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The effect of weekly iron and vitamin A supplementation on hemoglobin levels and iron status in adolescent schoolgirls in western Kenya

European Journal of Clinical Nutrition volume 63, pages 173–182 (2009)Cite this article

Abstract

Background/Objectives:

Iron deficiency anemia is a major public health problem in developing countries and may affect school performance and physical work capacity in nonpregnant adolescents, and may increase the risk of anemia during subsequent teenage pregnancies. We assessed the effect of weekly iron (120 mg elemental iron) and vitamin A (25 000 IU) supplementation on hemoglobin, iron status and malaria and nonmalaria morbidity in adolescent schoolgirls.

Subjects/Methods:

A total of 279 schoolgirls aged 12–18 years from public primary schools in Kisumu, western Kenya. Double-blind randomized placebo-controlled trial using a factorial design.

Results:

Five months of iron supplementation was associated with a 0.52 g dl−1 (0.21, 0.82) greater increase in hemoglobin relative to iron placebo. The effect was only observed in girls with iron deficiency on enrollment (1.34 g dl−1 (0.79, 1.88)), but not in iron-replete girls (−0.20 g dl−1 (−0.59, 0.18)). Similar differences in treatment effect were seen between menstruating and nonmenstruating girls. The effect of iron was independent of vitamin A. The baseline prevalence of vitamin A deficiency was low (6.7%) and no sustained increase in hemoglobin was seen with weekly vitamin A (−0.07 g dl−1 (−0.38, 0.25)). Incidence of malaria parasitemia was higher in the iron than iron-placebo groups (Rate ratio 1.33 (0.94, 1.88)).

Conclusions:

Weekly iron supplementation results in substantial increases in hemoglobin concentration in adolescent schoolgirls in western Kenya, which may outweigh possible risks caused by malaria, but only in iron-deficient or menstruating girls and not in iron-replete and nonmenstruating girls.

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Acknowledgements

We are grateful to all the schoolgirls, parents and teachers who participated in the study. We are indebted to Jenifer Matara and other staff from KEMRI for all their hard work and dedication to this project. We thank Laboratory and Allied Limited, Nairobi, Kenya for donating the study supplements. We thank Dr Margaret Oloo for her advice and contributions as the study pediatrician. We thank Meghna Desai and Lisa Mirel (Centers for Disease Control) for their statistical support. We thank Julie Solomon for her assistance in developing and running the multiplex bead assays. We thank the director of the Kenya Medical Research Institute (KEMRI) for his permission to publish this work. This study was funded by The Netherlands Foundation for the Advancement of Tropical Research (WOTRO).

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Authors and Affiliations

  1. Kenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya

    T Leenstra, S K Kariuki, A J Oloo & F O ter Kuile

  2. Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, University of Amsterdam, The Netherlands

    T Leenstra, P A Kager & F O ter Kuile

  3. Center for International Health Research and Department of Pathology and Laboratory Medicine, Brown University School of Medicine, Providence, RI, USA

    J D Kurtis

  4. Liverpool School of Tropical Medicine, Liverpool,, UK

    F O ter Kuile

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  1. T Leenstra
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  2. S K Kariuki
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Correspondence to T Leenstra.

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Leenstra, T., Kariuki, S., Kurtis, J. et al. The effect of weekly iron and vitamin A supplementation on hemoglobin levels and iron status in adolescent schoolgirls in western Kenya. Eur J Clin Nutr 63, 173–182 (2009). https://doi.org/10.1038/sj.ejcn.1602919

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