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Association of iron supplementation and deworming with early childhood development: analysis of Demographic and Health Surveys in ten low- and middle-income countries

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Abstract

Purpose

We assessed the associations of iron supplementation and deworming separately or combined with improved early childhood development (ECD) status.

Methods

Cross-sectional data were analyzed for 29,729 children aged 36–59 months surveyed using the Demographic and Health Surveys in ten low- and middle-income countries, where iron supplementation and deworming are recommended by the World Health Organization. In each country, we estimated linear regression models for the effects of iron supplementation and deworming individually or combined on the Early Childhood Development Index (ECDI) z score, and whether this association differed between various ECD domains and the sex and residence of the child. Estimates were pooled using random-effects meta-analyses.

Results

Compared with receiving neither of the two interventions, iron supplementation plus deworming was associated with an increased ECDI z score (β = 0.13, 95% confidence interval (CI) 0.03–0.22, p = 0.009), particularly in rural residences. However, iron supplementation and deworming, individually, were not associated with the ECDI z score. Iron supplementation plus deworming was associated with higher odds of on-track development in literacy–numeracy (OR = 1.57, 95% CI 1.24–2.01, p < 0.001) and learning domains (OR = 1.27, 95% CI 1.09–1.48, p = 0.003), but not with development in the social–emotional and physical domains.

Conclusion

Iron supplementation plus deworming, particularly for populations who are more susceptible to iron deficiency and intestinal worm infections, could be an important intervention for improving ECD. These findings may inform the argument for the necessity of implementing iron supplementation and deworming for preschool-age children.

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Data availability

The datasets analyzed during the current study are available in the DHS Program data repository, [https://www.dhsprogram.com/].

Code availability

All code that supports the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Maternal and Child Health, School of Public Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing, China

    Yaqing Gao, Yinping Wang, Siyu Zou, Xiaoyi Mi & Hong Zhou

  2. International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

    Ashish Kc

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Contributions

YG designed the study, conducted the statistical analyses, and wrote the paper; YW, SZ, XM, and AK contributed to data interpretation, and the critical review of the manuscript; HZ supervise the study process; and all authors read and approved the final manuscript.

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Correspondence to Hong Zhou.

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Procedures and questionnaires for Demographic and Health Surveys (DHS) have been reviewed and approved by ICF Institutional Review Board (IRB). Additionally, country-specific DHS survey protocols are reviewed by the ICF IRB and typically by an IRB in the host country. ICF IRB ensures that the survey complies with the U.S. Department of Health and Human Services regulations for the protection of human subjects (45 CFR 46), while the host country IRB ensures that the survey complies with laws and norms of the nation.

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Gao, Y., Wang, Y., Zou, S. et al. Association of iron supplementation and deworming with early childhood development: analysis of Demographic and Health Surveys in ten low- and middle-income countries. Eur J Nutr 60, 3119–3130 (2021). https://doi.org/10.1007/s00394-021-02493-4

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