scholarly journals Impact of iron fortification on anaemia and iron deficiency among pre-school children living in Rural Ghana

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246362
Author(s):  
Samuel Kofi Tchum ◽  
Fareed Kow Arthur ◽  
Bright Adu ◽  
Samuel Asamoah Sakyi ◽  
Latifatu Alhassan Abubakar ◽  
...  
Keyword(s):  
Placebo Group ◽  
Iron Deficiency ◽  
School Children ◽  
Iron Status ◽  
Intervention Group ◽  
Iron Group ◽  
Double Burden ◽  
Micronutrient Powder ◽  
The Impact

Anaemia in young sub-Saharan African children may be due to the double burden of malaria and iron deficiency. Primary analysis of a double-blind, cluster randomized trial of iron containing micronutrient powder supplementation in Ghanaian children aged 6 to 35 months found no difference in malaria risk between intervention and placebo groups. Here, we performed a secondary analysis of the trial data to assess the impact of long-term prophylactic iron fortificant on the risk of iron deficiency and anaemia in trial subjects. This population-based randomized-cluster trial involved 1958 children aged between 6 to 35 months, identified at home and able to eat semi-solid foods. The intervention group (n = 967) received a daily dose containing 12.5 mg elemental iron (as ferrous fumarate), vitamin A (400 μg), ascorbic acid (30 mg) and zinc (5 mg). The placebo group (n = 991) received a similar micronutrient powder but without iron. Micronutrient powder was provided daily to both groups for 5 months. At baseline and endline, health assessment questionnaires were administered and blood samples collected for analysis. The two groups had similar baseline anthropometry, anaemia, iron status, demographic characteristics, and dietary intakes (p > 0.05). Of the 1904 (97.2%) children who remained at the end of the intervention, the intervention group had significantly higher haemoglobin (p = 0.0001) and serum ferritin (p = 0.0002) levels than the placebo group. Soluble transferrin receptor levels were more saturated among children from the iron group compared to non-iron group (p = 0.012). Anaemia status in the iron group improved compared to the placebo group (p = 0.03). Continued long-term routine use of micronutrient powder containing prophylactic iron reduced anaemia, iron deficiency and iron deficiency anaemia among pre-school children living in rural Ghana’s malaria endemic area.

scholarly journals Impact of Iron Fortification on Anaemia and Iron Deficiency among Pre-school Children Living in Rural Ghana

2020 ◽  
Author(s):  
Samuel Kofi Tchum ◽  
Fareed Kow Arthur ◽  
Bright Adu ◽  
Samuel Asamoah Sakyi ◽  
Latifatu Alhassan Abubakar ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
School Children ◽  
Iron Deficiency Anaemia ◽  
Iron Status ◽  
Iron Group ◽  
Deficiency Anaemia ◽  
Rural Ghana ◽  
Micronutrient Powder ◽  
To Receive

