OpenLB
Open Library of Bioscience
Advanced Search
European journal of nutrition
Sep, 2021;60 (6): 3119-3130.

Association of iron supplementation and deworming with early childhood development: analysis of Demographic and Health Surveys in ten low- and middle-income countries.

Yaqing Gao, Yinping Wang, Siyu Zou, Xiaoyi Mi, Ashish Kc, Hong Zhou
Author Information
  1. Yaqing Gao: Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
  2. Yinping Wang: Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
  3. Siyu Zou: Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
  4. Xiaoyi Mi: Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
  5. Ashish Kc: International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
  6. Hong Zhou: Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China. hongzhou@bjmu.edu.cn.
PMID: 33521887 DOI: 10.1007/s00394-021-02493-4

Abstract

PURPOSE: We assessed the associations of iron supplementation and deworming separately or combined with improved early childhood development (ECD) status.
METHODS: Cross-sectional data were analyzed for 29,729 children aged 36-59 months surveyed using the Demographic and Health Surveys in ten low- and middle-income countries, where iron supplementation and deworming are recommended by the World Health Organization. In each country, we estimated linear regression models for the effects of iron supplementation and deworming individually or combined on the Early Childhood Development Index (ECDI) z score, and whether this association differed between various ECD domains and the sex and residence of the child. Estimates were pooled using random-effects meta-analyses.
RESULTS: Compared with receiving neither of the two interventions, iron supplementation plus deworming was associated with an increased ECDI z score (β = 0.13, 95% confidence interval (CI) 0.03-0.22, p = 0.009), particularly in rural residences. However, iron supplementation and deworming, individually, were not associated with the ECDI z score. Iron supplementation plus deworming was associated with higher odds of on-track development in literacy-numeracy (OR = 1.57, 95% CI 1.24-2.01, p < 0.001) and learning domains (OR = 1.27, 95% CI 1.09-1.48, p = 0.003), but not with development in the social-emotional and physical domains.
CONCLUSION: Iron supplementation plus deworming, particularly for populations who are more susceptible to iron deficiency and intestinal worm infections, could be an important intervention for improving ECD. These findings may inform the argument for the necessity of implementing iron supplementation and deworming for preschool-age children.

