Long Term Effect of Early Iron Supplementation and Psychosocial Stimulation on Growth and Development of Iron-deficient Anaemic Infants

Millions of young children in developing countries have developmental deficits due to some preventable factors like poor nutrition, lack of a stimulating environment, and poverty. Although Bangladesh is doing well in achieving MDGs, still poor nutrition, poverty and poor parental education are prevalent. These mutually exclusive factors have an implication not only for the individuals' future but also for national income and development.

Usually, iron deficiency in the neonatal period and early childhood is considered a key to the development of disturbances in cognitive development. There is increasing evidence that iron deficiency anemia detrimentally affects children's development. Many cross sectional studies have shown that iron deficiency is associated with poor psycho motor development and behavioral deficits in young children, and poor cognition and school achievement in school-aged children. However, anemia is associated with many adverse social and economic family circumstances which may adversely affect children's development.

Nutrition along with early child development interventions can have additive or synergistic effects on child development, and in some cases, nutritional outcomes. Meta analysis, studies conducted in low, middle and high income countries in randomized controlled trials among primary school aged children (5-12 years) showed that concurrent iron supplementation improved global cognitive scores and growth and reduced risk of anemia and iron deficiency among anemic children by 50% and 75% respectively. According to the Lancet reviews on child development iron deficiency anemia during early childhood, when brain growth spurt occurs is one of the identified risk factor for later development. Similarly early psycho social stimulation acts as a protective factor in optimizing later development. Studies in Indonesia and Canada both found benefits from iron treatment to infants' motor development but not to mental development. It has been suggested that the poor level of mental development found in IDA infants may be irreversible in some circumstances. One systematic review and meta analysis revealed that daily iron supplementation in 2 to 5 years children increases hemoglobin and ferretin but has limited evidence in cognitive development and physical growth..

Anemia is a public health problem in Bangladesh where 51% of young children aged 6 to 59 months are suffering and the main cause of this problem is iron deficiency. A study conducted in Bangladesh found a non significant benefit to motor development from iron alone however the power of the study was extremely limited and the group receiving iron and zinc benefited in motor development. We also conducted a cluster randomized controlled trial in 2007-2008 on 6-24 months old iron deficient anemic (IDA) and non- anemic non-iron deficient (NANI) children with iron supplementation to IDA children for 6 months and weekly psycho social stimulation to all children in the stimulation clusters for 9 months in Bangladesh. The result showed that although the intervened IDA group recovered from their iron deficient status after 9 months, hey had significantly lower psycho motor development index (PDI) and responsiveness to the examiner compared to NANI group. Random-effects multilevel regressions of the developmental scores showed that psycho social stimulation improved children's mental development Index (MDI) in both the group. Interaction between iron status and stimulation showed a suggestive trend indicating that children with IDA and NANI responded differently to stimulation, i.e. the IDA group improved less than the NANI group. During that time we predicted that benefit of Iron supplementation and psycho social stimulation on children may appear in later life with application of more sensitive measurement tools for intelligence. The present study provides us a unique opportunity to examine long term effect of early iron supplementation and psycho social stimulation on growth and development of iron deficient anemic children.

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