Weekly iron, folic acid supplement reduces anemia in high prevalence population

NEW YORK (Reuters Health) – Once-a-week supplementation with iron and folic acid is as effective as daily supplementation in reducing the incidence of anemia among adolescent girls in Nepal, researchers report in the February issue of the Archives of Pediatrics and Adolescent Medicine.

Dr. Binay Kumar Shah, from the B. P. Koirala Institute of Health Sciences, Dharan, Nepal, and Dr. Piyush Gupta, now at the University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India, randomly assigned 209 girls, median 15 years of age, to 350 mg ferrous sulfate plus 1.5 mg folic acid once a day for 90 to 100 days, or the same combination, given under supervision once a week for 14 weeks, or no treatment.

Twenty-eight subjects were excluded at the end of trial. Two of these girls, in the daily supplementation group, withdrew from treatment due to severe gastrointestinal problems, Drs. Shah and Gupta note. The others were either noncompliant or had incomplete follow-up.

The prevalence of anemia decreased significantly (p < 0.001) from 68.6% to 20% among the girls receiving daily supplementation, and from 70.1% to 13.4% for those receiving weekly supplementation. It remained basically unchanged in the girls who received no treatment (68.1% to 65.3%), the researchers found.

In both treatment groups, mean hematocrit rose significantly (p < 0.001) from about 33% to 40%, but there was no appreciable change in the control group, Drs. Shah and Gupta note.

"The prevalence of anemia in Nepalese adolescent girls is quite high," the investigators note. "To counter this, weekly supervised therapy is a good alternative to daily iron and folic acid administration. Weekly therapy appears to be equally effective yet causes fewer adverse effects, improves compliance, and reduces the cost of supplementation," they conclude.

"The greatest limitation of this study is the relatively unique population that it employs," Dr. W. Clayton Bordley, from the University of North Carolina in Chapel Hill, and colleagues comment in a journal editorial. "Nevertheless, public health officials interested in the treatment of anemia can potentially use this study to justify similar approaches in larger, more diverse populations."

Arch Pediatr Adolesc Med 2002;156:128-135.

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