Fighting infant anemia in the developing world

A combination of daily followed by weekly iron supplementation appears to be the answer for treating severe anemia in babies in the developing world, according to a new joint French - Vietnamese study.

In Vietnam, approximately 60 per cent of infants under two years of age suffer from anemia due to a deficiency in iron, an illness which affects their growth, motor-neural development and reduces their resistance to infections. It is mainly due to the lack of iron in food in an easily absorbable form. Boiled rice, traditionally given to infants in addition to breast feeding, is not enough to meet their iron requirements, which are said to be particularly high from between 4 and 6 months of age.

In response to this problem, researchers from the French Institut de Recherche pour le Developpement (IRD) and the National Institute of Nutrition in Hanoi, Vietnam decided to evaluate the efficacy of daily and weekly provisions of iron in Vietnamese breast-feeding infants.

The scientists explain that while daily administration of a supplement is an efficient way of rapidly reducing deficiency in severely iron deficient individuals and the occurrence of anemia in a population, it poses problems when it needs to be given to breast-feeding infants. The most practical iron supplement for the infants is administered in the form of a syrup, which must be available in large quantities. Moreover, they say that if taken during a meal, the absorption of other elements essential to the growth of the infant is reduced, such as zinc.

According to the study authors, weekly iron supplementation, which reduces the constraints of availability and frequency of administration of the supplement, has been the object of previous conclusive studies on young children and pregnant women but never on breast feeding infants.

They performed a trial on nearly 300 infants, aged five to 12 months, between March and September 1997, in four communes of the rural district of Bac Ninh situated 50 km east of Hanoi.

During this placebo controlled trial, the infants received either a daily or weekly dose of 15mg of iron sulfate in 2.5ml of syrup, administered outside of feeding times by the mothers or by the health workers, also comparing two periods of treatment of three and six months.

Weight and size of the infants were measured before the start of the trial, after three months and then six months of treatment, in order to evaluate the effects of the iron supplementation on the evolution of the rate of anemia observed in the unweaned infants.

The rate of anemia was greater than 80 per cent at the start of the trial. It was brought down to 9 per cent at the end of three months of daily iron supplementation, which was nearly six times lower than that for the placebo group, proof, according to the researchers, that the anemia was caused by a nutritional deficiency of this element.

The researchers noted that the fact that the mothers, informed of the harmful consequences of such a deficit on the health of their children and the benefits of the treatment, administered the supplement to their child themselves seemingly improved the follow-up and increased the efficiency of the treatment.

The weekly provision of iron during a six month period also permitted an increase in the concentration of hemoglobin for the infants in the concerned group and a reduction in the proportion of anemic subjects, say the researchers, which dropped from 83.1 per cent to nearly 8 per cent at the end of the trial.

However ,they also note that this approach proved to be slower and less efficient than the daily supplementation when trying to restore a satisfactory level of haemoglobin in the breast feeding child. In fact, they comment that only the daily treatment over six months resulted in the complete suppression of all the cases of anemia among the infants in the other group, for which the prevalence rate was 85.1 per cent at the beginning of the study.

The researchers concluded - following evaluation of additional knowledge already acquired concerning children and young women - that this study justifies the recommendation of a daily iron supplementation for a period of three months, when the prevalence of anemia in breast feeding infants is high. This should be carried out by the mothers as soon as the child reaches six months of age, followed by a weekly supplementation up to the age of 15 months.

In addition, the researchers highlight the importance of iron and folic acid supplementation to the healthy progress of a pregnancy and urge that this too should be reinforced in pregnant women, as their iron levels will in turn determine those of their child at birth.

As a final comment they remark that informing mothers, as in the study, and the encouragement of local production at low cost of accompanying foods enriched with micronutrients, can undoubtedly help to prevent such deficiencies and promote the healthy development of young infants.