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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 9; 334(7605): 1180.
PMCID: PMC1889980
Anaemia in Developing Countries

Mass iron treatment is cheaper than routine deworming

Shailendra Kapoor, resident physician

Gulani et al say that routine administration of intestinal anthelmintic agents results in a marginal increase in haemoglobin (1.71 g/l).1 What needs to be considered is whether this approach of mass anthelmintic therapy is actually economically feasible, especially in third world countries where iron deficiency anaemia is a major health issue.2 This needs special consideration, given the fact that the primary cause of anaemia in third world countries is dietary malnutrition rather than intestinal infestation with helminths.3

A better and more economically feasible approach to thwart the “epidemic” of anaemia might be mass supplementation with iron supplements such as oral ferrous sulphate.4 The average cost of mebendazole treatment (100 mg three times a day for three days) is £15. According to Gulani et al, this regimen increases haemoglobin by 1.7 g/l. On the other hand, ferrous sulphate at a dose of 325 mg three times a day will increase haemoglobin by the same amount in about two weeks and cost £1.


Competing interests: None declared.


1. Gulani A, Nagpal J, Osmond C, Sachdev HP. Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials. BMJ 2007;334:1095-7. (26 May.) [PMC free article] [PubMed]
2. Cook JD, Reusser ME. Iron fortification: an update. Am J Clin Nutr 1983;38:648-59. [PubMed]
3. Tatala S, Svanberg U, Mduma B. Low dietary iron availability is a major cause of anemia: a nutrition survey in the Lindi District of Tanzania. Am J Clin Nutr 1998;68:171-8. [PubMed]
4. Mitra AK, Akramuzzaman SM, Fuchs GJ, Rahman MM, Mahalanabis D. Long-term oral supplementation with iron is not harmful for young children in a poor community of Bangladesh. J Nutr 1997;127:1451-5. [PubMed]

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