage ( portable ss-Hemoglobin-meter ) and anthropometric and dietary assessment s being performed and socioeconomic question naire applied . Impact indicators used were prevalence of anemia , hemoglobin variation , adherence to and side effects of supplements . RESULTS Groups were homogeneous in terms of socioeconomic , biological and before-intervention health variables . After six months of supplementation , higher means of hemoglobin were found in group 1 than in group 2 ( 11.66 ; SD=1.25 and 10.95 ; SD=1.41 , respectively , p=0.015 ) ; in addition to lower prevalences of anemia ( 20.6 % and 43.5 % , respectively , p=0.04 ) . Only ' supplementation time ' influenced severe anemia ( p=0.009 ) . Statistically significant differences were not found for the ' adherence to supplementation ' and ' side effects ' variables . CONCLUSIONS The daily dosage recommended by the Sociedade Brasileira de Pediatria was found to be more effective to prevent anemia in infants , when compared to the dosage used by the Ministry of Health . The weekly dosage recommended by the Brazilian government program needs to be review ed to increase the effectiveness of prevention of anemia in infants cared for in public health services A r and omized , placebo-controlled , double-blind trial was carried out in 1994 - 96 among 231 children and 181 adults in order to determine the effects of iron on reinfection rates and intensities of hookworm  , Ascaris lumbricoides , Trichuris trichiura and Schistosoma mansoni . Adults given 60 mg elemental iron twice-weekly for 12 months had significantly lower reinfection rates of A. lumbricoides ( 16.7 % vs 31.9 % , P = 0.046 ) , T. trichiura ( 6.9 % vs 20.6 % , P = 0.03 ) and S. mansoni ( 38.3 % vs 61.8 % , P = 0.008 ) compared to adults given placebo . In contrast , adults allocated to iron had a significantly higher reinfection rate of hookworm at the 4-month examination ( 11.1 % vs 0 % , P = 0.009 ) , but the difference was not significant at 8- and 12-month follow-up examinations . Iron supplementation had no effect on reinfection intensities in adults . Surprisingly , iron supplementation had no effect on either reinfection rates or intensities in children . Multiple logistic regression analyses controlling for baseline infection status confirmed the effect in adults of iron on A. lumbricoides , T. trichiura and S. mansoni reinfection rates . The effect is suggested to be due to reduced risk behaviour , to improved immune function or to unfavourable host gut conditions caused by an increased oxidative stress . In each case , the lack of effect in children remains to be explained . In contrast , iron supplementation apparently was short-lived in favour of hookworm infection , an effect that needs further clarification . The findings suggest that iron supplementation has a role to play in helminth control programmes and that intraluminal factors may contribute to the regulation of some helminth infections OBJECTIVE The effect of daily and once weekly iron supplementation on hemoglobin(Hb ) , serum ferritin ( SF ) , erythrocyte protoporphyrin ( EFP ) in whole blood , prevalence of iron deficiency , body weight and height of preschool children was compared in this study . METHODS Preschool children ( n = 353 ) from one kindergarten in Baotou City , was recruited . All children were divided into three groups by class , and received either daily or once weekly iron supplementation , or a placebo ( control ) for 14 weeks . RESULTS The prevalence of iron deficiency was reduced in both intervention groups , and the rate in the group supplemented with iron once weekly was significantly lower than that of the control group(P < 0.05 ) . The levels of Hb , SF , increased after once weekly and daily iron supplementation . Weight gain and WAZ were greater in children who received daily supplement than in those who received placebo .  Height gain and HAZ were not significantly different among three groups . CONCLUSION Daily micronutrient supplement can improve growth of preschool children . Once weekly iron supplement is effective same as daily supplement in improving iron status and reducing the prevalence of iron deficiency in the preschool children BACKGROUND Information about the zinc status of low-income minority children in the United States is lacking . OBJECTIVE The objective was to determine the prevalence of zinc deficiency and anemia and their interrelation among low-income African American and Hispanic preschool children . DESIGN This was a cross-sectional study in which a prospect i ve 3-d food diary was completed , and hemoglobin , serum ferritin , zinc , copper , and C-reactive protein concentrations were measured . Children with elevated C-reactive protein concentrations were excluded from analysis . RESULTS Of 292 children recruited , 280 ( mean + /- SD age : 2.5 + /- 1.2 y ) qualified for analysis . One hundred forty-six ( 52 % ) children were African American and 134 ( 48 % ) were Hispanic ; 202 ( 72 % ) were enrolled in the Women , Infants , and Children nutrition program . A low serum zinc concentration ( < 10.7 mumol/L ) was present in 34 ( 12 % ) children , and 37 ( 13 % ) were anemic ( hemoglobin < 110 g/L ) . African American ( odds ratio : 3.47 ; 95 % CI : 1.51 , 7.96 ) and anemic ( odds ratio : 2.92 ; 95 % CI : 1.24 , 6.90 ) children had an increased risk of zinc deficiency . Serum zinc correlated with hemoglobin ( r = 0.24 , P < 0.001 ) . Children with a height/length less than the fifth percentile had significantly lower mean serum zinc concentrations than those with a height/length greater than the fifth percentile ( 12.4 + /- 1.8 compared with 13.0 + /- 2.2 micromol/L ; P < 0.001 ) . In a multiple logistic regression model , African American race-ethnicity was associated with zinc deficiency ( odds ratio : 0.26 ; P = 0.02 ) . The main sources of iron and zinc in the diets were meat products and cereals . CONCLUSIONS The prevalence of zinc deficiency and anemia was high in this population of low-income minority children , especially among African Americans . Further investigation of the incidence of zinc deficiency and the ability of anemia to screen for it is warranted Background Weekly iron – folic acid supplementation in small-scale research trials