Study (year), and Location

Sample Size (n), age of participants

Duration of intervention

Measurement of exposure and outcomes of interest

Summary of key findings

Direction of results

Remarks

Aaron, et al. [37]

Nigeria

Intervention group = 270

Control group = 564

Children aged 5 -13 years

6 months

Intervention Measurement: 250 mls of pre-cooked maize and soy with additional minerals and vitamins served to children in packs on each school day (5 days/week)

Outcome measurement: Fasting venous blood was taken at baseline and endline and hematological analysis done to determine haemoglogin, serum ferritin concentration

Haemoglobin and serum ferritin concentration increased in both groups but the changes did not differ significantly between the intervention and control groups .

Odds ratio for anaemia OR = 0.69 95% CI (0.43-1.11)

Odds ratio for iron deficiency OR = 0.77, 95% CI (0.31-1.95)

*Negative

Intervention did not significantly improve hemoglobin and serum ferritin levels

All children included in the study at baseline had haemoglobin ≥ 70 g/l

Muthayya, et al. [43]

India

N (total) = 401 at baseline (intervention group = 200, control group = 201)

N (total) = 379 at endline (intervention group = 186, control group = 193)

children aged 6-15 years

7 months

Intervention measurement: Each child received 3 standard sizes of chapatis made from 100 g of wheat flour with 4 different local recipe for vegetable or lentil dishes. Children were fed 6 days/week except on holidays

Outcome measurement:

- Hematological analysis was done for haemoglobin, serum ferritin, transferrin receptor, zinc protoporphrin

Anaemia prevalence reduced in treatment group (20.5 to 14% p < 0.001) but increased in control group (19.2 to 24.4%; p = 0.05)

Prevalence of iron deficiency decreased in intervention group (62.5% to 20.5%; p < 0.01) but did not change in control group

Iron deficiency anaemia prevalence decreased in intervention group (17.7% to 8.6%; p < 0.001) but there was no change in control group

*Positive

Intervention significantly reduced iron deficiency and iron deficiency anaemia

The study area is not endemic for malaria and presence of intestinal parasites is low.

The wheat based meal (chapatis) provided was fortified with iron as NaFe EDTA which is known to protect iron from phytic acid making iron more bioavailable.

Anemia was defined as an Hb Conc. < 120 g/L in children aged > 12 y and < 115 g/L in children

aged 5-11 y .

ID was defined as having an SF < 15 mg/L

Stuijvenberg, et al. [38]

South Africa - Kwazulu Natal

N (total) = 139

Intervention group = 108

Control group = 31

Children aged 6 - 11 years

12 months

Intervention measurement: School pupils received 3 biscuits weighing 15 g each within the first two hours of school days. Each child also received a cold drink fortified with vitamin C

Outcome measurement:

- Hematological analysis was done to determine serum ferritin, serum iron and total iron binding capacity

Significant increase in haemoglobin concentration as well as serum ferritin among the intervention group (p < 0.0001 and p < 0.005 respectively)

*Positive

Intervention resulted in significant improvement in serum ferritin, haemoglobin and transferrin saturation in the intervention group at 12 months of follow up

Biscuits were fortified with iron = 5 mg

Children were also dewormed with 400 mg albendazole at 4 monthly interval

Vitamin c rich drink provided could enhance iron absorption.

All indicators or iron status were observed to have declined after the summer holidays

Lannotti, et al. [27]

Haiti

N(total) = 1167

Mamba intervention group = 301 (baseline), 314 (endline)

Tablet Yo intervention Group = 347 (baseline), 332 (endline)

Control group = 288 (baseline), 251 (endline)

Children aged 3- 13 years

100 days

Intervention Measurement: Children in the Mamba group received 50 g of the product and the Tablet Yo group received 42 g of the product once per day and compliance was monitored

Outcome Measurement: -Biochemical, anthropometric and bioelectrical impedance were used to determine haemoglobin concentration, nutritional status and body composition respectively

Haemoglobin concentration did not vary significantly among groups at end point (p = 0.40)

Anaemia prevalence did not differ among groups at endline (p = 0.32)

Mamba provision showed reduced odds (28%) of developing anaemia over control ( OR = 0.72, 95% CI, 0.57 - 0.91)

*Negative

Intervention has no impact on mean haemoglobin concentration and anaemia prevalence with only Mamba showing reduced odds of developing anaemia

School pupils in the intervention groups were given take home rations for 10 days during vacation.

