Iron supplements for school children in the Philippines

There is increasing evidence that iron deficiency affects children’s ability to learn at school. Are iron supplements the answer?  And are daily or weekly supplements more effective?

The World Health Organisation (WHO) has recommended that if more than 40 percent of a country's school children are anaemic, then children should be given iron supplements. Save the Children, together with the University of Westminster, UK, carried out research into the effects of iron supplements on rural school children on the islands of Iloila and Guimaras in the Philippines. Children in 25 schools were given an iron pill each week for 10 weeks while children in another 24 schools were used as a control.  

Iron supplements are part of a wide-ranging health programme in the Philippines aimed at improving children’s educational performance. 2 age groups were targeted: children aged 7 to 8, and those aged 10 to 12.

The study found that:

• The younger children had lower levels of haemoglobin in their blood than the older children before they took the tablets.
• As a result the younger children benefited more from the course of tablets than the older children.
• After taking the tablets levels of anaemia fell slightly from 20 percent to 18 percent.
• During the same period of time, anaemia in the control group of children rose from 14 percent to 26 percent.

Haemoglobin counts in the control group may have dropped because it was the lean season between harvests and food was scarce. The study shows that small amounts of iron given to children in areas where anaemia is considered a mild health problem may have quite long lasting effects.  For every child with anaemia, another one or two will be suffering from an iron deficiency, so many more children benefit from the supplements.

The report recommends that:

• children should be dewormed before beginning to take iron supplements
• a large dose of vitamin A may be appropriate before starting the course of iron, as some anaemia is caused by vitamin A deficiency
• a control group should be used initially so that the benefits of iron tablets are visible.  Without this a school programme might conclude that iron tablets were of no use because the children had the same level of anaemia at the end of the treatment as they had at the beginning
• if anaemia levels are above 20 percent, rural children would benefit from a course of iron tablets over a period of 10 to 16 weeks. These could be given by the class teacher on a weekly basis
• supplements should, in particular, be given to those children in areas that suffer from annual food shortages.

The WHO recommends iron supplements for school children on a daily basis for three months where anaemia is a major health problem. However, weekly tablets are just as effective if they are given in a supervised environment such as a school.  Even where anaemia is only a mild public health problem, weekly iron supplements given by teachers will prevent a fall in the haemoglobin count and benefit anaemic and non-anaemic children.

Source(s):
'Weekly iron supplements given by teachers sustain the haemoglobin concentration of school children in the Philippines', Tropical Medicine and International Health 9(8): 904-909, by N. Roschnik and A. Parawan, 2004
HINARI subscribers can access the full-text article here. Full document.

Funded by: Save the Children

id21 Research Highlight: 17 June 2005

Further Information:
Natalie Roschnik
191 Coldhams Lane
Cambridge, CB1 3HY
UK

Tel: +44 (0) 1223 704 644
Fax: +44 (0) 1223 704 644
Contact the contributor: nroschnik@savechildren.org

Save the Children

University of Westminster, UK

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