Effects of Iron Treatment of Anemia in a Tropical Area

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Abstract
Girls in primary public schools served as subjects in a study to determine the iron requirements in the Peruvian jungle area. The girls were heavily infested with a variety of intestinal parasites. Seventy-five per cent of the subjects showed Ascaris, 91 per cent hookworm, and 81 per cent Trichuris. Protozoan cysts were found in 31 per cent. The hemoglobin levels ranged from 4.0 to 13.8 g/100 ml with an average value of 9.8. Approximately half of the girls had hemoglobin levels less than 10 g/100 ml. Quantitative studies showed that the degree of anemia below 10 g/100 ml was related to the hookworm load. Four groups of approximately 50 girls received respectively 0 (placebos), 15, 30, or 50 mg of iron as ferrous sulfate daily for periods up to 14 weeks. The hemoglobin response was essentially maximal within six weeks. The most anemic children showed the greatest response with average increases of 3 to 4 g of hemoglobin per 100 ml. Hemoglobin levels above 10 g/100 ml were not increased by iron treatment. All levels of iron used appeared to be equally effective. When iron treatment was stopped, the group of children which had received 50 mg of iron daily maintained their hemoglobin levels for three months, but had returned to pretreatment levels within eight months. The other groups were not studied after therapy. The average dietary intake of iron for the subjects was estimated to be approximately 12 mg per day and the total iron requirement to maintain the hemoglobin levels at approximately 10 g/100 ml would appear to be somewhat less than 25 mg per day. Thus, relatively small increases in the iron intake proved to be beneficial. It is concluded that means should be sought, by fortification and/or dietary instruction, to increase the iron intake.