Abstract Background Micronutrient interventions, principally vitamin A and zinc supplementation for children, and fortification of foods with iron and iodine, are considered the most cost-effective global development efforts. Multiple micronutrient powder is a mixture of at least iron, zinc and vitamin A used to prevent malnutrition in children and during health emergencies. Micronutrient deficiencies are a universal health burden among young children in developing countries. However, the use of this low cost but sustainable micronutrient powder as an innovative home-fortification approach to control a common nutritional disorder like iron deficiency anaemia among pre-school children living in malaria endemic sub-Saharan Africa is unclear. The aim of our study was to determine the effect of providing long-term continued prophylactic micronutrient powder with iron on the risk of iron deficiency and anaemia among pre-school children living in rural Ghana.Methods This population-based randomized-cluster trial was conducted in the Bono region of Ghana from 3rd April to 6th July 2010. 1958 children were recruited, and 967 randomly assigned to receive prophylactic micronutrient powder with iron and 991 assigned to receive placebo. The trial participants were children aged between 6 to 35 months, identified at home and able to eat semi-solid foods (with or without breast milk). Structured questionnaires were administered, their blood samples were also taken for biochemical analysis. They were randomly assigned to receive daily micronutrient powder without or with iron (12·5 mg) added to complementary meals immediately after enrollment for five months. Each participant also received anti-malaria treated bednet and chemotherapy. Weekly follow up visits were conducted at home or health facility where data on malaria using rapid diagnostic test and hospital admissions were collected. The primary outcome was post supplementation of prophylactic micronutrient powder with iron to mitigate the effects of iron deficiency and anaemia.Results 1958 children were recruited and 967 randomly assigned to receive prophylactic micronutrient powder with iron and 991 assigned to receive placebo. Loss to follow up was 7 % (143), with vital status at 35 months of age reported for 1904 (97.2 %). Anthropometry, anaemia, iron status, demographic characteristics and dietary intakes were similar between the groups at baseline. Baseline haemoglobin level was significantly higher compared to haemoglobin level at endline (p < 0.0001). Though, we recorded an increase in haemoglobin (p = 0.0001) and ferritin (p = 0.0002) levels in the iron group than in the placebo group at the end of the intervention. Soluble transferrin receptor levels were more saturated among children from the iron group compared to placebo group (p = 0.012). Anaemic status in the iron group improved compared to the non-iron group (p = 0.03).Conclusion The risk of childhood morbidity and mortality in rural Ghana is high, mainly due to iron deficiency anaemia. National nutritional policy coupled with the current WHO recommendations are required to support the provision of prophylactic micronutrient powder with iron in order to improve anaemic and iron status among pre-school children in rural Ghana.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01001871. Registered 27th October 2009, http://www. ClinicalTrials.gov/ NCT01001871

scholarly journals Impact of IgG response to malaria-specific antigens and immunity against malaria in pre-school children in Ghana. A cluster randomized, placebo-controlled trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253544
Author(s):  
Samuel Kofi Tchum ◽  
Samuel Asamoah Sakyi ◽  
Bright Adu ◽  
Fareed Arthur ◽  
Felix Boakye Oppong ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
School Children ◽  
Iron Status ◽  
Malaria Episode ◽  
Iron Fortification ◽  
Micronutrient Powder ◽  
Specific Antigens ◽  
Endemic Areas ◽  
Cluster Randomized ◽  
The Impact

Background Iron fortification and micronutrient initiatives, specifically, vitamin A, and zinc supplementation are the most cost-effective developmental strategies against malnutrition and health emergencies in pre-school children. Iron-deficiency among pre-school children have been documented, however, studies evaluating the impact of immunoglobulin G (IgG) isotype responses among iron-fortified pre-school children in malaria endemic communities has not been assessed. We evaluated the impact of iron fortification on the IgG responses to GLURP R0, GLURP R2 and MSP3 FVO malaria-specific antigens among pre-school children in malaria endemic areas. Methods This community-based, placebo-controlled, double-blinded, cluster-randomized trial study was conducted in Wenchi Municipal and Tain District of Bono Region. The trial was registered at ClinicalTrials.gov-registered trial (Identifier: NCT01001871). Ethical approval was obtained and informed consent were sought from each participant parents/guardian. For the current objective, 871 children aged 6–35 months were screened, from which 435 children received semi-liquid home-made meals mixed with 12.5 mg of iron daily (intervention group), and 436 received micronutrient powder without iron (placebo group) for 5 months. Standardized clinical and epidemiological questionnaires were administered and blood samples taken to measure IgG responses to GLURP R0, GLURP R2 and MSP3 FVO recombinant antigens using the Afro Immunoassay (AIA) protocol. Results Baseline anthropometry, malaria diagnosis, anaemia and iron status, demographic features and dietary intake were identical among the groups (p > 0.05). After the intervention, there was no significant difference in the IgG response against GLUP R0, GLUP R2 and MSP3 FVO between the iron-containing micronutrient and placebo groups (p > 0.05). The iron-containing micronutrient powder group who were iron-sufficient or iron replete had significantly higher IgG response to GLURP R0 and GLURP R2 compared to iron-deficient and iron-deficiency anaemia in the same group (p < 0.05). The IgG responses to all the three malaria specific antigens were low among children without malaria episode but high among those with two and four episodes due to exposure differences. Conclusion Iron fortification did not influence antibody response against endogenous malaria specific antigens among pre-school children in malaria endemic areas, however, IgG response to malaria specific antigens were high among children with sufficient iron status.

scholarly journals Malnutrition in an obese world: Can a dietary intervention improve iron status in pre-school children?

