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Meta-Analysis
. 2019 Jan 31;1(1):CD009218.
doi: 10.1002/14651858.CD009218.pub3.

Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women

Ana C Fernández-Gaxiola  1 , Luz Maria De-Regil
Affiliations
Meta-Analysis

Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women

Ana C Fernández-Gaxiola et al. Cochrane Database Syst Rev. .

Abstract

Background: Anaemia is a condition in which the number of red blood cells is insufficient to meet physiologic needs; it is caused by many conditions, particularly iron deficiency. Traditionally, daily iron supplementation has been a standard practice for preventing and treating anaemia. However, its long-term use has been limited, as it has been associated with adverse side effects such as nausea, constipation, and teeth staining. Intermittent iron supplementation has been suggested as an effective and safer alternative to daily iron supplementation for preventing and reducing anaemia at the population level, especially in areas where this condition is highly prevalent.

Objectives: To assess the effects of intermittent oral iron supplementation, alone or in combination with other nutrients, on anaemia and its associated impairments among menstruating women, compared with no intervention, a placebo, or daily supplementation.

Search methods: In February 2018, we searched CENTRAL, MEDLINE, Embase, nine other databases, and two trials registers. In March 2018, we also searched LILACS, IBECS and IMBIOMED. In addition, we examined reference lists, and contacted authors and known experts to identify additional studies.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs with either individual or cluster randomisation. Participants were menstruating women; that is, women beyond menarche and prior to menopause who were not pregnant or lactating and did not have a known condition that impeded the presence of menstrual periods. The intervention was the use of iron supplements intermittently (one, two or three times a week on non-consecutive days) compared with placebo, no intervention, or the same supplements provided on a daily basis.

Data collection and analysis: Both review authors independently assessed the eligibility of studies against the inclusion criteria, extracted data from included studies, checked data entry for accuracy, assessed the risk of bias of the included studies, and rated the quality of the evidence using GRADE.

Main results: We included 25 studies involving 10,996 women. Study methods were not well described in many of the included studies and thus assessing risk of bias was difficult. The main limitations of the studies were lack of blinding and high attrition. Studies were mainly funded by international organisations, universities, and ministries of health within the countries. Approximately one third of the included studies did not provide a funding source.Although quality across studies was variable, the results consistently showed that intermittent iron supplementation (alone or with any other vitamins and minerals) compared with no intervention or a placebo, reduced the risk of having anaemia (risk ratio (RR) 0.65, 95% confidence interval (CI) 0.49 to 0.87; 11 studies, 3135 participants; low-quality evidence), and improved the concentration of haemoglobin (mean difference (MD) 5.19 g/L, 95% CI 3.07 to 7.32; 15 studies, 2886 participants; moderate-quality evidence), and ferritin (MD 7.46 μg/L, 95% CI 5.02 to 9.90; 7 studies, 1067 participants; low-quality evidence). Intermittent regimens may also reduce the risk of having iron deficiency (RR 0.50, 95% CI 0.24 to 1.04; 3 studies, 624 participants; low-quality evidence), but evidence was inconclusive regarding iron deficiency anaemia (RR 0.07, 95% CI 0.00 to 1.16; 1 study, 97 participants; very low-quality evidence) and all-cause morbidity (RR 1.12, 95% CI 0.82 to 1.52; 1 study, 119 participants; very low-quality evidence). Women in the control group were less likely to have any adverse side effects than those receiving intermittent iron supplements (RR 1.98, 95% CI 0.31 to 12.72; 3 studies, 630 participants; moderate-quality evidence).In comparison with daily supplementation, results showed that intermittent supplementation (alone or with any other vitamins and minerals) produced similar effects to daily supplementation (alone or with any other vitamins and minerals) on anaemia (RR 1.09, 95% CI 0.93 to 1.29; 8 studies, 1749 participants; moderate-quality evidence). Intermittent supplementation may produce similar haemoglobin concentrations (MD 0.43 g/L, 95% CI -1.44 to 2.31; 10 studies, 2127 participants; low-quality evidence) but lower ferritin concentrations on average (MD -6.07 μg/L, 95% CI -10.66 to -1.48; 4 studies, 988 participants; low-quality evidence) compared to daily supplementation. Compared to daily regimens, intermittent regimens may also reduce the risk of having iron deficiency (RR 4.30, 95% CI 0.56 to 33.20; 1 study, 198 participants; very low-quality evidence). Women receiving iron supplements intermittently were less likely to have any adverse side effects than those receiving iron supplements daily (RR 0.41, 95% CI 0.21 to 0.82; 6 studies, 1166 participants; moderate-quality evidence). No studies reported on the effect of intermittent regimens versus daily regimens on iron deficiency anaemia and all-cause morbidity.Information on disease outcomes, adherence, economic productivity, and work performance was scarce, and evidence about the effects of intermittent supplementation on these outcomes unclear.Overall, whether the supplements were given once or twice weekly, for less or more than three months, contained less or more than 60 mg of elemental iron per week, or given to populations with different degrees of anaemia at baseline did not seem to affect the findings. Furthermore, the response did not differ in areas where malaria was frequent, although very few trials were conducted in these settings.

