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Community and International Nutrition

Multiple Micronutrients Including Iron Are Not More Effective Than Iron Alone for Improving Hemoglobin and Iron Status of Malian School Children^1,2

³ UNICEF Country Office, New Delhi 110 003, India; ⁴ Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853; ⁵ School of Medicine, Pharmacy and Odonto-Stomatology, University of Bamako, B.P. 1805, Bamako, Mali; and ⁶ Boston College, Chestnut Hill, MA 02467

Iron deficiency and anemia remain among the most important global public health problems facing school children. Helminth infections often peak at school age and aggravate nutritional risks. We conducted a 12-wk randomized controlled trial in 406 Malian anemic schoolchildren infected with Schistosoma hematobium to examine the effects of 2 doses of praziquantel (P) (40 mg/kg body weight), P + 60 mg/d iron (Fe), and/or a multiple micronutrient supplement (MM) that included 18 mg/d Fe. Supplements were administered to the children each school day (5 d/wk) throughout the study. Changes in hemoglobin (Hb), serum ferritin (SF), and serum transferrin receptors (s-TfR) were followed. We also examined interactions between Fe and MM supplements on Hb and SF concentrations and malaria incidence. The effects of Fe on Hb and SF concentrations were greater than the effects of P alone and MM with or without added Fe at 6 and 12 wk (P < 0.001). In all groups, s-TfR decreased at 6 and 12 wk compared with baseline. The decrease was most pronounced in the P + Fe group compared with the other 3 groups at wk 6 (P = 0.05). Fe and MM interacted negatively at wk 6 and 12 to affect Hb (β = –0.43, 95% CI = –0.77, –0.09; P = 0.01 and β = –0.47, 95% CI = –0.83, –0.11; P = 0.01, respectively) and SF (β = –0.42, 95% CI = –25.60, 12.31; P < 0.001, and β = –0.37, 95% CI = –0.63, –0.12; P = 0.004, respectively). Malaria incidence was higher in the groups treated with added Fe (relative risk: 1.66; 95% CI: 0.75, 3.67). In this context, MM with added iron were not more effective than Fe without MM. Fe supplementation of schoolchildren with 60 mg/d for anemia control should be considered carefully.

^* To whom correspondence should be addressed. E-mail: bert.garza{at}bc.edu.

Manuscript received 2 March 2009. Initial review completed 30 April 2009. Revision accepted 10 July 2009.

Published online 12 August 2009.