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Ellen van der Gaag ◽  
Kim Grootelaar ◽  
Thalia Hummel
Keyword(s):  
Iron Deficiency ◽  
School Children ◽  
Dietary Intervention ◽  
Growth Parameters ◽  
Iron Status ◽  
Controlled Trial ◽  
Intervention Group ◽  
Dietary Advice ◽  
Control Group ◽  
National Guidelines

AbstractIntroduction:In previous studies iron deficiency was present in preschool children in the developed world1. The objective of this randomized controlled trial was to investigate whether iron deficiency was present in pre-school children and to what extend laboratory values could be improved with a nutrient rich diet.Material and Methods:A diet consisting of green vegetables, beef, full-fat milk and butter was developed. This diet comes close to the traditional Dutch diet from a century ago. All food products were in age appropriate portions, according to the national guidelines. Children aged one to four years, who were referred to the paediatrician due to recurrent URTI (without immunologic disorders) were allocated to the intervention or the control group. Both groups were given standard care. The intervention group was also given the dietary advise. All parents were asked to note of daily food intake.Results:No iron deficiency was present in our group of 1–4 years old. Mean Hb was 7.3 mmol/l in both groups. After following the dietary advice for 6 months,the hemoglobulin (Hb) concentration increased in both groups, but a little more in the intervention group :(0,280 mmol/l; p < 0,001 in the dietary intervention group and 0,214 mmol/l in the control group; p = 0,003). MCV values increased in the interventiongroup from 77.9 to 78.8 fl (p = 0.007) whereas a smaller increase was visible in the control group ;78.5 to 78.9 fl (p = 0.18). Ferritin, a marker for iron status but also a marker for inflammation, decreased non-significantly in both groups. There was a significantly correlation with decreasing CRP levels, therefore indicating a decrease in inflammation and not merely representing iron status. Growth parameters (weight, height or BMI) did not change significantly in both groups.Discussion and Conclusion:NoHb deficiency was present in our research population. However, a diet consisting of green vegetables, beef, full-fat milk and butter did improve the iron status in pre-school children. Hb and MCV values increased, suggesting some evidence of subclinical iron deficiency in this group.

scholarly journals Knowledge, attitudes and practices (KAP) to assess the impact of school children's awareness of malaria using the MOSKI KIT® tool: study case of some Dakar schools in Senegal

2020 ◽  
Author(s):  
Isaac Akhénaton Manga ◽  
Aissatou Gaye ◽  
Aliou Dia Kouevidjin ◽  
Ekoue ◽  
Maria Rosa Dos Reis ◽  
...  
Keyword(s):  
School Children ◽  
Intervention Group ◽  
Control Group ◽  
Household Level ◽  
Attitudes And Practices ◽  
Number Of Children ◽  
And Control ◽  
The Impact ◽  
Knowledge Attitudes And Practices

Abstract Background MOSKI KIT® is a fun tool designed to interest children for prevention and management of malaria. This study was carried out with the objective to assess the short- and long-term impacts of this tool on the knowledge, attitudes and practices of school children, and on the transmission of the knowledge received at the household level as well. Method The study took place in elementary schools in the city center (with relatively low endemicity) and in the Niayes area (at high risk of anopheline and malaria) in the Dakar region of Senegal. The various schools chosen for our study were divided into an intervention group and a control group. The intervention schools were also divided into two subgroups, a full package subgroup and another partial package. We conducted three surveys there, a first before exposure to the MOSKI KIT®, a second a week later and a third a year later. In the control schools, we only carried out one at the same time as the last in the intervention schools. We carried out two household surveys (a week and a year after exposure) for the intervention schools, against one for the control schools.Results Before sensitization, the proportion of school children with a grade above or equal to the average was 50% for the complete package subgroup (CPS) and 53% for the partial package subgroup (PPS). A week later, these proportions were 69% and 71% respectively for the complete and PPSs. A year later, they were 99.4% for the CPS, 98.1% for the PPS and 99.5% for the control group; The number of children who spoke to their parents about malaria was greater in intervention schools than that of control schools. They were 46.63% and 32.58% respectively in intervention and control schools.Conclusion The MOSKI KIT, has enabled an increase of the knowledge of school children about malaria in the short term and favored its retention in the long term. However, its impact was not felt on their attitudes and practices.

