title: The effect of a school-based iron intervention on the haemoglobin concentration of school children in north-west Pakistan.
abstract: OBJECTIVE
  To assess the effectiveness of iron supplements administered to school children through a longitudinal school health intervention in terms of child haemoglobin concentration and anaemia prevalence.
  
  
  METHODS
  Children and adolescents aged 5-17 years were selected from 30 schools in north-west Pakistan for a longitudinal iron supplement intervention. Children received once-weekly iron supplements (200 mg ferrous sulphate containing 63 mg of elemental iron) for 24 weeks (n=352); or the same supplements twice-weekly for 12 weeks (n=298) or received no tablets (n=298). Haemoglobin concentration was estimated in finger-prick blood samples at baseline, 12 and 24 weeks. Follow-up samples were taken at 36 weeks.
  
  
  RESULTS
  A non-significant increase in haemoglobin concentration was observed in children receiving iron supplements after 12 weeks (mean 1.4 g/l s.d. 15.0 g/l in once-weekly versus 2.5 g/l s.d. 14.5 g/l in twice-weekly) compared with the group receiving no iron supplements. There was no significant reduction in the prevalence of anaemia in the once-weekly or twice-weekly group compared with the unsupplemented group. The prevalence of anaemia increased in all three groups during the follow-up period (24-36 weeks).
  
  
  CONCLUSIONS
  Once-weekly and twice-weekly iron supplements were not associated with significant increases in haemoglobin concentration compared with unsupplemented children. In all groups, baseline haemoglobin concentration was the strongest predictor of haemoglobin increase. The lack of improvement may stem from the moderate baseline prevalence of anaemia (33%); other micronutrient deficiencies; variable compliance; or the worsening of haemoglobin status owing to seasonal changes in dietary iron and other nutrients.
authors.affiliation: Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
authors.forename: E K
authors.initials: EK
authors.lastname: Rousham
authors.forename: B
authors.initials: B
authors.lastname: Uzaman
authors.forename: D
authors.initials: D
authors.lastname: Abbott
authors.forename: S F
authors.initials: SF
authors.lastname: Lee
authors.forename: S
authors.initials: S
authors.lastname: Mithani
authors.forename: N
authors.initials: N
authors.lastname: Roschnik
authors.forename: A
authors.initials: A
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D019266:Iron, Dietary / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D010154:Pakistan; D012572:School Health Services; D014131:Trace Elements / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005296:Ferrous Compounds; D006454:Hemoglobins; D019266:Iron, Dietary; D014131:Trace Elements; C020748:ferrous sulfate; D007501:Iron