and as administered in institutions has been demonstrated to be effective in reducing anemia in adolescent girls . Objective To assess the effectiveness of weekly iron – folic acid supplementation in a large-scale project in reducing the prevalence of anemia in adolescent girls . Methods The project provided weekly iron – folic acid tablets , family life education , and deworming tablets every 6 months to 150,700 adolescent school girls and non-schoolgirls of a total district population of 3,647,834 . Consumption of the iron – folic acid tablets was supervised for schoolgirls but not for non-schoolgirls . Hemoglobin levels were assessed in a r and om sample of non-schoolgirls at 6 and 12 months and schoolgirls at 6 months . The effect of supplementation on the prevalence of anemia and the compliance rate were assessed over a 4-year period . Results In 4 years , the overall prevalence of anemia was reduced from 73.3 % to 25.4 % . Hemoglobin levels and anemia prevalence were influenced significantly at 6 months . No difference in the impact on hemoglobin or anemia prevalence was observed between supervised and unsupervised girls . Counseling on the positive effects of regular weekly iron – folic acid intake contributed to a high compliance rate of over 85 % . The cost of implementation was US$ 0.36 per beneficiary per year . Conclusions Weekly iron – folic acid supplementation combined with monthly education sessions and deworming every 6 months is cost-effective in reducing the prevalence of anemia in adolescent girls . Appropriate counseling , irrespective of supervision , is critical for achieving positive outcomes Iron deficiency anemia ( IDA ) remains the most prevalent nutritional deficiency in infants worldwide . The purpose of this study was to determine the efficacy of daily and weekly iron supplementation for 3 months to improve the iron status in 4-month-old , exclusively breast-fed healthy infants . Infants 4 months of age were eligible for the open , r and omized controlled trial if their mothers intended to continue exclusive breast-feeding until the infants were 6 months of age . Infants or mothers with iron deficiency ( ID ) or IDA on admission were excluded . The infants ( n = 79 ) were r and omly assigned to three groups , the first group receiving daily ( 1 mg/kg daily ) , the second group weekly ( 7 mg/kg weekly ) , and the third group no iron supplementation .  Anthropometric measurements were taken on admission and at 6 and 7 months of age . Iron status was analyzed on admission and monthly for 3 months . Both hematologic parameters and anthropometric measurements were found to be similar among the three groups during the study period . Seven infants ( 31.8 % ) in the control group , six ( 26.0 % ) in the daily group , and three ( 13.6 % ) in the weekly group developed ID or IDA ( P > 0.05 ) . Infants whose mothers had ID or IDA during the study period were more likely to develop ID or IDA independently from iron supplementation . Serum ferritin levels decreased between 4 and 6 months of age in the control and daily groups ; the weekly group showed no such decrease . In all groups , the mean levels of serum ferritin were significantly increased from 6 months to 7 months of age during the weaning period . In this study , which had a limited number of cases , weekly or daily iron supplementation was not found to decrease the likelihood of IDA . In conclusion , exclusively breast-fed infants with maternal IDA appeared to be at increased risk of developing IDA We assessed the effectiveness of iron+folic acid for the treatment of  severe anemia [ hemoglobin ( Hb ) < 70 g/L ] and the efficacy of added multivitamins and /or anthelminthics among children aged 6 - 24 mo in periurban Karachi , Pakistan . The study design was a double blind , placebo-controlled , r and omized trial of currently recommended daily iron ( 25 mg ) and folic acid ( 100 microg ) for 90 d with daily multivitamins [ vitamin A ( 300 microg , as retinol palmitate ) , vitamin E ( 6 mg tocopherol equivalents ) , vitamin B-12 ( 0.9 microg ) , vitamin C ( 15 mg ) , riboflavin ( 0.5 mg ) ] and /or anthelminthics ( 100 mg mebendazole twice daily for 3 d ) compared with placebos . Treatment response was defined as reaching a Hb concentration > or = 100 g/L at the end of 90 d. The prevalence of severe anemia in the 9518 children screened was 5.7 % and a total of 462 severely anemic children were enrolled in the study .  Adherence to treatment was approximately 70 % for iron+folic acid , approximately 80 % for multivitamins , and almost 100 % for mebendazole . Children receiving iron+folic acid alone had a response rate of 38.7 % at 90 d. The additional treatment with mebendazole or multivitamins did not significantly improve cure rates or change the Hb concentration over and above iron+folic acid treatment alone . Adherence to iron+folic acid of higher than the median result ed in a better treatment response rate of 50 % . High-dose daily iron+folic acid performed as well as iron+folic acid with anthelminthics and multivitamins in the treatment of severe anemia in this setting . Higher adherence may be important in enhancing treatment impact
BACKGROUND Approximately 600 million children of preschool and school age are anaemic worldwide .
It is estimated that half of the cases are due to iron deficiency .
Consequences of iron deficiency anaemia during childhood include growth retardation , reduced school achievement , impaired motor and cognitive development , and increased morbidity and mortality .
The provision of daily iron supplements is a widely used strategy for improving iron status in children but its effectiveness has been limited due to its side effects , which can include nausea , constipation or staining of the teeth .
As a consequence , intermittent iron supplementation ( one , two or three times a week on non-consecutive days ) has been proposed as an effective and safer alternative to daily supplementation .
OBJECTIVES To assess the effects of intermittent iron supplementation , alone or in combination with other vitamins and minerals , on nutritional and developmental outcomes in children from birth to 12 years of age compared with a placebo , no intervention or daily supplementation .