scholarly journals Growth velocity in elementary school children with iron deficiency anemia after iron therapy

2009 ◽  
Vol 49 (5) ◽  
pp. 249
Author(s):  
Dina Lyfia ◽  
Melda Deliana ◽  
Hakimi Hakimi ◽  
Nelly Rosdiana ◽  
Bidasari Lubis
Keyword(s):  
Placebo Group ◽  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
School Children ◽  
Growth Velocity ◽  
Elementary School Children ◽  
Hemoglobin Concentration ◽  
Iron Therapy ◽  
Deficiency Anemia ◽  
Iron Group

Background Iron supplementation in children with iron deficiencyanemia could decrease the incidence of stunting.Objective To study the effect of iron therapy on growth velocityin children with iron deficiency anemia.Methods A randomized clinical trial study was conducted atLabuhan Batu on November 2006 to May 2007. Iron deficiencyanemia was diagnosed if there were anemia, with mean corpuscular hemoglobin concentration <31 %, red cell distribution width index > 220, and Mentzer index> 13. Elementary school children (6-12 year old) with iron deficiency anemia were randomly assigned either to iron therapy group (children were given 6 mg iron/kg/day) or to placebo group for 3 months.Results Among 300 children recruited, there were 125 children,who suffered from iron deficiency anemia. After one month ofiron therapy, means of hemoglobin concentration were 12.4 g/dl in iron group and 11.7 g/dl in placebo group. There was a significant increase of height in iron group (129.9 (SD 7.58) em vs. 132.2 (SD 7.23) em) and in placebo (130.8 (SD 8.78) em vs. 128.7 (SD 8. 79) em), However, no significant difference was found in the mean of growth velocity between placebo and iron groups (2.1 (SD 0.01) em vs. 2.0 (SD 0.9) em.Conclusion There is a significant increase in height, but nosignificant difference between both groups in growth velocity.

scholarly journals Knowledge, attitudes and practices (KAP) to assess the impact of school children's awareness of malaria using the MOSKI KIT® tool: study case of some Dakar schools in Senegal

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Isaac Akhénaton Manga ◽  
Aïssatou Gaye ◽  
Aliou Dia ◽  
Ekoue Kouevidjin ◽  
Maria Rosa Dos Reis ◽  
...  
Keyword(s):  
School Children ◽  
Intervention Group ◽  
City Centre ◽  
Control Group ◽  
Household Level ◽  
Attitudes And Practices ◽  
The Third ◽  
The Impact ◽  
Knowledge Attitudes And Practices

Abstract Background MOSKI KIT® is a fun tool designed to interest children for prevention and management of malaria. This study was carried out with the objective to assess the short- and long-term impacts of this tool on the knowledge, attitudes, and practices of school children, and on the transmission of the knowledge received at the household level as well. Method The study took place in elementary schools in the city centre (with relatively low endemicity) and in the Niayes area (at high risk of anopheline and malaria) in the Dakar region of Senegal. The various schools chosen for this study were divided into an intervention group and a control group. The intervention schools were also divided into two subgroups, a full package subgroup and another partial package. During this study three surveys were conducted, the first one before exposure to the MOSKI KIT®, the second one a week later and the third a year later. For the control schools only one survey was conducted and at the same time than the third for the intervention schools. Two household surveys (a week and a year after exposure) were also conducted for the intervention schools against one for the control schools. Results Before sensitization, the proportion of school children with a grade above or equal to the average was 50% for the complete package subgroup (CPS) and 53% for the partial package subgroup (PPS). A week later, these proportions were 69% and 71%, respectively for the complete and PPSs. A year later, they were 99.4% for the CPS, 98.1% for the PPS and 99.5% for the control group; The number of children who spoke to their parents about malaria was greater in intervention schools than that of control schools. They were 46.63% and 32.58%, respectively in intervention and control schools. Conclusion The MOSKI KIT, has enabled an increase of the knowledge of school children about malaria in the short term and favoured its retention in the long term. However, its impact was not felt on their attitudes and practices.

