Supplementation strategies to alleviate iron deficiency: Experiences from Indonesia

Anemia, mainly caused by iron deficiency; is common in Indonesia, especially among pregnant women and infants. In pregnancy iron deficiency anemia is associated with undesirable birth outcome, and in infants with reduced mental and motor development. Iron status can be improved through dietary changes, food fortification, antehelminthic treatment, and supplementation. Supplementation offers the best chance for improvement on short term, although reported effectiveness of large scale programs is often limited. In Indonesia supplementation programs exist for pregnant women, female factory workers, and under-five children from poor families. Effectiveness of the programs is limited by tablet supply, program coverage, compliance and a possibly by a low vitamin A status, and the following changes should be considered to improve effectiveness. Tablets should also be distributed through channels other than the health sector, such as through traditional birth attendants. In order to decrease the iron deficiency prevalence during pregnancy young women/adolescent girls should be supplemented before they get pregnant. Infants should also be targeted by programs. Supplementation on a weekly in stead of daily basis should be considered especially under conditions where supplementation can be supervised such as in schools or factories. Since intake of vitamin A and zinc are also frequently deficient, a multi-supplementation should be strived for.