Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China.
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Eur J Nutr. 2021 Sep;60(6):3119-3130. doi: 10.1007/s00394-021-02493-4. Epub 2021 Feb 1.
We assessed the associations of iron supplementation and deworming separately or combined with improved early childhood development (ECD) status.
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.
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.
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.
我们评估了铁补充剂和驱虫药单独或联合使用对改善儿童早期发展（ECD）状况的影响。
对来自十个中低收入国家的 29729 名 36-59 月龄儿童的横断面数据进行了分析，这些国家均推荐世界卫生组织使用铁补充剂和驱虫药。在每个国家，我们分别估计了铁补充剂和驱虫药单独或联合使用对儿童早期发展指数（ECDI）z 评分的影响，并评估了这种关联在不同 ECD 领域以及儿童的性别和居住地之间的差异。使用随机效应荟萃分析对估计值进行了汇总。
与未接受两种干预措施中的任何一种相比，铁补充剂加驱虫药联合使用与 ECDI z 评分的增加相关（β=0.13，95%置信区间 0.03-0.22，p=0.009），尤其是在农村地区。然而，铁补充剂和驱虫药单独使用与 ECDI z 评分均无相关性。铁补充剂加驱虫药联合使用与读写能力和学习领域的发展相关（OR=1.57，95%置信区间 1.24-2.01，p<0.001），但与社会情感和身体领域的发展无关。
铁补充剂加驱虫药，特别是对那些更容易缺铁和肠道蠕虫感染的人群，可能是改善 ECD 的重要干预措施。这些发现可能为实施铁补充剂和驱虫药治疗学龄前儿童的必要性提供依据。