Authors' conclusions: Intermittent iron supplementation may reduce anaemia and may improve iron stores among menstruating women in populations with different anaemia and malaria backgrounds. In comparison with daily supplementation, the provision of iron supplements intermittently is probably as effective in preventing or controlling anaemia. More information is needed on morbidity (including malaria outcomes), side effects, work performance, economic productivity, depression, and adherence to the intervention. The quality of this evidence base ranged from very low to moderate quality, suggesting that we are uncertain about these effects.

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Conflict of interest statement

Ana Cecilia Fernández‐Gaxiola (AG) is a Consultant at the Instituto Nacional de Salud Pública, Mexico, and a Professor at the Universidad Iberoamericanca Ciudad de México. AG declares that she received partial payment from the Evidence and Programme Guidance, World Health Organization (WHO), to update the review.

Luz Maria De‐Regil (LD‐R) is a full‐time staff member of Nutrition International (NI) (formerly the Micronutrient Initiative), an international non‐for‐profit organisation that delivers multiple micronutrient interventions to children, women of reproductive age and pregnant women; LD‐R did not assess any study funded by NI that met the inclusion criteria of this review, nor did she extract data, assess risk of bias, or rate the quality of the evidence from those studies. The Canadian Department of Foreign Affairs, Trade and Development provides funds to NI to implement programmes with different micronutrient interventions in different populations.

