Efficacy of Intermittent Iron Supplementation in the Control of Iron Deficiency Anaemia
An Analysis of Experience in Developing Countries

George H. Beaton and George P. McCabe

MI 1999, ISBN 1-894217-08-X
138 pp., paper, 8½" x 11" 

Résumé français à venir 

Ever-increasing data suggest that existing daily iron supplementation programs are not very effective due to poor patient compliance. In the early 1990s, two schools of thought emerged as to why this might be. The first held that insufficient patient motivation and social marketing were responsible for low compliance rates. The second considered the main obstacle to be the perceived severity of side effects from the dose levels in use. It was in this context that intermittent (weekly or bi-weekly) iron supplementation came to be proposed as a possible alternative to daily supplementation.

This report is based on analysis of results of 22 completed trials of intermittent iron supplementation in pregnant women, adolescents and schoolchildren, and preschool children. For 14 of the trials, comprising 5 100 individuals, complete data sets were available for analysis. For the other eight trials, including between 750 and 1 000 subjects, only summary statistics were obtained from abstracts, final reports or direct communication with the researchers involved.

The general pattern between groups was remarkably similar, leading to the overall conclusion that daily supplementation is more efficacious than weekly supplementation. It also pointed to the fact that neither is likely to be very effective unless ways can be found to maintain compliance at high levels. The authors conclude that it would be unwise, and perhaps even detrimental, to replace existing daily supplementation approaches with weekly supplementation during pregnancy. This study would be of interest to anyone involved in iron deficiency programs in a research, policy-making or programming capacity.
 

The Authors

George Beaton is Professor Emeritus of Nutritional Sciences, University of Toronto, Canada.

George P. McCabe is a professor of statistics and head of the Statistical Consulting Service at Purdue University. He is author or coauthor of over 100 publications in many different journals.

Contents

Executive Summary

Table of Contents

Preambule: Definition of terms

1. Background to the Report

2. Identification of Studies and Data Accessed

3. Analytic Methods and Organization of te Report

4. Results: Haemoglobin Level as the Outcome

5. Results: Serum Ferritin as the Outcome

6. Results: Anaemia as the Outcome

7. Results: Constraints to Response

8. Discussion, Conclusions, and Recommandations

9. References Citied

Appendix A: Study Descriptions

Appendix B: SAS Programs and Methods

Appendix C: The Special Case of Pregnancy: Use of the “Z-SCORE”

Appendix D: Reviewers’ Comments and Criticisms