Prevalence of Iron Deficiency and Iron Deficiency Anemia in Infants and Children and Treatment with Microencapsulated Iron II Fumarate and Supplied Ascorbic Acid as “Sprinkles”

DOI: 10.4236/pp.2014.57081   PDF   HTML     4,509 Downloads   6,130 Views   Citations


Background: Iron deficiency anemia (IDA) in children and infants is a common nutritional problem all over the world. Infants and young children have a high risk for developing iron deficiency (ID) because they have high demand for iron during the period of rapid growth. This is aggravated by the insufficiency of iron in their diet. Iron supplementation programs using pediatric tablets or drops have not been successful in the control of anemia amongst infants and children in some countries. “Sprinkles” is an innovative multi-micronutrient home fortification strategy to control iron deficiency and anemia to be more useful. Objective: The objective was to estimate the prevalence ID and IDA in infants and children in Ibb City, Yemen Republic; evaluate the use of a new form of iron and determine the hematologic response to different doses and forms of iron in Sprinkles and iron drops. Design: Using a prospective, randomized, controlled design, we studied 337 randomly children aged 24 - 48 months and infants aged 6 - 24 months in Ibb City (hemoglobin: 70 - 99 g/L). One group received a daily sachet of microencapsulated ferrous fumarate (80 mg elemental Fe) in powder form plus ascorbic acid to be sprinkled onto any complementary food eaten (sprinkles group); a control group received ferrous sulfate drops 3 times/d for 2 months (total dose: 40 mg elemental Fe). Hemoglobin and serum ferritin concentrations were measured at baseline and at the end of treatment. Results: Successful treatment of anemia (hemoglobin > 100 g/L) occurred in 58% of the sprinkles group and in 56% of the drops group, with minimal side effects in both groups. Geometric mean ferritin concentrations increased significantly in each group from baseline to the end of treatment (P < 0.001). Conclusion: Use of ferrous sulfate drops or a single daily dose of microencapsulated ferrous fumarate sprinkles plus ascorbicacid resulted in a similar rate of successful treatment of anemia without side effects. To our knowledge, this is the first demonstration of the use of microencapsulated iron sprinkles to treat anemia in this area. Improved ease of use may favor the use of sprinkles to deliver iron.

Share and Cite:

