The effect of a school-based iron intervention on the haemoglobin concentration of school children in north-west Pakistan
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E K Rousham1, B Uzaman, D Abbott
1Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
Insights
Iron supplements did not significantly improve hemoglobin levels or reduce anemia in school children. Baseline hemoglobin was the main predictor of increase, suggesting other factors influence iron status.
Area of Science:
- Public Health
- Pediatric Nutrition
- Micronutrient Deficiencies
Background:
- Iron deficiency anemia is a significant global health issue, particularly among school-aged children.
- School-based interventions are a common strategy for delivering micronutrient supplements.
Purpose of the Study:
- To evaluate the effectiveness of school-based iron supplementation on hemoglobin concentration and anemia prevalence in children aged 5-17 years.
- To compare once-weekly versus twice-weekly iron supplementation regimens.
Main Methods:
- A longitudinal intervention study involving 30 schools in north-west Pakistan.
- Children received either once-weekly iron supplements (200 mg ferrous sulfate) for 24 weeks, twice-weekly for 12 weeks, or no supplements.
- Hemoglobin concentration was measured at baseline, 12, 24, and 36 weeks.
Main Results:
- No significant increase in hemoglobin concentration was observed in either iron-supplemented group compared to the control group after 12 weeks.
- There was no significant reduction in anemia prevalence in the supplemented groups.
- Anemia prevalence increased across all groups during the follow-up period (24-36 weeks).
Conclusions:
- Neither once-weekly nor twice-weekly iron supplementation significantly improved hemoglobin levels or reduced anemia prevalence.
- Baseline hemoglobin concentration was the strongest predictor of hemoglobin increase.
- Factors such as moderate baseline anemia, potential co-existing micronutrient deficiencies, compliance, and seasonal dietary changes may explain the lack of improvement.
Background/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.
Subjects/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.
