Effect of Interventions on Iron-Deficiency Anemia Among School-Going Children in India: A Systematic Review and Network Meta-Analysis.

Abstract

Background: The prevalence of iron-deficiency anemia (IDA) among school-aged children in India varies from 27% to 90%. There is no evidence of the comparative effects of various available interventions. Thus, this study aimed to quantify and rank the effects of different interventions on IDA among school-going children. Study Design: Systematic review and Meta-analysis.

Methods: To this end, PubMed, Scopus, and ScienceDirect databases were searched, and randomized controlled trials (RCTs) evaluating the comparative effects of various interventions on hemoglobin (Hb) and serum ferritin against a control were included in this study. The random-effect model was conducted for Hb, and the fixed-effects model was performed for ferritin to estimate the mean difference (MD) and 95% confidence interval (CI) of the effect of interventions of outcomes based on the heterogeneity (I² ).

Results: Eight RCTs (including 2534 participants) investigating the effects of 12 interventions for IDA treatment among school-going children in India were obtained. The results of reference-based forest plots and P score indicated that iron-rich fish powder was the most effective intervention for increasing Hb levels (MD: 2.07 g/dL, 95% CI: 0.68-3.47, P score=0.8656), followed by iron and folic acid (IFA) given twice weekly (MD: 1.47 g/dL, 95% CI: -0.31-3.25, P score=0.7209). Additionally, IFA supplementation twice weekly was found to be highly effective in increasing serum ferritin levels among anemic school children (MD: 0.80 ng/mL, 95% CI: 0.33-1.27, P score=0.9148).

Conclusion: It seems that iron-rich fish powder and intermittent IFA supplementation were the most effective interventions, but further research is needed to confirm these results and assess their public health implications. Protocol Registration: PROSPERO registration number was CRD42024541802.