Effect of iron or multiple micronutrient supplements on the prevalence of anaemia among anaemic young children of a malaria-endemic area: a randomized double-blind trial

Abstract

Objective: To assess the effect of supplementation with iron or multiple micronutrients (MM) on the prevalence of anaemia in a malaria-endemic area.

Methods: A community-based randomized double-blind trial was conducted in rural Burkina Faso, including children aged 6-23 months with haemoglobin (Hb) concentrations of 70-109 g/l who were randomized into an iron group (Fe, n = 96), an iron and zinc group (IZ, n = 100) or an MM group (MM, n = 100), 5 days/week for 6 months. All children were provided with insecticide-treated bednets; those who had a Plasmodium falciparum (PF) positive-smear at baseline and/or at each monthly checking received antimalarial therapy.

Results: The mean (SD) endpoint Hb concentration was higher in the MM group [113.2 (13.6) g/l] than in the IZ group [106.3 (15.6) g/l] and the Fe group [107.1 (12.9) g/l] (P = 0.001). Children in the MM group were more likely to recover from anaemia than those in the Fe group [prevalence rate ratios, PRR (95% confidence interval, CI) = 1.62 (1.22-2.15), P < 0.001]. The IZ group did not differ from the Fe group [PRR (95% CI) = 0.94 (0.65-1.35), P = 0.72]. None of the interactions on the effect of supplementation of baseline age (0.13), or baseline height-for-age z-score (P = 0.33), or incident PF parasitemia (P = 0.99), was significant.

Conclusion: In this malaria-endemic area, in combination with malaria management, the MM supplement was more efficacious than the Fe supplement and the IZ supplement for reducing anaemia. Further investigation into limiting factors and amounts of micronutrients that would be more efficacious for reducing anaemia is recommended.