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An iron treatment trial in an aboriginal community: improving non-adherence
S G Kruske1, A R Ruben, D R Brewster
1Territory Health Services, Northern Territory, Australia.
Insights
Supervised, twice-weekly oral iron treatment significantly improved hemoglobin levels in anaemic Aboriginal children compared to unsupervised daily doses. This highlights the importance of directly observed therapy for effective iron deficiency anaemia management.
Area of Science:
- Paediatrics
- Public Health
- Nutritional Science
Background:
- Iron deficiency anaemia (IDA) is prevalent in remote Aboriginal communities, affecting child development.
- High rates of stunting and microcephaly are associated with IDA in this population.
Purpose of the Study:
- To compare the efficacy of supervised versus unsupervised oral iron treatment for anaemia in young Aboriginal children.
- To evaluate the impact of iron supplementation on growth parameters.
Main Methods:
- A randomized unblinded clinical trial involving children under 6 years with anaemia.
- Comparison of daily unsupervised oral iron (Group A) vs. twice-weekly supervised oral iron (Group B) for 12 weeks.
- Parenteral iron (Group C) was used for oral treatment failures.
Main Results:
- Supervised twice-weekly oral iron (Group B) showed significantly higher response rates (23/26) than unsupervised daily doses (3/25).
- Mean haemoglobin rise was substantially greater with supervised oral iron (10.9 g/L) and parenteral iron (12.4 g/L) compared to unsupervised oral iron (0.96 g/L).
- Iron treatment resulted in limited catch-up growth (0.28 Z-scores) despite improvements in anaemia.
Conclusions:
- Directly observed, twice-weekly oral iron therapy is superior to unsupervised treatment for IDA in this population.
- Addressing IDA and associated malnutrition requires community-partnered nutritional interventions, including fortified weaning foods.
- Micronutrient fortification (iron, vitamin A, zinc, folate) is crucial for improving child nutrition during the weaning period.
Objective:
To compare supervised vs unsupervised oral iron treatment in anaemic Aboriginal children living in a remote community with a 40% prevalence of iron deficiency anaemia.
Methodology:
A randomised unblinded clinical trial in children < 6 years presenting to a remote Health Centre with anaemia. Oral iron prescribed as a daily unsupervised dose (group A) was compared to twice weekly supervised administration (group B) over 12 weeks. Parenteral iron (group C) was reserved for failure of oral treatment.
Results:
Only 3 of 25 children in group A responded to treatment compared to 23 of 26 children in group B (odds ratio = 7.7, 95% confidence interval 2.6-25.0). After six weeks of treatment, the mean haemoglobin rise was 0.96 g/L in group A compared to 10.9 g/L in group B and 12.4 g/L in group C. On entry to the study, 29.4% of subjects were underweight, 33.3% stunted and 35.3% microcephalic. The mean catch-up in weight/height on iron treatment over the study was only 0.28 (0.08, 0.48) Z-scores.
Conclusions:
Oral iron as directly observed twice weekly treatment is superior to unsupervised therapy. In view of the poor compliance with unsupervised treatment and the high prevalence of iron deficiency anaemia (along with stunting and microcephaly) in Aboriginal children in northern Australia, we propose to undertake in partnership with communities a nutritional intervention program with a high energy weaning food fortified with micronutrients (iron, vitamin A, zinc, folate) as the most effective strategy to address these nutritional problems in the weaning period.