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Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study

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Stoltzfus, Rebecca J, Kvalsvig, Jane D, Chwaya, Hababu M, Montresor, Antonio, Albonico, Marco, Tielsch, James M, Savioli, Lorenzo, Pollitt, Ernesto·2001·BMJ

DOI 10.1136/bmj.323.7326.1389PMC PMC60982

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Abstract

Objective: To measure the effects of iron supplementation and anthelmintic treatment on iron status, anaemia, growth, morbidity, and development of children aged 6–59 months. Design: Double blind, placebo controlled randomised factorial trial of iron supplementation and anthelmintic treatment. Setting: Community in Pemba Island, Zanzibar. Participants: 614 preschool children aged 6–59 months. Main outcome measures: Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups. Results: Before intervention, anaemia was prevalent and severe, and geohelminth infections were prevalent and light— Plasmodium falciparum infection was nearly universal. Iron supplementation significantly improved iron status, but not haemoglobin status. Iron supplementation improved language development by 0.8 (95% confidence interval 0.2 to 1.4) points on the 20 point scale. Iron supplementation also improved motor development, but this effect was modified by baseline haemoglobin concentrations (P=0.015 for interaction term) and was apparent only in children with baseline haemoglobin concentrations <90 g/l. In children with a baseline haemoglobin concentration of 68 g/l (one standard deviation below the mean value), iron treatment increased scores by 1.1 (0.1 to 2.1) points on the 18 point motor scale. Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura , but not by hookworms. Mebendazole increased development scores by 0.4 (−0.3 to 1.1) points on the motor scale and 0.3 (−0.3 to 0.9) points on the language scale. Conclusions: Iron supplementation improved motor and language development of preschool children in rural Africa. The effects of iron on motor development were limited to children with more severe anaemia (baseline haemoglobin concentration <90 g/l). Mebendazole had a positive effect on motor and language development, but this was not statistically significant. What is already known on this topic: Iron is needed for development and functioning of the human brain Anaemic children show developmental delays, but it is not yet clear whether iron deficiency causes these deficits or whether iron supplementation can reverse them Helminth infections in schoolchildren are associated with cognitive deficits, but few studies have been made of helminth infection and early child development What this study adds: Low doses of oral iron supplementation given daily improved language development in children aged 1–4 years in Zanzibar Iron supplementation improved motor development, but only in children with initial haemoglobin concentrations below 90 g/l The effects of routine anthelmintic treatment on motor and language milestones were positive, but non-significant, with our sample size

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Authors: Stoltzfus, R. J., Kvalsvig, J. D., Chwaya, H. M., Montresor, A., Albonico, M., Tielsch, J. M., Savioli, L., & Pollitt, E.
Affiliations: Johns Hopkins University (US)
University of KwaZulu-Natal (ZA)
Ministry of Health, Community Development, Gender, Elderly and Children (TZ)
World Health Organization (CH)
University of California, Davis (US)
Corresponding author: Stoltzfus, Rebecca J
ORCID: Kvalsvig, Jane D
Montresor, Antonio
Albonico, Marco
Tielsch, James M
Venue: BMJ
Publisher: BMJ
Published: 2001-12-15
Volume: 323
Issue: 7326
Pages: 1389
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.323.7326.1389
PMC: PMC60982
OpenAlex: W1999316881
Cited by: 307
References: 33
Citations by year: 2026: 2 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 18 · 2020: 12 · 2019: 15 · 2018: 6 · 2017: 12 · 2016: 10 · 2015: 9 · 2014: 9 · 2013: 19 · 2012: 16
FWCI: 14.78
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations: BMJ (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
Life Sciences › Immunology and Microbiology › Parasitology › Parasites and Host Interactions
Keywords: iron supplementation, anthelmintic treatment, mebendazole, preschool children, motor development, language development, anemia, iron deficiency, helminthiasis, Ascaris lumbricoides, Trichuris trichiura, hookworm, hemoglobin, cognitive development, Zanzibar, Pemba Island, Plasmodium falciparum
MeSH terms: Anthelmintics, Anthropometry, Developmental Disabilities, Child, Preschool, Double-Blind Method, Female, Follow-Up Studies, Growth Disorders, Helminthiasis, Humans, Infant, Iron, Language Development, Male, Mebendazole, Motor Skills, Anemia, Iron-Deficiency

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Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study

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