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    Poa10131 PDF

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    Siti Holida

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    of 5
    porate Weekly vs Daily Iron and Folic Acid Supplementation in Adolescent Nepalese Girls Binay Kumar Shak, MBBS; Piyush Gupta, MD, MAMS Objectives To compare the effectiveness of weekly vs daily iron and folic acid supplementation for control of ‘anemia in adolescent Nepalese girls. Design: Randomized controlled trial Settings A Government Girl School in Dharan, Nepal, ‘an urban foothill town that is 305 m above sea level ‘Subjects: Consecutive healthy adolescent girls (n=209, median age 15 years) randomized to 3 groups matched for age, anthropometry, and personal and sociodemographic ‘characteristics. Of200 subjects, 181 completed the ial. Two blrlshad adverse reactions to treatment and were excliided, Intervention: Group A (1=70) received a 350-meg fer- rous sulfate and 1.5-mg folic acid combination once daily for 90 to 100 days. Group B (n=67) received the tablet under supervision once a week for 14 weeks. Group C (272) did not receive any drugs. Outcome Variable: Presupplementation and post. supplementation differences in prevalence of anemia and change in hematocrit Results: Prevalence of anemia (defined as hematocrit <36%) declined from 68.6% and 70.19% in groups A and B to 20% and 13.4%, respectively, postsupplementation (P<.001), whereas the prevalence in group C changed litle (68.1% to 65.3%, P=.81). There was a significant rise in the mean hematocrit ofboth supplemented groups (group A, 32.0%43.5% to 41.0%45.0%, P<.001; group B, 33.2% 43.6% to 40.4%24.0%, P.05). Mean hematocrit change in the responders was also not found to be influenced by the age or menarchal status of the subjects indifferent groups (3-way analysis, of variance; all 2-way and 3-way interactions insignifl- ‘cant at 5% level) — kL iaay_¥_—_§ The prevalence of anemia in this study was extraordi- narily high but matched closely with a few studies from the Indian subcontinent."=° This was in sharp contrast to studies in other parts of the world, where the preva- lence of anemia in adolescent girls ranges from 4% to 30% (Norway 4%, United States 5.9%, England 10.5%, Ku- wait and Peru 25%-30%).""" A detailed dietary history would have enabled further discussion on probable causes of the high prevalence in our sample. The concept ofa elose association between anemia and iron deficiency is closest to correct when the prevalence of iron deficiency is high.' Therefore, it was sale to as- sume that iron deliciency was the principal cause of ane mis and experiment with various modalities of on supple- mentation, The fect of hematinic supplementation indicates that most girls ad nutritional anemia, and other diagnoses may have contributed litleto the etiology: A high (©2002 American Med Downloaded From: on 04/13/2018 Mates son 6 Siena —_ Ba nc at a i> a Tindmaw | [Wns | [7 Rost Fee by fee eet Sepmece Sint ‘eam fe DiteAecie Sepamwtin 1 | evnd nate ay ar agree Pe Ha Dee scan Spenser Stemntee sie shane T waar Wada wd Naor ce wor ct Mawar ce 2 haFoon 6 Mofolonap 2 NaFaon Hens Aemase Aemase T T T a ce a Ce in| | Ftbamsien| | el ie Study protocol prevalence of anemia also justified our blanket approach of treating all girls in intervention groups with supple- ‘ments irrespective of their ron or hematocrit levels. The dose and duration of iron therapy in the pre sent study aligned with standard recommendations. The Centers for Disease Control and Prevention advocates 60 to 120 mg of elemental iron a day for 2 to 3 months to Uweat anemia in adolescent gils.'In the Indian subcon- tinent, folic acid is routinely added to iron tablets in eur- rent national programs for control of anemia.” Hemal- ocrit levels in groups supplemented with daily and weekly fron and folie acid improved to an equal extent but s nificantly more than the controls following 3 months of supplementation. 4 follow-up period of 6 to 9 months: would have helped to document the long-term ellects of supplementation. While refuting the mucosal block theory, Hallberg” also questioned the methodology and design of studies sug- gesting a similar hemoglobin response to weekly and daily tron administration. The controversy appears to have been put to rest by a recent meta-analysis of 22 completed t als on the efficacy of intermittent iron supplementation {in control of iron deficiency anemia in developing coun- Uwies.” Beaton and McCabe" concluded that both daily and weekly iron supplementation schedules are efficacious. Weekly iron supplementation is likely o be less effective than daily administration except in situations where su- pervision is feasible with weekly but not daily schedules. We proved that supervised weekly iron supplementation fs as ellective as daily administration but could not com- ‘ment on a situation where weekly iron is given in an un- supervised manner. The question of whether there is mu- cosal block appears redundant now, as field trials have provided ample evidence of the equal efficacy of weekly and daily ron administration schedules, 1 Association, All rights reserved. Ta Formal nd foveonopeis dia me a es ax pate can wen aaa F eae ae a ae) a Pore an ty bo Farr = aaa snus can a A a ath Uptoigh stat sien ian size | 0 ieee ced 2 aa creat ‘ea 119 208 Unctld nrar ern 14 2a ] 1s Pee ga an ee a en ona eoxa Petaadas a uae 284] 0 eas aca ams ama > sont ee “in a3 ‘lea oun anes sox 2 a, ap a3 eta TR? npn a Topo Pei thea : aa ieee came en amy ea raaeuaain