A free weekly iron-folic acid supplementation and regular deworming program is associated with improved hemoglobin and iron status indicators in Vietnamese women

Abstract

Background: Anemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries although there are few reports of these programs working efficiently or effectively. Weekly iron-folic acid supplementation (WIFS) and regular deworming treatment is recommended for non-pregnant women living in areas with high rates of anemia. Following a baseline survey to assess the prevalence of anemia, iron deficiency and soil transmitted helminth infections, we implemented a program to make WIFS and regular deworming treatment freely and universally available for all women of reproductive age in two districts of a province in northern Vietnam over a 12 month period. The impact of the program at the population level was assessed in terms of: i) change in mean hemoglobin and iron status indicators, and ii) change in the prevalence of anemia, iron deficiency and hookworm infections.

Method: Distribution of WIFS and deworming were integrated with routine health services and made available to 52,000 women. Demographic data and blood and stool samples were collected in baseline, and three and 12-month post-implementation surveys using a population-based, stratified multi-stage cluster sampling design.

Results: The mean Hb increased by 9.6 g/L (95% CI, 5.7, 13.5, p < 0.001) during the study period. Anemia (Hb<120 g/L) was present in 131/349 (37.5%, 95% CI 31.3, 44.8) subjects at baseline, and in 70/363 (19.3%, 95% CI 14.0, 24.6) after twelve months. Iron deficiency reduced from 75/329 (22.8%, 95% CI 16.9, 28.6) to 33/353 (9.3%, 95% CI 5.7, 13.0) by the 12-mnth survey, and hookworm infection from 279/366 (76.2%,, 95% CI 68.6, 83.8) to 66/287 (23.0%, 95% CI 17.5, 28.5) over the same period.

Conclusion: A free, universal WIFS program with regular deworming was associated with reduced prevalence and severity of anemia, iron deficiency and hookworm infection when made available to Vietnamese women over a 12-month period.

Figure 1

Flow diagram of evaluation of WIFS ^# and 4 monthly deworming program: baseline, 3- and 12-months post-implementation. ^# WIFS = Weekly Iron-Folic acid Supplementation * WRA = Women of Reproductive Age defined as aged between 15 – 45 years.

Figure 2

Mean hemoglobin (95% CI) at baseline, 3- and 12-months post-implementation.

Figure 3

Prevalence of mild (Hb* <120 g/L & > = 100 g/L) and moderate/severe anemia (Hb <100 g/L), with 95% CI at each survey. * Hb = hemoglobin.

Figure 4

Geometric mean serum ferritin (95% CI) at baseline, 3- and 12-months post-implementation.