title: Daily iron supplementation is more efficacious than twice weekly iron supplementation for the treatment of childhood anemia in western Kenya.
abstract: A recent meta-analysis of 14 clinical trials indicated that daily compared with intermittent iron supplementation resulted 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-randomized 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.
authors.affiliation: Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. mdesai@cdc.gov
authors.forename: Meghna R
authors.initials: MR
authors.lastname: Desai
authors.forename: Ritesh
authors.initials: R
authors.lastname: Dhar
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Rosen
authors.forename: Simon K
authors.initials: SK
authors.lastname: Kariuki
authors.forename: Ya Ping
authors.initials: YP
authors.lastname: Shi
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Feiko O
authors.initials: FO
authors.lastname: Ter Kuile
mesh_terms: D000740:Anemia / Q000097:blood / Q000188:drug therapy*; D000962:Antimalarials / Q000627:therapeutic use; D002675:Child, Preschool; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D004338:Drug Combinations; D019353:Endemic Diseases; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage* / Q000009:adverse effects; D007630:Kenya; D008288:Malaria / Q000453:epidemiology; D008297:Male; D009994:Osmolar Concentration; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D006454:Hemoglobins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D007501:Iron; D011739:Pyrimethamine