Keywords

Deworming Early childhood development Iron deficiency Iron supplementation

References

  1. Daelmans B, Darmstadt GL, Lombardi J, Black MM, Britto PR, Lye S, Dua T, Bhutta ZA, Richter LM (2017) Early childhood development: the foundation of sustainable development. Lancet 389(10064):9–11. https://doi.org/10.1016/S0140-6736(16)31659-2 [DOI: 10.1016/S0140-6736(16)31659-2]
  2. McCoy DC, Peet ED, Ezzati M, Danaei G, Black MM, Sudfeld CR, Fawzi W, Fink G (2016) Early childhood developmental status in low- and middle-income countries: national, regional, and global prevalence estimates using predictive modeling. PLoS Med 13(6):e1002034. https://doi.org/10.1371/journal.pmed.1002034 [DOI: 10.1371/journal.pmed.1002034]
  3. Georgieff MK, Krebs NF, Cusick SE (2019) The benefits and risks of iron supplementation in pregnancy and childhood. Annu Rev Nutr 39:121–146. https://doi.org/10.1146/annurev-nutr-082018-124213 [DOI: 10.1146/annurev-nutr-082018-124213]
  4. Lozoff B (2007) Iron deficiency and child development. Food Nutr Bull 28(4):S560-571. https://doi.org/10.1177/15648265070284s409 [DOI: 10.1177/15648265070284s409]
  5. Lozoff B, Clark KM, Jing Y, Armony-Sivan R, Angelilli ML, Jacobson SW (2008) Dose-response relationships between iron deficiency with or without anemia and infant social-emotional behavior. J Pediatr 152(5):696–702. https://doi.org/10.1016/j.jpeds.2007.09.048 [DOI: 10.1016/j.jpeds.2007.09.048]
  6. Lukowski AF, Koss M, Burden MJ, Jonides J, Nelson CA, Kaciroti N, Jimenez E, Lozoff B (2010) Iron deficiency in infancy and neurocognitive functioning at 19 years: evidence of long-term deficits in executive function and recognition memory. Nutritional Neurosci 13(2):54–70. https://doi.org/10.1179/147683010x12611460763689 [DOI: 10.1179/147683010x12611460763689]
  7. Gewa CA, Weiss RE, Bwibo NO, Whaley S, Sigman M, Murphy SP, Harrison G, Neumann CG (2009) Dietary micronutrients are associated with higher cognitive function gains among primary school children in rural Kenya. Br J Nutr 101(9):1378–1387. https://doi.org/10.1017/s0007114508066804 [DOI: 10.1017/s0007114508066804]
  8. Siegel EH, Stoltzfus RJ, Kariger PK, Katz J, Khatry SK, LeClerq SC, Pollitt E, Tielsch JM (2005) Growth indices, anemia, and diet independently predict motor milestone acquisition of infants in south central Nepal. J Nutr 135(12):2840–2844. https://doi.org/10.1093/jn/135.12.2840 [DOI: 10.1093/jn/135.12.2840]
  9. Hulett JL, Weiss RE, Bwibo NO, Galal OM, Drorbaugh N, Neumann CG (2014) Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial. Br J Nutr 111(5):875–886. https://doi.org/10.1017/s0007114513003310 [DOI: 10.1017/s0007114513003310]
  10. Whaley SE, Sigman M, Neumann C, Bwibo N, Guthrie D, Weiss RE, Alber S, Murphy SP (2003) The impact of dietary intervention on the cognitive development of Kenyan school children. J Nutr 133(11):3965S-3971S. https://doi.org/10.1093/jn/133.11.3965S [DOI: 10.1093/jn/133.11.3965S]
  11. International Nutritional Anemia Consultative Group, World Health Organization (1998) Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. United Nations Children’s Fund, New York
  12. World Health Organization (2016) Guideline: daily iron supplementation in infants and children. World Health Organization, Geneva
  13. Tam E, Keats EC, Rind F, Das JK, Bhutta AZA (2020) Micronutrient supplementation and fortification interventions on health and development outcomes among children under-five in low- and middle-income countries: a systematic review and meta-analysis. Nutrients. https://doi.org/10.3390/nu12020289 [DOI: 10.3390/nu12020289]
  14. Thompson J, Biggs BA, Pasricha SR (2013) Effects of daily iron supplementation in 2- to 5-year-old children: systematic review and meta-analysis. Pediatrics 131(4):739–753. https://doi.org/10.1542/peds.2012-2256 [DOI: 10.1542/peds.2012-2256]
  15. Low M, Farrell A, Biggs BA, Pasricha SR (2013) Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials. CMAJ 185(17):E791-802. https://doi.org/10.1503/cmaj.130628 [DOI: 10.1503/cmaj.130628]
  16. Pasricha SR, Hayes E, Kalumba K, Biggs BA (2013) Effect of daily iron supplementation on health in children aged 4–23 months: a systematic review and meta-analysis of randomised controlled trials. Lancet Glob Health 1(2):e77–e86. https://doi.org/10.1016/s2214-109x(13)70046-9 [DOI: 10.1016/s2214-109x(13)70046-9]
  17. De-Regil LM, Jefferds ME, Sylvetsky AC, Dowswell T (2011) Intermittent iron supplementation for improving nutrition and development in children under 12 years of age. Cochrane Database Syst Rev 12:CD009085. https://doi.org/10.1002/14651858.CD009085.pub2 [DOI: 10.1002/14651858.CD009085.pub2]
  18. Koski KG, Scott ME (2001) Gastrointestinal nematodes, nutrition and immunity: breaking the negative spiral. Annu Rev Nutr 21:297–321. https://doi.org/10.1146/annurev.nutr.21.1.297 [DOI: 10.1146/annurev.nutr.21.1.297]
  19. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018) Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392(10159):1789–1858. https://doi.org/10.1016/s0140-6736(18)32279-7 [DOI: 10.1016/s0140-6736(18)32279-7]
  20. Grigorenko EL, Sternberg RJ, Jukes M, Alcock K, Lambo J, Ngorosho D, Nokes C, Bundy DA (2006) Effects of antiparasitic treatment on dynamically and statically tested cognitive skills over time. J Appl Dev Psychol 27(6):499–526. https://doi.org/10.1016/j.appdev.2006.08.005 [DOI: 10.1016/j.appdev.2006.08.005]
