Dose

The WHO has published global guidelines for iron supplementation and recommends daily prophylactic iron supplementation with 60 mg of iron for all women in developing countries in the second and third trimesters of pregnancy (Table 1). In other countries, iron supplementation is recommended only for women with proven iron-deficiency anemia (in Great Britain) or for women with low pre-pregnancy iron stores (in Canada). The efficacy of maternal iron supplementation increases with daily iron doses of up to 60 mg. The WHO also recommends providing low-birth-weight infants with supplemental iron drops from 2 months of age.

Table 1 Micronutrient supplementation: target groups and prevention schedules

Micronutrient

Target group

Dosage

Frequency and duration

Vitamin Aa

Children at risk of vitamin A deficiency

<6 months

50000IU

One dose at 4, 10, and 14 weekse

6-11 months

100000IU

One dose every 4-6 monthsf

1-5 years

200000IU

One dose every 4-6 months

Post-partum women

400000IUg

One dose before 8 weeks

Iron (plus folate)0

post-partum

Pregnant women (living in areas where

60 mg iron and

Daily for 6monthsh in

anemia prevalence is less than 40%)

400 mg folic acidi

pregnancy

Pregnant women (living in areas where

60 mg iron and

Daily for 6 monthsh in

anemia prevalence is at least 40%)

400 mg folic acidi

pregnancy, and continuing to 3 months post-partum

6-24-month-old children of normal birth

12.5 mg iron and

Daily to 6-12 months of age

weight (living in areas where the

50 mg folic acid

prevalence of anemia in children is less

than 40%)

6-24-month-old children of normal birth

12.5 mg iron and

Daily to 6-24 months of age

weight (living in areas where the

50 mg folic acid

prevalence of anemia in children is

greater than or equal to 40%)

2-24-month-old children of low birth

12.5 mg iron and

Daily to 2-24 months of age

weight (less than 2500 g)

50 mg folic acid

Iodinec

Pregnant women in areas where iodine deficiency is endemici

300-480 mg

One dose annually

Non-pregnant fertile women7

400-960 mg

One dose annually

Children in areas where iodine deficiency

240 mg iodine

One dose annually

is endemic7

Zincd

Children with persistent diarrheak

10-20 mg

Daily for 14 days

Children with an elevated risk of zinc

Further research needed on relative efficacy of

deficiency; children who are severely

different frequencies and doses

stunted, or have low plasma zinc, or both

aAdapted from World Health Organization (1997) Vitamin A Supplements: A Guide to Their Use in the Treatment and Prevention of Vitamin A Deficiency and Xerophthalmia, 2nd edn. Geneva: World Health Organization.

bAdapted from Stoltzfus RJ and Dreyfus JL (1998) Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. INACG ILSI Press, Washington DC.

cAdapted from World Health Organization (1996) Safe Use of iodized oil to prevent iodine deficiency in pregnant women - a Statement by the WHO. Bulletin of the World Health Organization 74: 1-3.

dAdapted from the recommendations of an expert group: Fontaine O (2001) Effect of zinc supplementation on clinical course of acute diarrhoea. Journal of Health Population and Nutrition 19: 339-346.

eGive at the time of each of the three diphtheria-pertussis-tetanus vaccinations.

fImmunization against measles provides a good opportunity to give one of these doses.

gProvisional recommendation of the International Vitamin A Consultative Group, Annecy, France, 30 October-2 November, 2000. hIf 6 months' duration cannot be achieved in pregnancy, continue to supplement during the post-partum period for 6 months or increase the dose to 120 mg iron in preganancy.

'Where iron supplements containing 400 mg of folic acid are not available, an iron supplement with less folic acid may be used. Supplementation with less folic acid should be used only if supplements containing 400 mg are not available. jWhere access to iodine-fortified salt is limited and immediate attention is needed. kIn areas where there is an elevated risk of zinc deficiency in the population.

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