title: Relative efficacy of weekly and two differing doses of daily iron-folate supplementation in improving hemoglobin in mild and moderately anemic children between 3 and 5 years of age: a cluster randomized trial.
abstract: OBJECTIVE
  In India, 75% of children <5 years of age have anemia. The National Nutritional Anemia Control Program (NNACP) recommends 20 mg iron and 100 μg folic acid (IFA) supplementation for 100 days/year, but still anemia prevalence has remained high. To accelerate the progress, suggestions include increase in IFA to therapeutic dose or supervised weekly supplementation to improve compliance. The objectives of this study was to compare the hemoglobin response with two dosages of daily (20 mg iron and 100 μg folic acid, or 40 mg iron and 200 μg folic acid) and weekly (40 mg iron and 200 μg folic acid) IFA supplementation in children of 3-5 years of age with mild or moderate anemia (hemoglobin 7-10 g/dl).
  
  
  METHODS
  Community-based cluster randomized control trial in nine adjoining Anganwadi Centers. Four hundred twenty six enrolled participants received directly supervised IFA tablet supplementation as per the above three groups. After 100 days, the number of available subjects in the NNACP daily dose (A), daily dose doubled (B) and weekly dose (C) groups were 112, 114 and 110, respectively. Hemoglobin was estimated at baseline, 50 and 100 days by the Cynmeth hemoglobin method.
  
  
  RESULTS
  At 50 days, there were no differences between the three groups, but at 100 days, adjusted hemoglobin was lowered with weekly supplementation. The mean (95% confidence interval) hemoglobin (g/dl) differences were: (i) A-B: -0.05 (-0.17, 0.05), (ii) A-C: -0.38 (-0.50, -0.27) and (iii) B-C: -0.33, (-0.45, -0.21). Anemia reduction was 18.8%, 18.4% and 10.9%, respectively, in the three groups.
  
  
  CONCLUSIONS
  Directly supervised IFA supplementation at the NNACP or double dose is equally efficacious but superior to weekly regimen.
authors: Department of Human Nutrition, All India Institute of Medical Sciences, New Delhi, India. umeshkapil@gmail.com
authors: U
authors: U
authors: Kapil
authors: H P S
authors: HP
authors: Sachdev
authors: S N
authors: SN
authors: Dwivedi
authors: R M
authors: RM
authors: Pandey
authors: A D
authors: AD
authors: Upadhyay
authors: N
authors: N
authors: Sareen
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000188:drug therapy*; D002675:Child, Preschool; D016000:Cluster Analysis; D019587:Dietary Supplements; D004305:Dose-Response Relationship, Drug; D005492:Folic Acid / Q000008:administration & dosage*; D006397:Hematinics / Q000008:administration & dosage; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007194:India; D007501:Iron / Q000008:administration & dosage*; D012959:Socioeconomic Factors
chemical_list: D006397:Hematinics; D006454:Hemoglobins; D005492:Folic Acid; D007501:Iron