Ms. Le Thi Huong: "Anemia among school children in Vietnam: The efficacy of iron fortification"

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12 Dec 2006 13:30
Unit: Wageningen UR
Location: Aula, building 362, Gen. Foulkesweg 1, Wageningen
Organisation: Wageningen University
Promotor: prof.dr.ir. F.J. Kok (Nutrition and Health)
Co Promotor: Nguyen Cong Khan (National Institute of Nutrition, Hanoi), I.D. Brouwer

 The present thesis aimed to determine the efficacy of a school-based food fortification program to improve hemoglobin concentrations and iron stores of intestinal parasites-prone school children. Furthermore this thesis also compares the effect of iron fortification and iron supplementation on the changes in hemoglobin and iron status.
A cross-sectional study among school children (6-8 years) in Tam Nong district Phu Tho province indicated a high prevalence of anemia (25%) with low iron deficiency as indicated by SF (0.5%) and TfR (2%). More than 90% of children were infected by intestinal parasites, especially Trichuris infection was associated with a double risk of anemia. Subsequent studies evaluate the acceptability and efficacy of iron fortification on anemia in an infection prone population. The acceptability study showed that instant noodle was an appropriate vehicle for iron fortification; noodles were consumed by half of the children at least once a week and were mainly associated with positive attributes. Although children and adults were able to differentiate between iron fortified and non-fortified noodles, fortified instant noodles were accepted by children. Boredom for noodles increased slightly over time, the acceptance ratings remained high. In the intervention study we used a randomized placebo controlled double blind trial with iron fortified noodles and de-worming plus standard treatment (iron supplementation and de-worming) to test our hypothesis that de-worming is more effective than iron fortification in an anemic infection prone population that was not considered iron deficient. However, de-worming did not show an effect on hemoglobin level and iron status, while iron fortified noodles significantly improved hemoglobin, SF and body iron (2.6 g/L, 16.2 µg /L and 1 mg/kg respectively). A seasonal improvement of hemoglobin levels and anemia status took place in all groups, also in the placebo group. The efficacy of iron fortification based on hemoglobin change was 58% less than that of supplementation. It is concluded that anemia is partly caused by iron deficiency, intestinal parasite infection does not play a role but chronic infection may be considered as a cause of anemia among our children. Iron fortification rather than iron supplementation is recommended as intervention to reduce anemia in a population with low iron deficiency. Future research should be focused on the role of chronic infection on anemia in school age children.
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