Al-Mamari, A. , Al-Hegami, M. , Al-Hag, S. , Al-Buryhi, M. , Al-Amawi, S. , Ahmed, L. , Al-Awadi, L. , Al-Jamal, S. , Mohammad, W. and Mohammad, Y. (2014) Prevalence of Iron Deficiency and Iron Deficiency Anemia in Infants and Children and Treatment with Microencapsulated Iron II Fumarate and Supplied Ascorbic Acid as “Sprinkles”. Pharmacology & Pharmacy, 5, 716-724. doi: 10.4236/pp.2014.57081.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Kapur, D., Agarwal, K.N., Sharma S., Kela, K. and Kaur, I. (2002) Iron Status of Children Aged 9 - 36 Months in an Urban Slum Integrated Child Development Services Project in Delhi. Indian Pediatric, 39, 136-144.
[2] Verma, M., Chhatwal, J. and Kaur, G. (1998) Prevalence of Anemia among Urban School Children of Punjab. Indian Pediatric, 35, 1181-1186.
[3] Zlotkin, S. (2002) Current Issues for the Prevention and Treatment of Iron Deficiency Anemia. Indian Pediatric, 39, 125-129.
[4] Zlotkin, S.H., Schauer, C., Christofides, A., Sharieff, W. and Hyder, S.M. (2005) Micronutrient Sprinkles to Control Childhood Anemia: A Simple Powdered Sachet May Be the Key to Addressing a Global Problem. PLoS Med, 2, e1.
[5] Liyanage, C. and Zlotkin, S. (2002) Bioavailability of Iron from Micro-Encapsulated Iron Sprinkle Supplement. Food and Nutrition Bulletin, 23, 133-137.
[6] Zlotkin, S., Arthur, P., Antwi, K.Y. and Yeung, G. (2001) Treatment of Anemia with Microencapsulated Ferrous Fumarate Plus Ascorbic Acid Supplied as Sprinkles to Complementary (Weaning) Foods. The American Journal of Clinical Nutrition, 74, 791-795.
[7] Zlotkin, S., Antwi, K.Y., Schauer, C. and Yeung, G. (2003) Use of Microencapsulated Iron (II) Fumarate Sprinkles to Prevent Recurrence of Anemia in Infants and Young Children at High Risk. Bulletin of the World Health Organization, 81, 108-115.
[8] Schauer, C. and Zlotkin, S. (2003) Home Fortification with Micronutrient Sprinkles—A New Approach for the Prevention and Treatment of Nutritional Anemia. Pediatric Child Health, 8, 87-90.
[9] World Health Organization (2000) Malnutrition. The Global Picture. World Health Organization, Geneva.
[10] Oski, F.A., Honig, A.S., Helu, B. and Howanitz, P. (1983) Effect of Iron Therapy on Behavior Performance in Nonanemic, Iron-Deficient Infants. Pediatrics, 71, 877-880.
[11] Nestel, P. and Alnwick, D. (1996) Iron/Multi-Micronutrient Supplements for Young Children. Summary and Conclusions of a Consultation Held at UNICEF, Copenhagen.
[12] Tondeur, M.C., Schauer, C., Christofides, A.L., Asante, K.P. and Newton, S. (2004) Determination of Iron Absorption from Intrinsically Labeled Microencapsulated Ferrous Fumarate (Sprinkles) in Infants with Varying Iron/Hematologic Status Using a Dual Stable Isotope Method. The American Journal of Clinical Nutrition, 80, 1436-1444.
[13] Zlotkin, S.H., Christofides, A., Schauer, C., Asante, K.P. and Owusu-Agyei, S. (2004) Home Fortification Using Sprinkles Containing 12.5 mg of Iron Successfully Treats Anemia in Ghanian Infants and Young Children. FASEB Journal, 18.
[14] Galloway, R. and McGuire, J. (1994) Determinants of Compliance with Iron Supplements: Supplies, Side Effects or Psychology. Social Science & Medicine, 39, 381-390.
[15] Davidsson, L., Kastenmayer, P., Szajewska, H., Harrell, R.F. and Barclay, D. (2000) Iron Bioavailability in Infants from an Infant Cereal Fortified with Ferric Pyrophosphate or Ferrous Fumarate. The American Journal of Clinical Nutrition, 71, 597-602.
[16] Heinrich, H.C., Gabbe, E.E., Whang, D.H., Bender-Gotze, C. and Schafer, K.H. (1975) Ferrous and Hemoglobin-59Fe Absorption from Supplemented Cow’s Milk in Infants with Normal and Depleted Iron Stores. Zeitschrift für Kinderheilkunde, 120, 251-257.
[17] Cohen, A.R. and Seidl-Friedman, J. (1988) HemoCue System for Hemoglobin Measurement. Evaluation in Anemic and Nonanemic Children. American Journal of Clinical Pathology, 90, 302-305.
[18] Miles, L.M., Lipchitz, D.A., Bibber, C.P. and Cook, J.D. (1974) Measurement of Serum Ferritin by a 2-Site Immunoradiometric Assay. Anal Biochem, 61, 209-224.
[19] Zlotkin, S.H., Arthur, P., Antiri, K.Y. and Yeung, G. (2001) Treatment of Anemia with Microencapsulated Ferrous Fumarate Plus Ascorbic and Supplied as “Sprinkles” to Complementary (Weaning) Foods. The American Journal of Clinical Nutrition, 74, 791-795.
[20] Rajurkar, N.S., Patil, S.F. and Zatakia, N.H. (2012) Assessment of Iron and Hemoglobin Status in Working Women of Various Age Groups. Journal of Chemical and Pharmaceutical Research, 4, 2300-2305.
[21] Gangadhar, T., Srikanth, P. and Suneetha, Y. (2010) Predictive Value of Iron Store Markers in Anemia of Chronic Kidney Disease. Journal of Chemical and Pharmaceutical Research, 2, 400-410.
[22] Yazar, H. and Kayhan, B.C. (2010) Adult Hemodialysis Patients with End-Stage Renal Disease and Erythropoietin Treatment of the Relation between Hypertension. Journal of Chemical and Pharmaceutical Research, 2, 588-593.
[23] Lozoff, B., Brittenham, G.M. and Wolf, A.W. (1987) Iron Deficiency Anemia and Iron Therapy Effect on Infants Developmental Test Performance. Pediatrics, 79, 981-993.
[24] AL-Jabri, F.M. and Mosa, E.Sh. (2012) Second Derivative Differential Electrolytic Potentiometers for Oxidation Reduction Reactions. Journal of Chemical and Pharmaceutical Research, 4, 2180-2187.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.