Iron supplementation is the most common intervention used to prevent and treat iron deficiency anemia. Global guidelines established by the International Nutritional Anemia Consultative Group, the World Health Organization, and UNICEF identify pregnant women and children 6-24 months of age as the priority target groups for iron supplementation because these populations are at the highest risk of iron deficiency and most likely to benefit from its control. However, recommendations are given for other target groups, such as children, adolescents, and women of reproductive age, who may also benefit from iron supplementation for the prevention of iron deficiency. The recommendations are given in Table 2. Recommended dose and/or duration of supplementation are increased for populations where the prevalence of anemia is 40% or higher. The recommended treatment for severe anemia (Hb <70g/l) is to double prophylactic doses for 3 months and then to continue the preventive supplementation regimen.

Ferrous sulfate is the most common form of iron used in iron tablets, but fumarate and gluconate are also sometimes used. A liquid formulation is available for infants, but it is not used often in anemia control programs in developing countries because of the expense compared to tablets. Crushed tablets can be given to infants and young children as an alternative, but this has not been very successful programmatically.

Efforts to improve the iron status of populations worldwide through supplementation have met with mixed success. Given the frequency with which iron

Table 2 Guidelines for iron supplementation to prevent iron deficiency anemia

Target group Dose Duration

Pregnant women 60 mg iron + 400 mg folic acid daily 6 months in pregnancya,b

Children 6-24months (normal birth weight) 12.5 mg ironc+50mg folic acid daily 6-12months of aged

Children 6-24months (low birth weight) 12.5 mg iron + 50 mg folic acid daily 2-24months of age

Children 2-5years 20-30mg ironc daily

Children 6-11 years 30-60 mg iron daily

Adolescents and adults 60 mg iron dailye aIf 6-months' duration cannot be achieved during pregnancy, continue to supplement during the postpartum period for 6 months or increase the dose to 120 mg iron daily during pregnancy.

bContinue for 3 months postpartum where the prevalence of pregnancy anemia is >40%.

cIron dosage based on 2mg iron/kg body weight/day.

dContinue until 24 months of age where the prevalence of anemia is >40%.

eFor adolescent girls and women of reproductive age, 400 mg folic acid should be included with iron supplementation.

Adapted with permission from Stoltzfus RJ and Dreyfuss ML (1998) Guidelines for the Use of Iron Supplements to Prevent and Treat

Iron Deficiency Anemia. Washington, DC: International Nutritional Anemia Consultative Group.

tablets must be taken to be effective, a lack of efficacy of iron supplementation in research studies and programs has often been attributed to poor compliance and the presence of side effects such as nausea and constipation. Ensuring compliance in some settings also requires extensive logistical support. Although in developing countries the maximum coverage of iron supplementation programs for pregnant women is higher than 50%, other high-risk groups are less frequently targeted for iron supplementation.

Comparative trials have demonstrated that both weekly and daily iron supplementation regimens significantly increase indicators of iron status and anemia, but that daily supplements are more efficacious at reducing the prevalence of iron deficiency and anemia, particularly among pregnant women and young children who have high iron demands. Therefore, daily iron supplements continue to be the recommended choice for pregnant women and young children because there is often a high prevalence of iron deficiency anemia in these populations. Weekly supplementation in school-age children and adolescents holds promise for anemia prevention programs because it reduces side effects, improves compliance, and lowers costs. Further assessment of the relative effectiveness of the two approaches is needed to determine which is more effective in the context of programs.

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