Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
J Nutr. 2021 Jun 1;151(6):1646-1655. doi: 10.1093/jn/nxab024.
School-based iron and folic acid (IFA) supplementation is recommended for adolescent girls in countries with high burdens of anemia.
We aimed to evaluate the context-specific effectiveness of a school-based, integrated anemia control program with IFA supplementation in Ghana.
Using data from a pre-post, longitudinal program evaluation, we evaluated the effectiveness of school-based weekly IFA supplementation in reducing the burden of anemia and increasing hemoglobin concentrations (Hb; primary outcomes) in 2 regions of Ghana. Generalized linear mixed effects models with schools (clusters) as random effects were used to quantify the change in the anemia prevalence and the mean Hb associated with cumulative IFA tablet consumption over 1 school year (30-36 weeks), controlling for participant-level potential confounders. A cut point for minimum effective cumulative IFA consumption that is reflective of adequate Hb was derived following logistic regression. This cut point was verified by a restricted cubic spline model of IFA consumption and Hb.
The analytical sample included 60 schools and 1387 girls ages 10-19 years. The prevalence of anemia declined during 1 school year of the intervention, from 25.1% to 19.6% (P = 0.001). Students consumed a mean of 16.4 IFA tablets (range, 0-36). IFA consumption was positively associated with Hb and negatively associated with anemia. Each additional IFA tablet consumed over the school year was associated with a 5% (95% CI, 1-10%) reduction in the adjusted odds of anemia at follow-up, though the relationship is nonlinear. The cut point for minimum effective consumption was 26.7 tablets over a 30-36-week school year, with tablets provided weekly.
School-based weekly IFA supplementation is effective in improving Hb and reducing the anemia prevalence among schoolgirls in Ghana, though most participants consumed fewer than the minimum effective number of IFA tablets. Increasing intake adherence may further improve anemia outcomes in this population.
在贫血负担较高的国家，建议为少女提供基于学校的铁和叶酸（IFA）补充。
我们旨在评估加纳基于学校的综合贫血控制项目中，使用 IFA 补充剂的具体情况的有效性。
利用一项前后纵向方案评估的数据，我们评估了在加纳的 2 个地区，每周使用 IFA 补充剂进行基于学校的方案对降低贫血负担和提高血红蛋白浓度（Hb；主要结局）的有效性。采用具有学校（集群）为随机效应的广义线性混合效应模型，以量化在 1 个学年（30-36 周）内，与累积 IFA 片消耗相关的贫血患病率和平均 Hb 的变化，同时控制参与者层面的潜在混杂因素。根据逻辑回归得出了反映 Hb 充足性的最小有效累积 IFA 消耗的切点。通过 IFA 消耗和 Hb 的限制三次样条模型验证了该切点。
分析样本包括 60 所学校和 1387 名 10-19 岁的女孩。在干预的 1 个学年期间，贫血患病率从 25.1%下降到 19.6%（P=0.001）。学生平均消耗 16.4 片 IFA（范围，0-36）。IFA 消耗与 Hb 呈正相关，与贫血呈负相关。在学年中每多服用一片 IFA 与随访时贫血调整后几率降低 5%（95%CI，1-10%）相关，尽管这种关系是非线性的。最小有效消耗的切点为在 30-36 周的学年中，每周提供 26.7 片 IFA 片，这一切点可有效改善加纳女学生的 Hb 并降低贫血患病率。然而，大多数参与者的 IFA 片消耗都低于最小有效量。提高摄入的依从性可能会进一步改善该人群的贫血结果。