scholarly journals Maternal Iron Status in Pregnancy and Child Health Outcomes after Birth: A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2221
Author(s):  
Hugo G. Quezada-Pinedo ◽  
Florian Cassel ◽  
Liesbeth Duijts ◽  
Martina U. Muckenthaler ◽  
Max Gassmann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Iron Deficiency ◽  
Child Health ◽  
Methodological Quality ◽  
Iron Status ◽  
Meta Analysis ◽  
Child Health Outcomes ◽  
Maternal Iron ◽  
In Pregnancy

In pregnancy, iron deficiency and iron overload increase the risk for adverse pregnancy outcomes, but the effects of maternal iron status on long-term child health are poorly understood. The aim of the study was to systematically review and analyze the literature on maternal iron status in pregnancy and long-term outcomes in the offspring after birth. We report a systematic review on maternal iron status during pregnancy in relation to child health outcomes after birth, from database inception until 21 January 2021, with methodological quality rating (Newcastle-Ottawa tool) and random-effect meta-analysis. (PROSPERO, CRD42020162202). The search identified 8139 studies, of which 44 were included, describing 12,7849 mother–child pairs. Heterogeneity amongst the studies was strong. Methodological quality was predominantly moderate to high. Iron status was measured usually late in pregnancy. The majority of studies compared categories based on maternal ferritin, however, definitions of iron deficiency differed across studies. The follow-up period was predominantly limited to infancy. Fifteen studies reported outcomes on child iron status or hemoglobin, 20 on neurodevelopmental outcomes, and the remainder on a variety of other outcomes. In half of the studies, low maternal iron status or iron deficiency was associated with adverse outcomes in children. Meta-analyses showed an association of maternal ferritin with child soluble transferrin receptor concentrations, though child ferritin, transferrin saturation, or hemoglobin values showed no consistent association. Studies on maternal iron status above normal, or iron excess, suggest deleterious effects on infant growth, cognition, and childhood Type 1 diabetes. Maternal iron status in pregnancy was not consistently associated with child iron status after birth. The very heterogeneous set of studies suggests detrimental effects of iron deficiency, and possibly also of overload, on other outcomes including child neurodevelopment. Studies are needed to determine clinically meaningful definitions of iron deficiency and overload in pregnancy.

The impact of Vaccination worldwide on SARS-CoV-2 infection: A Review on Vaccine Mechanisms, Results of Clinical Trials, Vaccinal Coverage and Interactions with Novel Variants

2021 ◽  
Vol 28 ◽  
Author(s):  
Douglas Henrique Pereira Damasceno ◽  
Arthur Aguiar Amaral ◽  
Cecília Andrade Silva ◽  
Ana Cristina Simões e Silva
Keyword(s):  
Immune Response ◽  
Clinical Trials ◽  
Placebo Group ◽  
Mechanisms Of Action ◽  
Novel Variants ◽  
The Impact ◽  
Positive Results ◽  
Epidemiological Information ◽  
Long Term Studies

