The effect of daily versus weekly iron supplementation in the control and prevention of iron Deficiency anemia in lactating mothers: a case study Of urban slums in Addis Ababa, Ethiopia

Abstract

This study was designed to take a sequential step, comprising a cross sectional study with a longitudinal observation, to demonstrate the biological effectiveness and social feasibility of weekly versus daily iron supplementation in the control and prevention of '" anaemia in women of reproductive age. It compares the haemoglobin, serum ferritin and compliance in Teklehaimanot Wereda, Ethiopia between March and May 2001. A total of 1017 lactating women were recruited, and screened clinically and biochemically for anaemia; out of which, only 207 of the women were found to be eligible and enrolled in this study. After an informed written consent was obtained from all the subjects, they were then assigned to the daily, weekly supplementation or control groups following randomisation. The daily group (n=71) received 60 mg of elemental iron containing 300 mg ferrous sulphate with 400 IJg folic acid from Monday to Friday, while the weekly group (n=68) received only one tablet of iron of the same content once a week, every Monday supervised by the field workers; and the control group (n=68) was advised to take no iron tablets or other drugs without the knowledge of the investigator until the completion of the study. Before the supplementation of iron, every subject was dewormed with 120 mg levamisole, and then baseline information on sociodemographic, nutritional status, and the appropriate laboratory tests taken from all groups. 11 To evaluate the outcome of the study, haemoglobin from all and serum ferritin from a sub-sample of the subjects were measured before and after the completion of the study; and compliance was observed every two weeks by the researcher together with the field workers. The mean age, household size, parity, frequency of meals, body mass index, education, employment status, baseline haemoglobin and serum ferritin levels of the groups was not significantly different between groups indicating that the groups enrolled were homogenous. Ascariasis (17.9%), strongyloidiasis (2.4%), and hookworm (1.9%) were found to be the commonest infestation, and had a close association with low serum ferritin concentration (P=0.05) in the Wereda. To see the confounding effect of contraceptive, information was collected and analysed among the groups. The commonest (55.4%) type of contraceptives used was pills and injection and were nearly uniform in all the groups. No association was observed between contraceptive use and level of anaemia (P=0.5). Chronic energy deficiency in the Wereda was higher (27.0%) when compared with the figure for Addis Ababa Administrative region, which was (17.9%). Prevalence of anaemia, as determined by haemoglobin concentration in the Wemda was 22.3% and iron deficiency (determined by serum ferritin below 12 !J.g/litre)22.6% and iron deficiency anaemia (determined by serum ferritin below 12 !J.g/litre and haemoglobin less than 12 gm/dL) 22.3%. Following the supplementation, significant increase in haemoglobin concentration and a three fold reduction in the prevalence of anaemia in both the daily and weekly supplemented groups were found. When the daily and weekly supplementations groups were compared, the therapeutic effectiveness was equally significant in both schedules. The reports of side effects observed in this study were related to the