A WHO collaborative study on iron supplementation in Burma and in Thailand

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Abstract
Studies on the treatment and prevention of iron deficiency anemia, in pregnant and nonpregnant women and in men, were conducted in Thailand and Burma. The effects of the dose of Fe, duration of Fe administration, additional supplementation with folate, mode of supplement delivery (either supervised or unsupervised), and the presence of Hb(AE) were studied. The frequency and severity of side effects were also recorded. Fe administration resulted in an increase in hemoglobin concentration in all anemic individuals but approximately 20% failed to reach normality. The length of administration and the dose influenced the results. Frequency and severity of side effects increased with the dose of Fe administered. Folate supplementation did not affect the results. It appears possible to integrate a program of prevention and treatment of Fe deficiency anemia in a primary health-care system but the constraints and limitations of achievable results should be recognized. 4 collaborative trials of iron supplements with or without folate on the following groups: adult men and women in central Thailand; pregnant women in northeastern Thailand; adult women in northern Thailand; and pregnant women in Burma, are reported as separate studies here. Subjects took 30, 60, 120 or 240 mg Fe sulfate with or without 2.5 mg folic acid. Those with chronic disease or hemoglobin 80 g/L were excluded. Presence of hemoglobin EE or EF, or hookworm infestations were determined in some cases. Hemoglobin E, which tends to increase incidence of anemia, occurs in up to 4.8% of women in northern Thailand, 27.6% of adults in northeastern Thailand, and 19% of pregnant women in Burma. Hookworm infection was a high as 35% in central Thais. Iron supplementation significantly increased mean Hb and reduced incidence of anemia in all study groups. 20% of subjects remained anemic. In northeastern Thailand treatment for 15 weeks resulted in higher Hb than did 10 weeks treatment. No significant difference was seen with dose of Fe or inclusion of folate. Supervised administration of supplements had no additional effect. Gastrointestinal side effects were a problem, and were dose related, but tended to resolve after a while. The fact that Hb levels did not rise to normal levels indicates that a combined program possibly including parasite control and food fortification should be considered.