  21. Pabalan N, Singian E, Tabangay L, Jarjanazi H, Boivin MJ, Ezeamama AE (2018) Soil-transmitted helminth infection, loss of education and cognitive impairment in school-aged children: a systematic review and meta-analysis. PLoS Negl Trop Dis 12(1):e0005523. https://doi.org/10.1371/journal.pntd.0005523 [DOI: 10.1371/journal.pntd.0005523]
  22. World Health Organization (2017) Guideline: preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups. World Health Organization, Geneva
  23. Taylor-Robinson DC, Maayan N, Donegan S, Chaplin M, Garner P (2019) Public health deworming programmes for soil-transmitted helminths in children living in endemic areas. Cochrane Database Syst Rev 9(9):CD000371. https://doi.org/10.1002/14651858.CD000371.pub7 [DOI: 10.1002/14651858.CD000371.pub7]
  24. Kvalsvig J, Albonico M (2013) Effects of geohelminth infections on neurological development. Handb Clin Neurol 114:369–379. https://doi.org/10.1016/b978-0-444-53490-3.00029-7 [DOI: 10.1016/b978-0-444-53490-3.00029-7]
  25. Hall A (2007) Micronutrient supplements for children after deworming. Lancet Infect Dis 7(4):297–302. https://doi.org/10.1016/s1473-3099(07)70084-1 [DOI: 10.1016/s1473-3099(07)70084-1]
  26. Girum T (2018) The effect of deworming school children on anemia prevalence: a systematic review and meta-analysis. Open Nurs J. https://doi.org/10.2174/1874434601812010155 [DOI: 10.2174/1874434601812010155]
  27. Boivin MJ, Giordani B (1993) Improvements in cognitive performance for schoolchildren in Zaire, Africa, following an iron supplement and treatment for intestinal parasites. J Pediatr Psychol 18(2):249–264. https://doi.org/10.1093/jpepsy/18.2.249 [DOI: 10.1093/jpepsy/18.2.249]
  28. Ebenezer R, Gunawardena K, Kumarendran B, Pathmeswaran A, Jukes MC, Drake LJ, de Silva N (2013) Cluster-randomised trial of the impact of school-based deworming and iron supplementation on the cognitive abilities of schoolchildren in Sri Lanka’s plantation sector. Trop Med Int Health 18(8):942–951. https://doi.org/10.1111/tmi.12128 [DOI: 10.1111/tmi.12128]
  29. Stoltzfus RJ, Kvalsvig JD, Chwaya HM, Montresor A, Albonico M, Tielsch JM, Savioli L, Pollitt E (2001) Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study. BMJ 323(7326):1389–1393. https://doi.org/10.1136/bmj.323.7326.1389 [DOI: 10.1136/bmj.323.7326.1389]
  30. U.S. Agency for International Development (2020) Demographic Health Survey (DHS). https://www.dhsprogram.com/ . Accessed 9 June 2020
  31. WHO Neglected tropical diseases PCT databank (Soil-transmitted helminthiases). https://apps.who.int/neglected_diseases/ntddata/sth/sth.html . Accessed 24 June 2020
  32. Loizillon A, Petrowski N, Britto P, Cappa C (2017) Development of the early childhood development index in MICS surveys. United Nations Children’s Fund, New York
  33. Jeong J, McCoy DC, Yousafzai AK, Salhi C, Fink G (2016) Paternal stimulation and early child development in low- and middle-income countries. Pediatrics. https://doi.org/10.1542/peds.2016-1357 [DOI: 10.1542/peds.2016-1357]
  34. Tran TD, Luchters S, Fisher J (2017) Early childhood development: impact of national human development, family poverty, parenting practices and access to early childhood education. Child Care Health Dev 43(3):415–426. https://doi.org/10.1111/cch.12395 [DOI: 10.1111/cch.12395]
  35. Jeong J, Adhia A, Bhatia A, McCoy DC, Yousafzai AK (2020) Intimate partner violence, maternal and paternal parenting, and early child development. Pediatrics. https://doi.org/10.1542/peds.2019-2955 [DOI: 10.1542/peds.2019-2955]
  36. Croft TN, Allen CK, Marshall AMJ (2018) Guide to DHS statistics. Rockville, Maryland, USA
  37. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188 [DOI: 10.1016/0197-2456(86)90046-2]
  38. Bhoite RM, Iyer UM (2012) Effect of deworming vs iron-folic acid supplementation plus deworming on growth, hemoglobin level, and physical work capacity of schoolchildren. Indian Pediatr 49(8):659–661. https://doi.org/10.1007/s13312-012-0129-y [DOI: 10.1007/s13312-012-0129-y]
  39. Taylor M, Jinabhai CC, Couper I, Kleinschmidt I, Jogessar VB (2001) The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial. Trans R Soc Trop Med Hyg 95(2):211–216. https://doi.org/10.1016/S0035-9203(01)90171-3 [DOI: 10.1016/S0035-9203(01)90171-3]
  40. Kruger M, Badenhorst CJ, Mansvelt EPG, Laubscher JA, Benadé AJS (1996) Effects of iron fortification in a school feeding scheme and anthelmintic therapy on the iron status and growth of six- to eight-year-old schoolchildren. Food Nutr Bull 17(1):1–11 [DOI: 10.1177/156482659601700104]
  41. Working Group on Fortification of Salt with Iron (1982) Use of common salt fortified with iron in the control and prevention of anemia—a collaborative study. Am J Clin Nutr 35(6):1442–1451. https://doi.org/10.1093/ajcn/35.6.1442
  42. Shield JM, Vaterlaws AL, Kimber RJ, Payne R, Casey GJ, Blunden RW, Kutkaite D (1981) The relationship of hookworm infection, anaemia and iron status in a Papua New Guinea highland population and the response to treatment with iron and mebendazole. Papua New Guinea Med J 24(1):19–34
  43. Stephenson LS, Holland C (1987) The impact of helminth infections on human nutrition: schistosomes and soil-transmitted helminths. Taylor & Francis, London
