Anemia
Conditions
Keywords
Anemia, Multiple Micronutrient Supplementation (MMS), Iron and Folic Acid (IFA), Nutrition, Adolescent Health
Brief summary
This purpose of this study is to assess effects of iron and folic acid supplementation and multiple micronutrient supplementation on anemia status and school performance/attendance among in-school adolescents in Zanzibar, Tanzania.
Detailed description
This study aims to implement and evaluate micronutrient supplementation interventions to improve adolescent nutrition, health and education in Zanzibar. Findings from this study will clarify the optimal supplementation strategy (iron and folic acid alone or adding other essential nutrients) and provide a basis for scale up of national micronutrient supplementation programs to benefit the adolescent population as a whole in Zanzibar. This will be a cluster randomized study with 3 arms. At the beginning of the academic year, 42 schools will be enrolled (14 schools per arm) to receive either 1) supplementation with weekly iron and folic acid (IFA); 2) supplementation with daily multiple micronutrient supplements (MMS) (including iron and folic acid as components); or 3) to serve as controls. Students in intervention schools will receive supplementation and students in control schools will receive the usual care (which does not include supplementation but does include existing curriculum on nutrition and water, sanitation and hygiene \[WASH\]). The program will be evaluated at the end of year 1, comparing effects of weekly IFA and daily MMS on anemia status and school attendance/performance. The more effective strategy (MMS or IFA) will be scaled up to all the study schools for year 2 of the intervention, and the outcomes will be re-assessed.
Interventions
DIETARY_SUPPLEMENTIron and folic acid (IFA)
IFA: Weekly regimen of one tablet containing iron (60 mg) and folic acid (2800 μg)
DIETARY_SUPPLEMENTMultiple Micronutrient Supplement (MMS)
MMS: Daily regimen of one multiple micronutrient tablet containing fifteen micronutrients in the United Nations International Multiple Micronutrient Preparation (UNIMMAP) preparation. Composition includes vitamin A (800 ug), vitamin D (5 ug), vitamin E (10 mg), vitamin C (70 mg), vitamin B1 (1.4 mg), vitamin B2 (1.4 mg), niacin (18 mg), vitamin B6 (1.9 mg), vitamin B12 (2.6 ug), folic acid (400 ug), iron (30 mg), zinc (15 mg), copper (2 mg), selenium (65 ug), and iodine (150 ug).
Sponsors
Africa Academy for Public Health
Zanzibar Association of People Living with HIV/AIDS (ZAPHA+)
Harvard School of Public Health (HSPH)
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Schools will be randomly assigned to weekly iron and folic acid (IFA) supplementation, daily multiple micronutrient supplements (MMS), or control. Supplementation will be conducted continuously over the course of the first year. Baseline and end-line surveys will be conducted to collect demographic information and assess outcomes. In the second year of the study, the more effective supplementation strategy (IFA or MMS) will be scaled up to all study schools and the outcomes will be re-assessed.
Eligibility
Sex/Gender
ALL
Age
10 Years to 17 Years
Healthy volunteers
Yes
Inclusion criteria
* Adolescents aged 10-17 years * Enrolled in secondary school form 1 at study initiation * Member of one of the selected classes in a participating school * Consent provided by the parent * Assent provided by the adolescent * Fluency in Swahili and/or English
Exclusion criteria
* No informed consent from parent or assent from adolescent * Self-reported pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Anemia status | Up to one year | Anemia will be defined based on the sex- and age- specific WHO cutoffs: 1. Children 12-14 years: \< 120 g/L 2. Non-pregnant women ≥ 15 years: \< 120 g/L 3. Pregnant women: \< 110 g/L 4. Men ≥ 15 years: \< 130 g/L |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| School attendance | Up to one year | Number of days of missed school per student |
| School retention | Up to one year | Number of students who drop out of school |
| School performance | Up to one year | Percent of students who pass to the next grade at the end of the year |
Countries
Tanzania
Outcome results
None listed