Daily Versus Alternate Day Regimen of Iron Supplementation in Children with Iron Deficiency Anemia

Children will be recruited from the pediatrics general clinic in Al Demerdash Hospital.

After checking fro inclusion and exclusion criteria and signing the informed consent form the following will be carried out.

1-History taking: Caregivers will be asked about:

• Sociodemographic data: using a self-structured questionnaire

• Age of the child
• Gender of the child
• Order of birth
• Consanguinity
• Mode of delivery (either vaginal delivery or by c-section)
• Age of the mother and father
• Level of education or the mother and father
• Address of the family
• Questions about risk factors for iron deficiency anemia/ to exclude other causes of anemia:

• Prematurity / low birth weight.
• Duration of exclusive breast feeding
• Consumption of cow milk before 1 year of age/excessive consumption of cow milk
• Mother's iron status during pregnancy
• family history for hemolytic anemias or regular blood transfusions.
• history of blood transfusions (or hemolysis: pallor ,jaundice, dark urine,anemia)
• History of chronic illness (Cardiac, hepatic or renal patients).
• History of chronic blood loss
• Questions about symptoms of iron deficiency anemia:

Headache, lack of concentration,fatigue, palpitations, irritability,fainting, wanting to eat odd substances such as dirt or ice (also called pica),,,,etc.

2-Examination:

General examination:

• Anthropometric measures (weight,height,BMI).
• Look for signs of anemia: Pallor, brittle hair and nails,angular stomatitis,glossitis, Koilonychia or spooning of nails, tachycardia, hyperdynamic circulation.
• Abdominal examination: look for tenderness, masses or hepatosplenomegaly. 3-Investigations: (a blood sample of about 5 ml will be drawn twice, once at presentation and again after 8 weeks) Complete Blood Picture (CBC) Iron profile: serum iron, TIBC. Participants will be divided into two groups.

Both groups will receive:

• Health education regarding IDA including:

Prenatal and postnatal nutrition, the definition of anemia, diagnosis of anemia, factors causing anemia, sources of heme and non-heme iron, foods and nutrients that interfere with and promote iron absorption, and the impact of anemia on toddlers. Also food sources high in nutrients and processing high iron content of complementary breastfeeding.

• Treatment for parasitic infections (deworming ) Albendazole 400 mg once.

Then:

Group (1) will receive daily dose of 3 mg/kg ferrous fumarate before bed. Group (2) will receive a dose of 6mg/kg ferrous fumarate before bed every other day with a maximum dose of 180 mg /day.

Participants will be dedicated to the study for 8 weeks. During this time, they will be monitored using weekly phone calls to:

• Reinforce the health education message.
• make sure they are compliant to their treatment.
• monitor if any new symptoms or side effects appear.

• Outcomes:

Participants will be followed for 8 weeks. Check in after 8 weeks to repeat hemoglobin levels and serum Iron and TIBC.

Inclusion criteria

children 2-12 years of age diagnosed wit Iron Deficiency anemia according to WHO criteria (hemoglobin below 11 g/dl and transferrin saturation below 16%)

Exclusion criteria

• Children already being treated for iron deficiency anemia
• Children known to have hemolytic anemias
• Children with GIT disorders that prevent iron absorption (Inflammatory bowel disease,celiac disease …etc)
• Children with chronic diseases (heart disease,liver disease,kidney disease, endocrinological disease).
• Children who are underweight or morbidly obese