Randomized intervention study comparing several regimens for the treatmentof moderate anemia among refugee children in Kigoma region, Tanzania

Anemia-specific mortality was markedly elevated among refugee children < 5 years of age in Tanzania. In a randomized, double-blind study, 215 anemic c hildren were initially treated for malaria and helminth infection and then received 12 weeks of thrice-weekly oral iron and folic acid. Group I receiv ed placebo and chloroquine treatment for symptomatic malaria infection (i.e ., no presumptive anti malarial treatment given). Group II received placebo and monthly presumptive treatment with sulfamethoxazole-pyrimethamine (SP) . Group III also received monthly SP and thrice-weekly vitamins A and C (VA C). Mean hemoglobin concentration increased from 6.6 to 10.2 g/dL, with no significant differences among groups. Group II had lower mean serum transfe rrin receptor levels (TfR) than group I [P = 0.023]. A greater proportion o f participants in group III had normal iron stores (TfR < 8.5 mug/mL) than in group II [P = 0.012]. Initial helminth and malaria treatment. followed b y thrice-weekly iron and folic acid supplements resulted in increased hemog lobin levels. Monthly SP and thrice-weekly VAC contributed to improve iron stores. Monthly SP may have a role in situations where asymptomatic disease is prevalent or where access to care is limited. Because administration of VAC also hastened recovery of iron stores over administration of monthly S P alone, health care personnel could add VAC to the treatment fur moderate anemia if maximum recovery of iron stores is desired.