Should Iron Supplementation be Daily or Weekly?

Two published papers

Nutrition guidelines for emergency programmes currently advocate a daily supplement of ferrous sulphate (100 mg/day) after fifteen days in therapeutic feeding programmes and daily for all anaemic children in supplementary feeding programmes from admission. However, two recent research studies under-taken in non-emergency situations suggest that weekly iron supplementation may be as effective as daily supplementation in restoring haemoglobin levels. These and other similar findings could have important implications for iron supplementation strategies as weekly supplementation in emergency or non-emergency situations would reduce costs and possibly increase subject compliance. One study compared the efficiency of daily versus weekly supplementation in a group of anaemic children living in a socio-economically disadvantaged district of high altitude La Paz in Bolivia. The children in this study were aged between 3-8 years and were split into three groups. One group was a placebo group (n=57) while the other two groups (n=58 for both other groups) were given a dose of 3-4 mg of elemental iron per kg body weight each week, or for five days a week over a 16 week period. Therefore, those who were supplemented daily received five times as much iron as those who were weekly supplemented. After 16 weeks of iron supplementation, 87.2% of the children receiving weekly supplementation and 82.7% of the group receiving the five day per week supplementation were no longer anaemic whereas only 5.4% of the placebo control group were non-anaemic. The study concluded that daily and weekly supplementation were equally efficient.

The full article can be found in the European Journal of Clinical Nutrition 1997, Vol. 51, pp 381-386

A second recent study in Indonesia reported similarly impressive results with weekly supplementation. The effect of weekly iron supplementation on haemoglobin with and without deworming on haemoglobin was investigated in 289 pre-schoolers randomly divided into three groups. Group 1 and 2 received 30 mg of iron once weekly for nine weeks and group 3 received a placebo over the same period. Group 1 additionally received antihelminthic treatment. Supplements were administered by mothers who were educated about iron deficiency beforehand. In the iron supplemented groups prevalence of anaemia decreased from 37.2% to 16.2%. Antihelminthic treatment did not have an additional effect

The full article: Effective community intervention to improve haemoglobin status in pre-schoolers receiving once weekly iron supplementation. AM J Clin Nutr J997;65.1057-61