title: Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops.
abstract: OBJECTIVE
  To determine whether low-income infants' adherence to nutritional supplementation with ferrous fumarate sprinkles was better than that with ferrous sulfate drops.
  
  
  METHODS
  The study was a randomized clinical trial of healthy 6-month-old infants. Each infant received either a daily packet of sprinkles or a dropperful of liquid. Follow-up included alternating telephone and home visits biweekly for 3 months. Adherence was defined as high if the infant's caregiver reported supplement use on 5 to 7 days during the week before assessment. Side effects and caregiver attitude about supplements were secondary outcomes. Analyses were conducted using generalized estimating equations and chi(2) and Wilcoxon rank-sum tests.
  
  
  RESULTS
  A total of 150 of 225 eligible infants were enrolled. Adherence to supplementation was generally poor. High adherence ranged from 32% to 63% at any assessment in the subjects receiving drops, compared with 30% to 46% in those receiving sprinkles. The drops group was more likely to have at least four assessments with high adherence (22% vs 9.5%; P = .03). Caregivers of the drops infants were more likely to report greater than usual fussiness (P < .01); however, fussiness had no consistent impact on adherence.
  
  
  CONCLUSIONS
  The use of ferrous fumarate sprinkles rather than traditional ferrous sulfate drops did not improve adherence with daily iron supplementation in low-income infants.
authors.affiliation: Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA. pgeltman@bu.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Geltman
authors.forename: L Kari
authors.initials: LK
authors.lastname: Hironaka
authors.forename: Supriya D
authors.initials: SD
authors.lastname: Mehta
authors.forename: Priscilla
authors.initials: P
authors.lastname: Padilla
authors.forename: Patricia
authors.initials: P
authors.lastname: Rodrigues
authors.forename: Alan F
authors.initials: AF
authors.lastname: Meyers
authors.forename: Howard
authors.initials: H
authors.lastname: Bauchner
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000517:prevention & control*; D001294:Attitude to Health; D017028:Caregivers; D019587:Dietary Supplements; D004304:Dosage Forms; D005240:Feasibility Studies; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage*; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D055118:Medication Adherence; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D014131:Trace Elements / Q000008:administration & dosage*; D014481:United States
chemical_list: D004304:Dosage Forms; D005296:Ferrous Compounds; D014131:Trace Elements; C020748:ferrous sulfate; C031621:ferrous fumarate