ieee Hoan sia nes “Preece of area among th 3 groups compared with tt (presuplamentaton: Av, P '30;AveC, Pe O91 Bus P01) Wihr-grup ciflereness npravalnce of anemia prasiplemriaion ad pstauppiametaon sald wih Awe, Mel ar st (A, P00; B, P00: I) “flzan hematert aang ihe 3 groups compared ih toma aaj of variance presupplenation- A vB, P= 85; Avs, P= 06: Bs. Pa Avs 6, Pe DOI: Bs C, P=ODI-nathamatoert change ve B, P= Si-A vaC, P= DD BveC, P= Ot), Win-poup postsuplamentaton Avs, P {ferences in mean arab presupplamenttio and possupplamentaon anayad with pad ret (A POT; 8, POO; C In developing counties, hematinic supplements are distributed through the primary health care systems. How- ever, sustained efficacy is uncommon, owing to factors such as irregular tablet distribution and poor compli- (©2002 American Medical As. Downloaded From: on 04/13/2018 Ave. P= 95; Bw, P 78, postsuplamentation: 0 1) ance. A less-[requent schedule would mean less cost and better compliance. Cook" argued against better compl ance in the weekly group based on a dismal record of ad- herenceto weekly programs for malarial prophylaxis, We jon, All rights reserved. ‘Table 3 Response to Hematinic Supplementation ? rosupplemestton vs ‘row creupe total etweon esponeecalgory _Postupplementton Sat (207) _(=72) _(9=200) _croups_ AB AvsC Bc Responders ‘nomic normal Ne.(%) 35/600) 38667) 10/189) as(sar) <001 48 —<001_<00T Meantematecitchange +80 126437 104440 d4sd4 106445 <001 05 <001 <001 Nonesponders -Nomaltonomal,No.(s) | 21200) © 20,208) 15(208) seams) 57th 22 Meantematecitchange+80 63238 4444 01422 30448 <01 24 <01 02 ‘nomic tanec No(s) 13 (188) 91134) 30/642) oreea2) <001 At <001 < oot Meantematecitchanges80 02406 02416 05415 03214 15 992530, Nomaltaanenic Wo.(%) 1114) THA) 9) Mean hematocrit changes 80-80 -a0aid 22612 (01) Epes inate not ppb Cen Daly iron supplementation sa key strategy for short- term contcl of ron deficiency anemia, Control of ane- tna particularly important in adolescent gles be- cause they may be future mothers A reduction in the Frequency of ron supplement administration once ot twice a week is being examined in developing coun- tres If elfecive, thls schedule would improve compi- ance and reduce cots. ‘The resultso the presen study indicate that weekly supervised iron and folic acid administration fs an ef fective alternative to daily administration. In adoles- cent girs, weekly supplementation through school- based programs lowers the prevalence ofntiain areas swith High prevalence ofthe disease. think this problem can be obviated with « high degree ‘of supervision, which is realistic and elfective in school based weekly iron supplementation programs. Dropouts because of poor compliance were almost double in the daily supplementation group as compared, with the weekly group, and persistent adverse effects were also limited to the daily supplementation group. How= ever, because there were fewer subjects, the Impact of a daily vs weekly schedule on the adverse effects of iron therapy could not be confidently demonstrated. Inci- dence of adverse effects could have been better analyzed ifwe had administered placebos to our control group. Also, we did not question the girls bout their perceptions and preferences with regard to daly vs weekly therapy. Itwould he interesting to know whether girls liked a particular schedule, and if so, what their reasons were To conclude, the prevalence of anemia in Nepalese adolescent girls is quite high. To counter this, weekly st pervised therapy isa good alternative to daily iron and fo- licacid administration. Weekly therapy appears to be equally ‘flective yet causes fewer adverse eflects, improves com- pliance, and reduces the cost of supplementation. “Accepted for publication September 20, 2001 This study was supported by the Research Committee of BP. Koirala Institute of Health Sciences, Dharan. (©2002 American Medical Ass Downloaded From: on 04/13/2018 “Batsen-goupdfernce by group or reponse calagary compared with 2-wayanasieovaracs alway and 2a actions ware inca Corresponding author and reprints: Piyush Gupta, MD, MAMS, Block R-6-A, Dilshad Garden, Near Telephone Exchange, Delhi 110095, India (e-mail: drpiyush®satyam net.in). —_ I mm” 1. Cars a Dissent and Premio. acommendtns opraert enolien deny Untied See MMP hr Mora Wi ap. 0 ‘miamy tae Angel Ageppa, Schlik W,Sastoario, Ges Raya Wey ‘tone supra bul fon stoves nui Indonesian ao lect Amn utr 5786177183, ion, aX. Tolan, Marin Tr asortion a tenon of up rea an ore ect when ns dren vr dye rate an {iyo encmal and orden a, J ur 10051252201, 4 Schuh W, Gross luo Marya, Musi Petts of daly vs twice a iton supemenan densa preschtehidren hiaw Yon tts Ap Cr 085-111-115 alonayR Mule. aly eel how may rnpilsdpregnart women esa? Mare BSUS 208 {ip on suplmenston sug pregnancy ist tecie? Am J Cn Ma ‘cease Sons Daly sway ton. MR. 18075-41142, ack 0 Rea MB Eco eel compare wth al on suppemer- tehon And Cin er 1250917120, Her Caran Worden: daly adinitrsinn toni a sup wel arnt. An Cl Mu 00686821827. Geel arvopuetie standart tance (see conbind) a. ‘eared trom tard standard I The Assesment of Marton Stas ‘fhe Cammunty Gee, Suze Ward ath Orgenzton 168 HD Hevogaph Ses 28 221 1. Fler, Don OO rao J anos AK, Heron MS, arc KE nan tanto etn na ale I Paaee KE Soa lesen Dra Be Sar and Developme Ne York WY Marl Dlr 19081350 por naa atonal erin adoaen ii Indian Pada. 00 Pon StamaV, Sharma Help of reasons among sale papuston fasta nda Ads Heath 100213895 608 Feder Waited, odes Hanogab,leran ad n isish

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