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Updated: Aug 21, 2026
A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
A randomized comparison of two anemia treatment regimens in Tanzanian children
David Schellenberg1, Elizeus Kahigwa, Sergi Sanz
1Centre for International Health, Institut d'Investigacions Biomedicas August Pi i Sunyer, Hospital Clinic, Villarroel 170, Barcelona 08036, Spain. dmschellenberg@aol.com
Insights
Extended iron and antimalarial treatment for anemic children in Tanzania showed improved packed cell volume (PCV) levels. However, benefits were only significant at six months, highlighting the need for better treatment compliance in malaria-endemic areas.
Area of Science:
- Pediatrics
- Hematology
- Tropical Medicine
Background:
- Anemia is a significant health concern in children in malaria-endemic regions.
- Iron deficiency anemia, often exacerbated by malaria, requires effective treatment strategies.
Purpose of the Study:
- To compare the efficacy of standard versus extended treatment regimens for anemia in Tanzanian children.
- To evaluate the impact of treatment duration and compliance on packed cell volume (PCV) levels.
Main Methods:
- A prospective, open-label randomized trial was conducted.
- Two treatment arms were evaluated: standard (14 days) and extended (three months) ferrous sulfate and antimalarial therapy.
- Anemia prevalence (PCV < 25% and PCV < 33%) and mean PCV were measured at two weeks and six months post-treatment.
Main Results:
- Extended treatment led to a lower prevalence of PCV < 33% (44% vs. 58%) and higher mean PCV (32.1% vs. 30.8%) two weeks post-treatment.
- No significant difference in PCV < 25% was observed initially.
- Benefits of extended therapy were evident at six months, particularly in compliant children (OR of PCV < 25% = 0.16, P = 0.06).
- Treatment compliance was low (39% in the first week).
Conclusions:
- Extended iron and antimalarial therapy may improve anemia outcomes in children in malaria-endemic settings.
- Improving treatment compliance is crucial for realizing the full health benefits of extended regimens.
- Further research into strategies to enhance compliance is warranted.
Abstract:
We used a prospective, open-label randomized trial to evaluate two treatment regimens in Tanzanian children two months to four years of age presenting to a hospital with a packed cell volume (PCV) < 25%. Treatment was either standard (14 days of ferrous sulfate and an antimalarial) or extended (three months of ferrous sulfate and three antimalarial treatments). The prevalence of anemia was measured two weeks after completion of treatment and six months after recruitment. Two weeks after completing treatment, the prevalence of PCV < 33% was 58% in the standard treatment arm and 44% in the extended treatment group (P = 0.04), and the mean PCV was significantly higher in the extended treatment arm (32.1%, SD = 4.5% versus 30.8%, SD = 4.9%; P = 0.031). However, there was no difference in the prevalence of PCV < 25% in the first survey, and the benefits of extended therapy were only apparent six months after recruitment in children compliant with the extended treatment (odds ratio of PCV < 25% = 0.16, P = 0.06). Compliance was satisfactory in only 39% (82 of 209) of the children in the first week of treatment. Extending the duration of therapy and improving compliance may have health benefits for anemic children in malaria-endemic settings.