Investigation of the causes of suboptimal haemoglobin response to iron supplementation.

The investigation concerned 572 children, 6-11 years of age, who were divided into three groups: urban control, rural control and rural study. During the first phase of supplementation, each child received 120 mg of elemental iron (as ferrous sulphate) with 0.50 mg of folic acid daily for 60 school days (five days a week) which resulted in a suboptimal haemoglobin concentration. During the second phase, all groups continued to take iron-folate tablets for 60 school days while the children in the study group also received protein, vitamins and minerals. Final blood examinations showed no significant difference in mean haemoglobin concentrations between the rural study and rural control groups. Only 1.5% of all children had haemoglobin below 12 g/dl. It can therefore be concluded that strict supervision of iron tablet intake and long-term supplementation with iron are essential for optimal haemoglobin response.

The effect of riboflavin on the hematologic changes in iron supplementation of schoolchildren.

A supplementation trial was carried out in 101 children, 6-12 years of age, in 3 primary schools in a rural area. Their hemoglobin level and PCV (mean +/- SD) were 11.64 +/- 1.21 g/dl and 0.356 +/- 0.028 respectively, 74% of them were anemic and the hemoglobin level were correlated with the MCHC (P < .01) . Fifty-one per cent of them had hookworm infection and all those with hemoglobin levels below 10 g/dl had hookworm infection, but there was no difference in mean hemoglobin level between those with hookworm infection and those without. The children were divided into 3 groups: Group I comprising 39 children who received placebo tablest; Group II of 33, who received ferrous sulphate (60 mg elemental iron); Group III of 29, who received ferrous sulphate (60 mg elemental iron) with riboflavin (6mg). Each child received one tablet after lunch on schooldays and evaluation was carried out after receiving 80 to 90 tablets. The mean hemoglobin change of Group II was 0.60 g/dl larger than that of Group I (P < .005) with 52% of them responding to iron. The mean hemoglobin change of Group III was 0.38 g/dl larger than that of Group II (P < .005) with 86% of them responding to iron and riboflavin. Thus additional riboflavin is beneficial in iron supplementation.