A review of the strategies used to reduce the prevalence of iron deficiency and iron deficiency anaemia in infants aged 6–36 months

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Abstract

Iron deficiency (ID) and iron deficiency anaemia (IDA) are global public health concerns that impact on infants worldwide in low and middle income populations. There is indication that ID affects long-term neurodevelopment and that these effects could be irreversible. The present study reviews the strategies available to reduce the prevalence of ID and IDA in 6-12 month-old infants.

A comprehensive review was carried out to identify all relevant studies. Four databases were searched: The Cochrane Library, PubMed/MEDLINE, Leeds Metropolitan Discover and Google Scholar up to 1 November 2014. Randomised controlled trials (RCTs), quasi-randomised trials and non-randomised trials investigating the effects of preventative strategies on the prevalence of ID and IDA in infants were included. Primary outcome measures were haemoglobin concentration, anaemia, iron deficiency and iron status. Identified articles were assessed against quality criteria, and a data extraction template was implemented to source all relevant information. A total of 1038 articles were identified by the initial search, with eight trials fitting the criteria for more detailed critical evaluation. Of the final eight articles reviewed, two trials investigated the effect of micronutrient sprinkles, two trials assessed iron-fortified milk programmes, two trials investigated the effect of iron supplementation, one trial evaluated food-based strategies, and one trial looked at the efficacy of different strategies to treat ID and IDA. Micronutrient sprinkles proved successful in reducing percentage prevalence of ID by an average of 20% as well as significantly increasing mean haemoglobin levels; additionally, iron-fortified milk programmes resulted in a significant reduction in percentage prevalence of IDA. Results of the iron supplementation trials were mixed, with one trial showing no difference between intervention and control groups for the incidence of ID and IDA whilst the other trial showed a dose–response effect in the daily supplementation group compared to the control group. Programmes focusing on iron rich food consumption were also unconvincing, with only red meat intake shown to help prevent the decline of iron stores. Results indicate that there are numerous beneficial strategies to reduce ID and IDA in young infants. Larger RCTs of longer duration are needed to determine the effects of timing and dose of these treatments, particularly the use of micronutrient sprinkles which are not commonly used in Europe but show promising results.

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