  44. Stephenson LS, Latham MC, Kurz KM, Miller D, Kinoti SN, Oduori ML (1985) Urinary iron loss and physical fitness of Kenyan children with urinary schistosomiasis. Am J Trop Med Hyg 34(2):322–330. https://doi.org/10.4269/ajtmh.1985.34.322 [DOI: 10.4269/ajtmh.1985.34.322]
  45. Stoltzfus RJ, Chway HM, Montresor A, Tielsch JM, Jape JK, Albonico M, Savioli L (2004) Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children. J Nutr 134(2):348–356. https://doi.org/10.1093/jn/134.2.348 [DOI: 10.1093/jn/134.2.348]
  46. Dossa RA, Ategbo EA, de Koning FL, van Raaij JM, Hautvast JG (2001) Impact of iron supplementation and deworming on growth performance in preschool Beninese children. Eur J Clin Nutr 55(4):223–228. https://doi.org/10.1038/sj.ejcn.1601126 [DOI: 10.1038/sj.ejcn.1601126]
  47. Molyneux DH, Hotez PJ, Fenwick A (2005) “Rapid-impact interventions”: how a policy of integrated control for Africa’s neglected tropical diseases could benefit the poor. PLoS Med 2(11):e336. https://doi.org/10.1371/journal.pmed.0020336 [DOI: 10.1371/journal.pmed.0020336]
  48. Stephenson LS, Latham MC, Adams EJ, Kinoti SN, Pertet A (1993) Physical fitness, growth and appetite of Kenyan school boys with hookworm, Trichuris trichiura and Ascaris lumbricoides infections are improved four months after a single dose of albendazole. J Nutr 123(6):1036–1046. https://doi.org/10.1093/jn/123.6.1036 [DOI: 10.1093/jn/123.6.1036]
  49. Stoltzfus RJ, Albonico M, Chwaya HM, Tielsch JM, Schulze KJ, Savioli L (1998) Effects of the Zanzibar school-based deworming program on iron status of children. Am J Clin Nutr 68(1):179–186. https://doi.org/10.1093/ajcn/68.1.179 [DOI: 10.1093/ajcn/68.1.179]
  50. Vir SC, Singh N, Nigam AK, Jain R (2008) Weekly iron and folic acid supplementation with counseling reduces anemia in adolescent girls: a large-scale effectiveness study in Uttar Pradesh. India Food Nutr Bull 29(3):186–194. https://doi.org/10.1177/156482650802900304 [DOI: 10.1177/156482650802900304]
  51. Kang Y, Aguayo VM, Campbell RK, West KP (2018) Association between stunting and early childhood development among children aged 36–59 months in South Asia. Matern Child Nutr 14(4):e12684. https://doi.org/10.1111/mcn.12684 [DOI: 10.1111/mcn.12684]
  52. Sudfeld CR, McCoy DC, Danaei G, Fink G, Ezzati M, Andrews KG, Fawzi WW (2015) Linear growth and child development in low- and middle-income countries: a meta-analysis. Pediatrics 135(5):e1266-1275. https://doi.org/10.1542/peds.2014-3111 [DOI: 10.1542/peds.2014-3111]
  53. National Institute of Child Health and Human Development Early Child Care Research Network (2004) Fathers’ and mothers’ parenting behavior and beliefs as predictors of children’s social adjustment in the transition to school. J Fam Psychol 18(4):628–638. https://doi.org/10.1037/0893-3200.18.4.628 [DOI: 10.1037/0893-3200.18.4.628]
  54. Pace GT, Lee SJ, Grogan-Kaylor A (2019) Spanking and young children’s socioemotional development in low- and middle-income countries. Child Abuse Negl 88:84–95. https://doi.org/10.1016/j.chiabu.2018.11.003 [DOI: 10.1016/j.chiabu.2018.11.003]
  55. Augustyn M, Frank DA, Zuckerman BS (2009) Chapter 3—infancy and toddler years. In: Carey WB, Crocker AC, Coleman WL, Elias ER, Feldman HM (eds) Developmental-behavioral pediatrics, 4th edn. W.B. Saunders, Philadelphia, pp 24–38. https://doi.org/10.1016/B978-1-4160-3370-7.00003-1 [DOI: 10.1016/B978-1-4160-3370-7.00003-1]
  56. Bobonis GJ, Miguel E, Puri-Sharma C (2006) Anemia and school participation. J Hum Resour 41(4):692–721 [DOI: 10.3368/jhr.XLI.4.692]
  57. World Health Organization (2015) The global prevalence of anaemia in 2011. World Health Organization, Geneva
  58. Pongcharoen T, DiGirolamo AM, Ramakrishnan U, Winichagoon P, Flores R, Martorell R (2011) Long-term effects of iron and zinc supplementation during infancy on cognitive function at 9 y of age in northeast Thai children: a follow-up study. Am J Clin Nutr 93(3):636–643. https://doi.org/10.3945/ajcn.110.002220 [DOI: 10.3945/ajcn.110.002220]
  59. Metallinos-Katsaras E, Valassi-Adam E, Dewey KG, Lönnerdal B, Stamoulakatou A, Pollitt E (2004) Effect of iron supplementation on cognition in Greek preschoolers. Eur J Clin Nutr 58(11):1532–1542. https://doi.org/10.1038/sj.ejcn.1602005 [DOI: 10.1038/sj.ejcn.1602005]
  60. Venegas-Aviles Y, Rodríguez-Ramírez S, Monterrubio-Flores E, García-Guerra A (2020) Sociodemographic factors associated with low intake of bioavailable iron in preschoolers: national health and nutrition survey 2012, Mexico. Nutr J 19(1):57. https://doi.org/10.1186/s12937-020-00567-3 [DOI: 10.1186/s12937-020-00567-3]
  61. Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P (2006) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York. https://doi.org/10.1596/978-0-8213-6179-5 [DOI: 10.1596/978-0-8213-6179-5]
  62. Jurek AM, Greenland S, Maldonado G, Church TR (2005) Proper interpretation of non-differential misclassification effects: expectations vs observations. Int J Epidemiol 34(3):680–687 [DOI: 10.1093/ije/dyi060]
  63. Basagaña X, Pedersen M, Barrera-Gómez J, Gehring U, Giorgis-Allemand L, Hoek G, Stafoggia M, Nieuwenhuijsen MJ, Brunekreef B, Slama R (2018) Analysis of multicentre epidemiological studies: contrasting fixed or random effects modelling and meta-analysis. Int J Epidemiol 47(4):1343–1354. https://doi.org/10.1093/ije/dyy117 [DOI: 10.1093/ije/dyy117]

