1. ¹Research Department of Human Nutrition, Royal Veterinary and Agricultural University, Frederiksberg, Denmark
2. ²Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
3. ³Division of Vector Borne Diseases, Ministry of Health, Nairobi, Kenya
4. ⁴Danish Bilharziasis Laboratory, Charlottenlund, Denmark

Correspondence: H Friis, Research Department of Human Nutrition, The Royal Veterinary and Agricultural University Rolighedsvej, Rolighedsvej 30, DK-1958 Frederiksberg C, Denmark. E-mail: hfr@kvl.dk

Guarantor: H Friis.

Contributors: Concept and planning was done by DM, EM, FT, JO, PM, PWG, KFM, HF. Laboratory and field work was done by DM, BO, JO, FT, PWG. Data processing was done by DM, EM, HF. Writing of the paper was done by DM, HF.

Received 18 January 2002; Revised 18 March 2002; Accepted 18 June 2002.

Abstract

Objective: To assess the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on haemoglobin concentration (Hb), using schools as a health delivery system.

Study area and population: Nine hundred seventy-seven children between 9 and 18 y of age from 19 primary schools in Bondo District, western Kenya, were included in the trial. The 746 (76.4%) children on whom baseline Hb was available were included in this study.

Design: The study was a randomized, placebo-controlled, double-blind, two-by-two factorial trial of the effects of multi-micronutrient supplementation and multi-helminth chemotherapy on Hb after 8 months.

Interventions: Single treatment of infected children with albendazole (600 mg) for geohelminths and praziquantel (40 mg/kg) for Schistosoma mansoni and daily supplementation with 13 micronutrients.

Results: Multi-micronutrient supplementation (3.5 g/l, 95% CI 1.7, 5.3; P=0.0002) and anthelminthic treatment (2.0 g/l, 95% CI 0.2, 3.9; P=0.03) increased Hb independently (interaction, P=0.33). The effects were also independent of baseline Hb and general nutritional status. The treatment effect was due to reductions in S. mansoni and hookworm intensities of infection, in that Hb increased by 0.4 and 0.2 g/l, respectively, per 100 epg reductions in egg output. Interestingly, among S. mansoni-infected children, the effect of treatment seemed stronger in those with compared to those without co-existing malaria parasitaemia (interaction, P=0.09).

Conclusion: Multi-micronutrient supplementation and multi-helminth chemotherapy increased Hb among school children, irrespective of initial Hb and nutritional status.

Sponsorship: The Danish International Development Assistance.