Disclaimer: The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policies, or views of the WHO, NI, or the Canadian Department of Foreign Affairs, Trade and Development.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 1: Anaemia (All)
1.2
1.2. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 2: Anaemia (by supplement composition)
1.3
1.3. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 3: Anaemia (by anaemia status at baseline)
1.4
1.4. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 4: Anaemia (by iron status at baseline): Mixed/Unknown
1.5
1.5. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 5: Anaemia (dose of elemental iron per week in the intermittent group)
1.6
1.6. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 6: Anaemia (by duration of supplementation)
1.7
1.7. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 7: Anaemia (by malaria endemicity)
1.8
1.8. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 8: Haemoglobin in g/L (All)
1.9
1.9. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 9: Haemoglobin in g/L (by supplement composition)
1.10
1.10. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 10: Haemoglobin in g/L (by anaemia status at baseline)
1.11
1.11. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 11: Haemoglobin in g/L (by iron status at baseline)
1.12
1.12. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 12: Haemoglobin in g/L (by dose of elemental iron per week in the intermittent group)
1.13
1.13. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 13: Haemoglobin in g/L (by duration of supplementation)
1.14
1.14. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 14: Haemoglobin in g/L (by malaria endemicity)
1.15
1.15. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 15: Iron deficiency (All)
1.16
1.16. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 16: Ferritin in µg/L (All)
1.17
1.17. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 17: Ferritin in µg/L (by supplement composition)
1.18
1.18. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 18: Ferritin in µg/L (by anaemia status at baseline)
1.19
1.19. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 19: Ferritin in µg/L (by iron status at baseline)
1.20
1.20. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 20: Ferritin in µg/L (by dose of elemental iron per week in the intermittent group)
1.21
1.21. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 21: Ferritin in µg/L (by duration of supplementation)
1.22
1.22. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 22: Ferritin in µg/L (by malaria endemicity)
1.23
1.23. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 23: Iron deficiency anaemia (All)
1.24
1.24. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 24: All cause morbidity (All)
1.25
1.25. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 25: Diarrhoea
1.26
1.26. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 26: Any adverse side effects
1.27
1.27. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 27: Adherence
1.28
1.28. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 28: Prevalence of malaria parasitaemia
1.29
1.29. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 29: Any malaria parasitaemia (Incidence rate; per 1000 person months)
1.30
1.30. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 30: High density malaria parasitaemia (parasites 200/wbc)
1.31
1.31. Analysis
Comparison 1: Intermittent iron supplementation (alone or with any other micronutrients) versus no supplementation or placebo, Outcome 31: Clinical malaria
2.1
2.1. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 1: Anaemia (All)
2.2
2.2. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 2: Anaemia (by supplement composition)
2.3
2.3. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 3: Anaemia (by anaemia status at baseline)
2.4
2.4. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 4: Anaemia (by iron status at baseline): Mixed/Unknown
2.5
2.5. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 5: Anaemia (by dose of elemental iron per week in the intermittent group)
2.6
2.6. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 6: Anaemia (by duration of supplementation)
2.7
2.7. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 7: Anaemia (by malaria endemicity)
2.8
2.8. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 8: Haemoglobin in g/L (All)
2.9
2.9. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 9: Haemoglobin in g/L (by supplement composition)
2.10
2.10. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 10: Haemoglobin in g/L (by anaemia status at baseline)
2.11
2.11. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 11: Haemoglobin in g/L (by iron status at baseline)
2.12
2.12. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 12: Haemoglobin in g/L (by dose of elemental iron per week in the intermittent group)
2.13
2.13. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 13: Haemoglobin in g/L (by duration of supplementation)
2.14
2.14. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 14: Haemoglobin in g/L (by malaria endemicity)
2.15
2.15. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 15: Iron deficiency (All)
2.16
2.16. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 16: Ferritin in µg/L (All)
2.17
2.17. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 17: Ferritin in µg/L (by duration of supplementation)
2.18
2.18. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 18: Ferritin in µg/L (by anaemia status at baseline)
2.19
2.19. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 19: Ferritin in µg/L (by iron status at baseline)
2.20
2.20. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 20: Ferritin in µg/L (by dose of elemental iron per week in the intermittent group)
2.21
2.21. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 21: Ferritin in µg/L (by supplement composition)
2.22
2.22. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 22: Ferritin in µg/L (by malaria endemicity): No malaria/Unknown
2.23
2.23. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 23: Diarrhoea
2.24
2.24. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 24: Any adverse side effects
2.25
2.25. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 25: Depression
2.26
2.26. Analysis
Comparison 2: Intermittent iron supplementation versus daily iron supplementation, Outcome 26: Adherence
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References

