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.