Background: The COVID-19 pandemic demanded a global effort towards quickly developing safe and effective vaccines against SARS-CoV-2. Objective: This review aimed to discuss the main vaccines available, their mechanisms of action, results of clinical trials and epidemiological behavior. The implications of viral variants were also debated. Methods: A non-systematic literature review was performed between February and March 2021 by searching the Pubmed, Scopus, and SciELO databases, using different combinations of the following terms: "vaccines", "clinical trials" , "SARS-CoV-2", "Coronavirus", "COVID-19", "mechanisms of action". Data regarding clinical trials of SARS-CoV-2 vaccines and epidemiological information were also searched. Results: The mechanisms of action included vector-virus, mRNA and inactivated virus vaccines. The vaccines showed positive results in phases 2/3 clinical trials. The efficacy of the mRNA 1273 and of mRNA BNT 162b2 vaccines were 94.1% and 95%, respectively. The effectiveness of the ChAdOx1 nCoV-19 vaccine varied according to the scheme, with an overall value of 70.4%. The Gam-COVID-Vac vaccine had an efficacy of 91.6%. Regarding the Ad26.COV2.S vaccine, 99% or more of seroconversion was observed in all subgroups 29 days after vaccination. The CoronaVac vaccine induced an immune response in 92% of the volunteers receiving 3ug and in 98% with 6ug, in comparison to 3% in the placebo group. Conclusion: Global efforts have resulted in vaccines available in record time, with good safety and immunogenicity profile. However, only long-term studies can provide more information on duration of immunity and the need for additional doses.

scholarly journals Length of Initial Prescription at Hospital Discharge and Long-Term Medication Adherence for Elderly, Post-Myocardial Infarction Patients: Protocol for an Interrupted Time Series Study (Preprint)

2020 ◽  
Author(s):  
J D Schwalm ◽  
Noah M Ivers ◽  
Zachary Bouck ◽  
Monica Taljaard ◽  
Madhu K Natarajan ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Usual Care ◽  
Intervention Group ◽  
Interrupted Time Series ◽  
Interventional Study ◽  
Cardiac Medication ◽  
The Impact ◽  
To Receive ◽  
Discharge Prescription

BACKGROUND Based on high-quality evidence, guidelines recommend the long-term use of secondary prevention medications post-myocardial infarction (MI) to avoid recurrent cardiovascular events and death. Unfortunately, discontinuation of recommended medications post-MI is common. Observational evidence suggests that prescriptions covering a longer duration at discharge from hospital are associated with greater long-term medication adherence. The following is a proposal for the first interventional study to evaluate the impact of longer prescription duration at discharge post-MI on long-term medication adherence. OBJECTIVE The overarching goal of this study is to reduce morbidity and mortality among post-MI patients through improved long-term cardiac medication adherence. The specific objectives include the following. First, we will assess whether long-term cardiac medication adherence improves among elderly, post-MI patients following the implementation of (1) standardized discharge prescription forms with 90-day prescriptions and 3 repeats for recommended cardiac medication classes, in combination with education and (2) education alone compared to (3) usual care. Second, we will assess the cost implications of prolonged initial discharge prescriptions compared with usual care. Third, we will compare clinical outcomes between longer (&gt;60 days) versus shorter prescription durations. Fourth, we will collect baseline information to inform a multicenter interventional study. METHODS We will conduct a quasiexperimental, interrupted time series design to evaluate the impact of a multifaceted intervention to implement longer duration prescriptions versus usual care on long-term cardiac medication adherence among post-MI patients. Intervention groups and their corresponding settings include: (1) intervention group 1: 1 cardiac center and 1 noncardiac hospital allocated to receive standardized discharge prescription forms supporting the dispensation of 90 days’ worth of cardiac medications with 3 repeats, coupled with education; (2) intervention group 2: 4 sites (including 1 cardiac center) allocated to receive education only; and (3) control group: all remaining hospitals within the province that did not receive an intervention (ie, usual care). Administrative databases will be used to measure all outcomes. Adherence to 4 classes of cardiac medications — statins, beta blockers, angiotensin system inhibitors, and secondary antiplatelets (ie, prasugrel, clopidogrel, or ticagrelor) — will be assessed. RESULTS Enrollment began in September 2017, and results are expected to be analyzed in late 2020. CONCLUSIONS The results have the potential to redefine best practices regarding discharge prescribing policies for patients post-MI. A policy of standardized maximum-duration prescriptions at the time of discharge post-MI is a simple intervention that has the potential to significantly improve long-term medication adherence, thus decreasing cardiac morbidity and mortality. If effective, this low-cost intervention to implement longer duration prescriptions post-MI could be easily scaled. CLINICALTRIAL ClinicalTrials.gov NCT03257579; https://clinicaltrials.gov/ct2/show/NCT03257579 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18981

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