Effect of Low-Level Iron and Vitamin Supplementation on a Tropical Anemia

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Abstract
This study represents an attempt to assess the relative public health importance of anemia and intestinal parasites in a representative Amazon Basin primary school population and evaluates a public health approach to the problem. A study was made of the effect of the daily administration of low levels of iron (5 mg elemental Fe/day), iron and vitamin supplementation (5 mg elemental Fe; 0.5 mg thiamine; 1 mg riboflavin; 3 µg B12; 0.2 mg folic acid; and 5 mg niacin), and anthelmintic treatment on the anemia of 156 parasitized Amazon Basin primary schoolchildren. Placebo groups which did and did not receive anthelmintic treatment served as controls. Initial hemoglobin 1evels were below 10 g/l00 ml in 34% of the cases. Ninety-five percent of the children exhibited hookworms in the stools. Of the 47 children receiving anthelmintic treatment 98% eliminated hookworms, 28% Ascaris, and 28% Trichocephalus. Five milligrams elemental iron/day were effective (P < 0.05) in raising hemoglobin and hematocrit values, particularly in those children whose initial hemoglobin values were below 10 g/100 ml. When initial hemoglobin levels were beween 10–12 g/100 ml, improvement occurred only if anthelmintic treatment accompanied iron therapy. Vitamin supplementation combined with iron was no more effective than iron alone. The normocytosis (X¯ 7.3 ± 0.3 µ), high sedimentation rates, frequent fever, and diarrhea, indicated that the anemia was due in part to chronic infection. This study demonstrated that carefully controlled low-level ferrous sulfate administration was effective in overcoming frank anemia in heavily parasitized primary schoolchildren, even at levels of 5 mg elemental iron per day. In public health programs this amount of iron could be supplied in pill form as was done in this study, or by somewhat higher level iron enrichment of staple foods.

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