Impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status of anemic infants.

OBJECTIVE: To evaluate the impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status in a sample of anemic infants from Zona da Mata Meridional in the state of Pernambuco, Brazil. METHODS: A controlled, community-based intervention was carried out with 378 infants who were followed-up for 18 months. Hemoglobin level was measured at 12 months in a total of 245 children randomly selected. Participating infants were divided into three groups: two received 45 mg of elemental iron weekly, from 12 to 18 months of life (69 children with moderate/severe anemia, and 111 with mild anemia); the third group was composed of 65 non-anemic children, who received no intervention. The remaining 133 children constituted the control group, for comparisons on nutritional status and morbidity. RESULTS: The prevalence of anemia was 73.5% at 12 months of life. After 6 months of treatment, 42.3% of anemic children reached hemoglobin levels >or= 11.0 g/dL. The mean increase was 1.6 g/dL, being higher (2.5 g/dL) in the group with lower levels of hemoglobin at baseline. Children without anemia at baseline received no treatment, and 40.3% of them became anemic at the end of follow-up, with a mean decrease of 0.5 g/dL in hemoglobin levels. A significantly greater weight gain was observed in the two treated groups, while no significant improvements were seen in linear growth and duration of diarrhea. CONCLUSIONS: The fact that less than half the children receiving ferrous sulfate recovered from anemia at the end of follow-up, along with the development of anemia in many untreated, previously non-anemic infants, suggests the need for effective control strategies.

Impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status of anemic infants

OBJETIVO: Avaliar o impacto do tratamento com sulfato ferroso, administrado semanalmente, sobre o nível de hemoglobina, morbidade e estado nutricional de lactentes anêmicos da Zona da Mata Meridional de Pernambuco. MÉTODOS: Estudo de intervenção de base comunitária, controlado, realizado com 378 lactentes acompanhados até 18 meses. Foram selecionadas aleatoriamente 245 crianças para avaliação da hemoglobina aos 12 meses. As crianças foram distribuídas em três grupos de estudo: dois com tratamento semanal de 45 mg de ferro elementar, dos 12 aos 18 meses de vida (69 crianças com anemia moderada/grave e 111 com anemia leve) e um sem tratamento, constituído de 65 crianças sem anemia. As 133 crianças restantes constituíram o grupo controle, utilizado para comparação do estado nutricional e da morbidade. RESULTADOS: A prevalência de anemia foi de 73,5 por cento aos 12 meses de vida. Após 6 meses de tratamento, houve recuperação do nível de hemoglobina para valores > 11,0 g/dL em 42,3 por cento dos lactentes anêmicos. O aumento médio foi de 1,6 g/dL, sendo maior (2,5 g/dL) para o grupo com nível inicial mais baixo de hemoglobina. Das crianças sem anemia e não tratadas, 40,3 por cento tornaram-se anêmicas ao término do acompanhamento, com uma redução média do nível de hemoglobina de 0,5 g/dL. Observou-se um ganho de peso significativamente maior nos grupos com tratamento, o mesmo não ocorrendo para crescimento linear e duração da diarréia. CONCLUSÕES: A redução da prevalência da anemia em menos da metade das crianças recebendo sulfato ferroso em doses semanais e o surgimento de anemia nos lactentes não anêmicos e sem suplementação de ferro são indicativos da necessidade de estratégias eficazes para seu controle.

OBJECTIVE: To evaluate the impact of weekly treatment with ferrous sulfate on hemoglobin level, morbidity and nutritional status in a sample of anemic infants from Zona da Mata Meridional in the state of Pernambuco, Brazil. METHODS: A controlled, community-based intervention was carried out with 378 infants who were followed-up for 18 months. Hemoglobin level was measured at 12 months in a total of 245 children randomly selected. Participating infants were divided into three groups: two received 45 mg of elemental iron weekly, from 12 to 18 months of life (69 children with moderate/severe anemia, and 111 with mild anemia); the third group was composed of 65 non-anemic children, who received no intervention. The remaining 133 children constituted the control group, for comparisons on nutritional status and morbidity. RESULTS: The prevalence of anemia was 73.5 percent at 12 months of life. After 6 months of treatment, 42.3 percent of anemic children reached hemoglobin levels > 11.0 g/dL. The mean increase was 1.6 g/dL, being higher (2.5 g/dL) in the group with lower levels of hemoglobin at baseline. Children without anemia at baseline received no treatment, and 40.3 percent of them became anemic at the end of follow-up, with a mean decrease of 0.5 g/dL in hemoglobin levels. A significantly greater weight gain was observed in the two treated groups, while no significant improvements were seen in linear growth and duration of diarrhea. CONCLUSIONS: The fact that less than half the children receiving ferrous sulfate recovered from anemia at the end of follow-up, along with the development of anemia in many untreated, previously non-anemic infants, suggests the need for effective control strategies.

Improved cognitive and motor development in a community-based intervention of psychosocial stimulation in northeast Brazil.

The aim of the study was to compare the development of children with and without a programme of psychosocial stimulation in 'control' and 'intervention' sites in a poorly resourced area of northeast Brazil. The sample (n = 156, born 1998) was from a larger cohort. The cohort was tested at 12 months (baseline) with the Bayley Scales of Infant Development. All children in the intervention site with a mental development index (MDI) and/or psychomotor development index (PDI) < or = 100 were enrolled. Each time such a child was enrolled, the next child tested in that site of the same sex and with an index of 101 to 115 was also enrolled, and the next two children matched for sex and scores of < or = 100 and 101 to 115 in the control sites were recruited in parallel. The intervention comprised 14 contacts between 13 and 17 months of age. All children were tested again at age 18 months. The intervention and control groups were similar at baseline for a range of socioeconomic, demographic, environmental, and biological variables, and their MDI and PDI were also similar. At 18 months, the mean differences between the intervention and control groups were + 9.4 points for MDI and + 8.2 points for PDI (p < 0.001 in each case). For children with an initial score of < or = 100, the mean difference between the intervened and control groups was + 11.2 points for MDI (p < 0.001), and + 10.8 points for PDI (p = 0.001). The intervention was thus associated with significant improvements in cognitive and motor development.