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J. Nutr. (June 17, 2009). doi:10.3945/jn.108.103507
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© 2009 American Society for Nutrition

Community and International Nutrition

Treatment Response to Iron and Folic Acid Alone Is the Same as with Multivitamins and/or Anthelminthics in Severely Anemic 6- to 24-Month-Old Children1,2

Zulfiqar Bhutta3, Rolf Klemm4, Farhana Shahid3, Arjumand Rizvi3, Jee Hyuan Rah4 and Parul Christian4,*

3 Department of Pediatrics and Child Health, Aga Khan University, Karachi 74800, Pakistan 4 Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205

We assessed the effectiveness of iron+folic acid for the treatment of severe anemia [hemoglobin (Hb) <70 g/L] and the efficacy of added multivitamins and/or anthelminthics among children aged 6–24 mo in periurban Karachi, Pakistan. The study design was a double blind, placebo-controlled, randomized trial of currently recommended daily iron (25 mg) and folic acid (100 µg) for 90 d with daily multivitamins [vitamin A (300 µg, as retinol palmitate), vitamin E (6 mg tocopherol equivalents), vitamin B-12 (0.9 µg), vitamin C (15 mg), riboflavin (0.5 mg)] and/or anthelminthics (100 mg mebendazole twice daily for 3 d) compared with placebos. Treatment response was defined as reaching a Hb concentration ≥100 g/L at the end of 90 d. The prevalence of severe anemia in the 9518 children screened was 5.7% and a total of 462 severely anemic children were enrolled in the study. Adherence to treatment was ~70% for iron+folic acid, ~80% for multivitamins, and almost 100% for mebendazole. Children receiving iron+folic acid alone had a response rate of 38.7% at 90 d. The additional treatment with mebendazole or multivitamins did not significantly improve cure rates or change the Hb concentration over and above iron+folic acid treatment alone. Adherence to iron+folic acid of higher than the median resulted in a better treatment response rate of 50%. High-dose daily iron+folic acid performed as well as iron+folic acid with anthelminthics and multivitamins in the treatment of severe anemia in this setting. Higher adherence may be important in enhancing treatment impact.

* To whom correspondence should be addressed. E-mail: pchristi{at}jhsph.edu.

Manuscript received 11 December 2008. Initial review completed 9 March 2009. Revision accepted 26 May 2009.