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Bruner 1996 {published data only}
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Casey 2009 {published data only}
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Cook 1995 {published data only}
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Crape 2005 {published data only}
    1. Crape CL, Kenefick E, Cavalli-Sforza T, Busch-Hallen J, Milani S, Kanal K. Positive impact of a weekly iron-folic acid supplement delivered with social marketing to Cambodian women: compliance, participation, and hemoglobin levels increase with higher socioeconomic status. Nutrition Reviews 2005;63(Suppl 2):S134-8. [DOI: 10.1111/j.1753-4887.2005.tb00159.x] [PMID: 16466089] - DOI - PubMed
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Deshmukh 2008 {published data only}
    1. Deshmukh PR, Garg BS, Bharambe MS. Effectiveness of weekly supplementation of iron to control anaemia among adolescent girls of Nashik, Maharashtra, India. Journal of Health, Population and Nutrition 2008;26(1):74-8. [PMC2740684] [PMID: ] - PMC - PubMed
Dwividi 2006 {published data only}
    1. Dwividi A, Schultink W. Reducing anaemia among Indian adolescent girls through once-weekly supplementation with iron and folic acid. Sub-Committe on Nutrition News 2006;31:19-23.
Horjus 2005 {published data only}
    1. Horjus P, Aguayo VM, Roley JA, Pene MC, Meershoek SP. School-based iron and folic acid supplementation for adolescent girls: findings from Manica Province, Mozambique. Food and Nutrition Bulletin 2005;26(3):281-6. [DOI: 10.1177/156482650502600305] [PMID: 16222919] - DOI - PubMed
Jackson 2003 {published data only}
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Joseph 2013 {published data only}
    1. Joseph B, Ramesh N. Weekly dose of iron-folate supplementation with vitamin C in the workplace can prevent anaemia in women employees. Pakistan Journal of Medical Sciences 2013;29(1):47-52. [DOI: 10.12669/pjms.291.3016] [PMC3809215] - DOI - PMC - PubMed
Kätelhut 1996 {published data only}
    1. Kätelhut A, Schultink W, Angeles I, Gross R, Pietrzik K. The effects of weekly iron supplementation with folic acid, vitamin A, vitamin C on iron status of Indonesian adolescents. Asia Pacific Journal of Clinical Nutrition 1996;5(3):181-5. [PMID: ] - PubMed
López de Romaña 2006 {published data only}
    1. Gross U, Valle C, Diaz MM. Effectiveness of distribution of multimicronutrient supplements in children and in women and adolescent girls of childbearing age in Chiclayo, Peru. Food and Nutrition Bulletin 2006;27(4 Suppl 4):S122-9. [DOI: 10.1177/15648265060274S403] [PMID: 17455398 ] - DOI - PubMed
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Moretti 2015 {published data only}
    1. Morreti D, Goede JS, Zeder C, Jiskra M, Chatzinakou V, Tjalsma H, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood 2015;126(17):1981-9. [DOI: 10.1182/blood-2015-05-642223] [NCT01785407] [NCT02050932] [PMID: ] - DOI - PubMed
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Perrin 2002 {published data only}
    1. Perrin E, Rothman R, Coyne-Beasley T, Ford C. Is weekly iron and folic acid supplementation as effective as daily supplementation for decreasing incidence of anemia in adolescent girls? Archives of Pediatrics and Adolescent Medicine 2002;156:128-30. [DOI: 10.1001/archpedi.156.2.128] [PMID: ] - DOI - PubMed
Ramakrishnan 2012 {published data only}
    1. Gonzalez-Casanova I, Nguyen PH, Young MF, Harding KB, Reinhart GT, Nguyen H, et al. Predictors of adherence to micronutrient supplementation before and during pregnancy in Vietnam. BMC Public Health 2017;17(1):452. [DOI: 10.1186/s12889-017-4379-4] [NCT01665378] [PMC5434576] [PMID: ] - DOI - PMC - PubMed
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    1. Nguyen PH, Young M, Gonzalez-Casanova I, Pham HQ, Nguyen H, Truong TV, et al. Impact of preconception micronutrient supplementation on anemia and iron status during pregnancy and postpartum: a randomized controlled trial in rural Vietnam. PLOS One 2016;11(12):e0167416. [DOI: 10.1371/journal.pone.0167416] [NCT01665378] [PMC5137891] [PMID: ] - DOI - PMC - PubMed
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Sen 2012 {published data only}
    1. Sen A, Kanani S. Intermittent iron folate supplementation: impact on hematinic status and growth of school girls. International Scholarly Research Notices Hematology 2012;2012:482153. [DOI: 10.5402/2012/482153] [PMC3412096] [PMID: ] - DOI - PMC - PubMed
Shah 2016 {published data only}
    1. Shah SP, Shah P, Desai S, Modi D, Desai G, Arora H. Effectiveness and feasibility of weekly iron and folic acid supplementation to adolescent girls and boys through peer educators at community level in tribal area of Gujarat. Indian Journal of Community Medicine 2016;41(2):158-61. [DOI: 10.4103/0970-0218.173498] [PMC4799641] [PMID: ] - DOI - PMC - PubMed
Siddiqui 2003 {published data only}
    1. Siddiqui IA, Jaleel A, Rahman MA. Preventive strategy to control iron deficiency anemia in children and adults. Journal of the Pakistan Medical Association 2003;53(4):131-3. [PMID: ] - PubMed
    1. Siddiqui IA, Rahman MA, Jaleel A. Efficacy of daily vs weekly supplementation of iron in schoolchildren with low iron status. Journal of Tropical Pediatrics 2004;50(5):276-8. [DOI: 10.1093/tropej/50.5.276] [PMID: 15510758] - PubMed
Taylor 2001 {published data only}
    1. Taylor M, Jinabhai CC, Couper I, Kleinschmidt I, Jogessar VB. The effect of different anthelmintic treatment regimens combined with iron supplementation on the nutritional status of schoolchildren in KwaZulu-Natal, South Africa: a randomized controlled trial. Transactions of the Royal Society of Tropical Medicine and Hygiene 2001;95(2):211-6. [PMID: ] - PubMed
Tee 1999 {published data only}
    1. Tee ES, Kandiah M, Awin N, Chong SM, Satgunasingam N, Kamarudin L, et al. School-administered weekly iron-folate supplements improve hemoglobin and ferritin concentrations in Malaysian adolescent girls. American Journal of Clinical Nutrition 1999;69(6):1249-56. [DOI: 10.1093/ajcn/69.6.1249] [PMID: ] - DOI - PubMed
Vir 2008 {published data only}
    1. Vir SC, Singh N, Nigam AK, Jain R. Weekly iron and folic acid supplementation with counseling reduces anemia in adolescent girls: a large-scale effectiveness study in Uttar Pradesh, India. Food and Nutrition Bulletin 2008;29(3):186-94. [DOI: 10.1177/156482650802900304] [PMID: 18947031 ] - DOI - PubMed
Viteri 1999 {published data only}
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References to studies awaiting assessment