MeSH Term

Child
Child, Preschool
Cross-Sectional Studies
Demography
Developing Countries
Dietary Supplements
Humans
Iron

Chemicals

Iron
Journal Article
Article has an altmetric score of 1

Word Cloud

Created with Highcharts 10.0.0supplementationdewormingirondevelopmentIronchildhoodECDHealthECDIzscoredomainsplusassociated95%CIcombinedearlychildrenusingDemographicSurveystenlow-middle-incomecountriesindividuallyEarlyp = 0particularlyOR = 11deficiencyPURPOSE:assessedassociationsseparatelyimprovedstatusMETHODS:Cross-sectionaldataanalyzed29729aged36-59 monthssurveyedrecommendedWorldOrganizationcountryestimatedlinearregressionmodelseffectsChildhoodDevelopmentIndexwhetherassociationdifferedvarioussexresidencechildEstimatespooledrandom-effectsmeta-analysesRESULTS:Comparedreceivingneithertwointerventionsincreasedβ = 013confidenceinterval003-022009ruralresidencesHoweverhigheroddson-trackliteracy-numeracy5724-201p < 0001learning2709-148003social-emotionalphysicalCONCLUSION:populationssusceptibleintestinalworminfectionsimportantinterventionimprovingfindingsmayinformargumentnecessityimplementingpreschool-ageAssociationdevelopment:analysisDeworming

Similar Articles

Cited By