title: 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.
abstract: 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, randomized 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 resulted 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.
authors.affiliation: Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Bhutta
authors.forename: Rolf
authors.initials: R
authors.lastname: Klemm
authors.forename: Farhana
authors.initials: F
authors.lastname: Shahid
authors.forename: Arjumand
authors.initials: A
authors.lastname: Rizvi
authors.forename: Jee Hyuan
authors.initials: JH
authors.lastname: Rah
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
mesh_terms: D000740:Anemia / Q000188:drug therapy* / Q000453:epidemiology; D018798:Anemia, Iron-Deficiency / Q000188:drug therapy*; D000969:Antinematodal Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007223:Infant; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008463:Mebendazole / Q000627:therapeutic use*; D010154:Pakistan / Q000453:epidemiology; D010349:Patient Compliance; D015995:Prevalence; D016896:Treatment Outcome; D014815:Vitamins / Q000627:therapeutic use*
chemical_list: D000969:Antinematodal Agents; D006454:Hemoglobins; D014815:Vitamins; D008463:Mebendazole; D005492:Folic Acid; D007501:Iron