Brabin 2014 {published data only}
    1. * Compaore A, Gies S, Brabin BJ, Tinto H, Brabin L. "There is iron and iron..." Burkinabe women's perceptions of iron supplementation: a qualitative study. Maternal and Child Health Journal 2014;18(8):1976-84. [DOI: 10.1007/s10995-014-1443-x] [PMC4167572] [PMID: ] - DOI - PMC - PubMed
    1. Compaore A, Gies S, Brabin BJ, Tinto H, Brabin L. A qualitative study of the acceptability of weekly iron supplementation prior to the first pregnancy in Burkina Faso. Tropical Medicine and International Health 2017;22(Suppl 1):98. [DOI: 10.1111/tmi.12978] [8S2.4] - DOI
Malhotra 2013 {published data only}
    1. Malhotra A, Tyagi A. Effect of nutrition education and biweekly IFA supplementation on anaemia related knowledge and iron status of underprivileged adolescent girls. Annals of Nutrition & Metabolism 2013;63(Suppl 1):320. [DOI: 10.1159/000354245] - DOI
Olsen 2000 {published data only}
    1. Olsen A, Nawiri J, Friis H. The impact of iron supplementation on reinfection with intestinal helminths and Schistosoma mansoni in western Kenya. Transactions of the Royal Society of Tropical Medicine and Hygiene 2000;94:493-9. [PMID: ] - PubMed
    1. Olsen A, Nawiri J, Magnussen P, Krarup H, Friis H. Failure of twice-weekly iron supplementation to increase blood haemoglobin and serum ferritin concentrations: results of a randomized controlled trial. Annals of Tropical Medicine and Parasitology 2006;100(3):251-63. [DOI: 10.1179/136485906X91486] [PMID: 16630383 ] - DOI - PubMed
Sharma 2000 {published data only}
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References to ongoing studies

CTRI/2017/11/010453 {published data only}
    1. CTRI/2017/11/010453. Weekly and daily ferrous sulphate supplementation for control of anaemia in menstruating adolescents [Efficacy of once a week vs daily iron supplementation for control of anaemia in school going adolescent girls - a randomized clinical trial]. apps.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2017/11/010453 (first received 10 November 2017). [CTRI/2017/11/010453]

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