When to start supplementary iron to prevent iron deficiency in early childhood in sub-Saharan Africa setting

Background To study the efficacy of oral ferrous fumarate, an inexpensive, readily available preparation on iron deficiency in infants in Africa. Procedure Four months old (group 1, n = 252) and 6–18 months old (group 2, n = 360) healthy infants attending four primary health care centers (PHC) for vaccination/well‐child visits in Benin were studied. Ninety‐six pregnant women (PW) over 36 weeks gestational age attending the same PHC during the study period were also studied. Infants were offered 2 months supplementation with oral powdered generic ferrous fumarate (GFF), that is, 5 mg/kg/day of elemental iron, given twice and were reevaluated 2 months later for hematological indices. The prevalence of anemia and iron deficiency among pregnant women was assessed using hematological indices and transferrin saturation. Results The prevalence of anemia was 42.0%, 61.9%, and 37.5% in groups 1, 2, and PW, respectively. All anemic PW were iron deficient. Hemoglobin level shifted towards high values after supplementation. In addition, 24 infants from group 1 whose mothers interrupted the treatment, showed a significant decrease in hemoglobin level values, and similar improvement after two additional months of supplementation. Conclusion Programs to prevent iron deficiency in Africa should utilize inexpensive preparations, start during pregnancy, continue in infants at 3 months of age and address problems of noncompliance. Pediatr Blood Cancer 2007;48:544–549. © 2007 Wiley‐Liss, Inc.