The Mamba group received fortified food

One control school reported children have received iron supplements from a community based programme

Deworming was done for both intervention groups as well as control group.

Jacoby, et al. [48]

Peru

N (Total) = 116

Intervention group = 58

Control group = 58

School children aged 5-10 years

7 months

Intervention measurement: Daily provision of breakfast consisting of cake and milk like beverage during school days

Outcome measurement: nonconsecutive 24 Hr dietary

Incidence of anaemia reduced significantly in the intervention group from 66% to 14%.

Mean iron intake was significantly higher (p < 0.001) in intervention group

**Positive

Intervention reduced Anaemia incidence and increased iron intake

Data on dietary intakes was reported for 2 months of follow up.

Kazianga, et al. [29]

Burkina Faso

N (Total) = 4140 (45 schools)

Lunch group = 15 schools

Take home ration group = 16 schools

Control group = 14 schools

School children aged 6 -15 years

1 year

Intervention measurement: school based lunches were provided every school day and compliance monitored. 10 kg of cereal flour was provided as take home rations every month

Outcome measurement: Haemoglobin was measured and difference in differences (DID) specification is used to estimate impact.

There was no significant impact of both school based lunch and take home rations on haemoglobin levels.

*Negative

Intervention did not improve haemoglobin levels

The take home rations were given to only girls in the selected schools.

Pinkaew, et al. [44]

Thailand

N (total) = 203

Intervention group = 101

Control group = 102

School children aged 4-12 years

5 months

Intervention measurement: school lunch comprising rice with chicken or fish and occasionally with vegetables for 5 days/week. 200 mls of milk is also provided 5 d/week

Outcome measurement: - biochemical analysis of blood samples to determine concentrations of Haemoglobin and serum ferritin

There was no significant difference in change in haemoglobin and serum ferritin between intervention and control.

*Negative

Intervention did not have a significant impact on haemoglobin and serum ferritin levels

The rice used for the intervention was triple fortified with zinc, iron and vitamin A.

All participants were not iron deficient at baseline.

Prior to the study, all children were receiving weekly iron supplementation

Hulett, et al. [40]

Kenya

N (total) = 360

Energy Group = 99

Milk Group = 105

Meat Group = 67

Control Group = 89

2 years

Intervention measurement: Intervention 1: 185 g of Githerie with added oil served on each school day except holidays

Intervention 2: 185 g of Githerie with 85 g of minced meat served each school day

Intervention 3: 185 g of Githerie with 250 ml of

Outcome measurement:

-repeated 24 Hr dietary recall were taken to estimate nutrient intake.

Dietary iron intake in the energy group did not vary significantly from the control group.

The meat and milk groups had significantly higher iron intakes over baseline levels and control

*Negative

Energy intervention did not have an impact on dietary iron intake

*Positive

Meat and milk interventions had a positive impact on dietary iron intakes

Dietary iron intakes were estimated as available iron instead of total iron intake. Availability was calculated based on 25% availability of haeme iron for all people and that 40% of iron from meat, fish and poultry is haeme iron.

Lien, et al. [45]

Vietnam

N (total) = 454

Regular milk group =

Fortified milk group =

Control group =

School children aged 7-8 years

6 months (November 2004-April 2005)

Intervention measurement: Intervention 1: 250 ml of regular milk provided 6 days per week and compliance monitored.

Intervention 2: 250 ml of milk fortified with mineral and vitamins and inulin served in the morning for 6 days per week.

Outcome measurement:

Biochemical analysis to assess levels of haemoglobin, serum ferritin.

24 Hr recalls conducted for dietary intake

Only fortified milk group showed significant increase in daily iron intake over control (p < 0.01)

Anaemia reduced in all groups and serum ferritin levels increased in both groups

*Positive

Fortified milk intervention improved iron intake

Both interventions reduced anaemia