Treatment Response to Iron and Folic Acid Alone Is the Same as with Multivitamins and/or Anthelminthics in Severely Anemic 6-to 24-Month-Old Children

Document Type

Article

Department

Paediatrics and Child Health

Abstract

We assessed the effectiveness of iron+folic acid for the treatment of severe anemia [hemoglobin (Hb) /L] and the efficacy of added multivitamins and/or anthelminthics among children aged 6-24 mo in periurban Karachi, Pakistan. The Study Design was a double blind, placebo-controlled, randomized trial of currently recommended daily iron (25 mg) and folic acid (100 mu g) for 90 d with daily multivitamins [vitamin A (300 mu g, as retinol palmitate), vitamin E (6 mg tocopherol equivalents), vitamin B-12 (0.9 mu g), vitamin C (15 mg), riboflavin (0.5 mg)] and/or anthelminthics (100 mg mebendazole twice daily for 3 d) compared with placebos. Treatment response was defined as reaching a Hb concentration 100 g/L at the end of 90 d. The prevalence of severe anemia in the 9518 children screened was 5.7% and a total of 462 severely anemic children were enrolled in the study. Adherence to treatment was similar to 70% for iron+folic acid, similar to 80% for multivitamins, and almost 100% for mebendazole. Children receiving iron+folic acid alone had a response rate of 38.7% at 90 d. The additional treatment with mebendazole or multivitamins did not significantly improve cure rates or change the Hb concentration over and above iron+folic acid treatment alone. Adherence to iron+folic acid of higher than the median resulted in a better treatment response rate of 50%. High-dose daily iron+folic acid performed as well as iron+folic acid with anthelminthics and multivitamins in the treatment of severe anemia in this setting. Higher adherence may be important in enhancing treatment impact.

Publication (Name of Journal)

Journal of Nutrition

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