Background: Although efforts to reduce iron deficiency during pregnancy have been made, programmes often struggle with their participants’ compliance and effectiveness is low. Nevertheless, there is only little information about determinants of compliance. The aim of this thesis is to investigate which factors contribute to women’s compliance to iron supplementation during pregnancy in rural Bangladesh. Methods: Secondary analysis of data collected within a randomized trial in Matlab, Bangladesh (MINIMat trial). 4436 pregnant women were assigned to six micronutrient supplementation groups. Questionnaires were administered and anthropometric measurements were taken. Compliance was measured using the eDEM® counting device which recorded every time a pill bottle was opened. Results: In linear regression maternal age, socio economic status (SES) and education showed a positive association with compliance (p<0.001). Parity showed a negative association (p=0.045). Knowledge of effects of iron supplementation and perception of importance of iron supplementation were not significantly associated with compliance. Experiencing positive effects of iron supplementation was related to higher compliance to iron supplementation, while experiencing nausea was related to lower compliance to iron supplementation (p<0.001). Dislike of the tablets (p<0.001) and other reasons that were not specifically mentioned (p=0.015) were significantly associated with a decrease in compliance. Conclusion: Pregnant women’s compliance to iron supplementation was determined by different factors. Educating women about anaemia, iron deficiency and iron supplementation should not be the only strategy to achieve high compliance. Development of supplements that cause fewer side effects should be considered and more research investigating determinants of compliance should be performed.

Half a billion school aged children suffer from anemia, with the majority of anemia caused by iron deficiency. Researchers have shown a strong correlation between low hemoglobin levels and presence of intestinal parasites in children with anemia. Childhood anemia has profound negative effects on physical growth, maturation, and cognitive development leading to poorer educational achievement. Using hemoglobin as a measure of anemia, this quasi-experimental study investigated impact of either iron supplementation or an antiparasitic medication on hemoglobin levels in two groups of children in a rural region of Eastern Ghana. Surprisingly, after a 6-month intervention period, hemoglobin levels in both groups significantly decreased. Further research is needed toinvestigate other factors impacting nutrition and incidence of anemia in pediatric populations in developing countries.

Background - The first 1000 days of life (from conception to two years of age) is a critical period of nutritional vulnerability, affecting lifelong health. Iron deficiency (ID) and iron deficiency anaemia (IDA) are considered major public health problems that adversely affect development and growth, impair immunity, and increase morbidity and mortality in infants. ID and IDA in sub-Saharan Africa can be attributed to poor dietary, socioeconomic and disease conditions. One of the major obstacles in determining the prevalence of ID, using serum ferritin (SF) as marker of iron status, is that it not only reflects the amount of iron that is stored in the body, but also functions as an acute phase reactant that is raised in the presence of infection or inflammation. Aim - We conducted a re-analysis of the International Research on Infant Supplementation (IRIS) study’s baseline data to determine a more accurate estimation of the ID prevalence in apparently healthy four to thirteen-month-old infants from rural KwaZulu-Natal while accounting for the effect of chronic and acute inflammation on SF. Study design and methods - A cross-sectional analysis was performed on the baseline data (192 infants) of the IRIS study that was conducted in 2000. Infants’ haemoglobin (Hb), SF, C-reactive protein (CRP) and alpha-1 glycoprotein (AGP) concentrations were interpreted to determine the prevalence of ID. Literature of the past four years served as a guide to compare the ID prevalence obtained from four methods that account for the influence of inflammation on SF concentrations, to a reference method that does not take inflammation into consideration, and to what was reported in the original IRIS study. Weight and recumbent length measurements were converted to z-scores to interpret subjects’ anthropometric nutritional status. Results - A high prevalence of inflammation (52.6%) was present, with 11.5% of the subjects being in the incubation, 17.2% in the early convalescent, and 24% in the late convalescent phase of inflammation. SF was significantly associated with both CRP (ß = 0.200; P = 0.005) and AGP (ß = 0.223; P = 0.002) when adjusting for gender and age. The IRIS study reported an ID prevalence of 18.3%, whereas the results of this study ranged from 17.2 to 52.1%. We derived an IDA prevalence that ranged from 12 to 24.5% according to the different methods. The prevalence of stunting [length-for-age Z-score <-2SD] was 12.5%; while 25.1% of infants were overweight/obese [weight-for-length z-score >2SD]. Conclusion - A double burden of malnutrition was evident from the high prevalence of both overweight and ID, together with inflammation. The disconcertingly large variance in ID prevalence observed between the different methods that were employed highlights that iron supplementation interventions to treat anaemia must be based upon accurate estimates of IDA prevalence, otherwise they pose an increased risk of adverse effects to susceptible, iron-replete, but anaemic infants. Given the detrimental consequences of ID, it is imperative that governments, health care providers and parents must act to prevent or treat ID and IDA among vulnerable infants. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

Background - The first 1000 days of life (from conception to two years of age) is a critical period of nutritional vulnerability, affecting lifelong health. Iron deficiency (ID) and iron deficiency anaemia (IDA) are considered major public health problems that adversely affect development and growth, impair immunity, and increase morbidity and mortality in infants. ID and IDA in sub-Saharan Africa can be attributed to poor dietary, socioeconomic and disease conditions. One of the major obstacles in determining the prevalence of ID, using serum ferritin (SF) as marker of iron status, is that it not only reflects the amount of iron that is stored in the body, but also functions as an acute phase reactant that is raised in the presence of infection or inflammation. Aim - We conducted a re-analysis of the International Research on Infant Supplementation (IRIS) study’s baseline data to determine a more accurate estimation of the ID prevalence in apparently healthy four to thirteen-month-old infants from rural KwaZulu-Natal while accounting for the effect of chronic and acute inflammation on SF. Study design and methods - A cross-sectional analysis was performed on the baseline data (192 infants) of the IRIS study that was conducted in 2000. Infants’ haemoglobin (Hb), SF, C-reactive protein (CRP) and alpha-1 glycoprotein (AGP) concentrations were interpreted to determine the prevalence of ID. Literature of the past four years served as a guide to compare the ID prevalence obtained from four methods that account for the influence of inflammation on SF concentrations, to a reference method that does not take inflammation into consideration, and to what was reported in the original IRIS study. Weight and recumbent length measurements were converted to z-scores to interpret subjects’ anthropometric nutritional status. Results - A high prevalence of inflammation (52.6%) was present, with 11.5% of the subjects being in the incubation, 17.2% in the early convalescent, and 24% in the late convalescent phase of inflammation. SF was significantly associated with both CRP (ß = 0.200; P = 0.005) and AGP (ß = 0.223; P = 0.002) when adjusting for gender and age. The IRIS study reported an ID prevalence of 18.3%, whereas the results of this study ranged from 17.2 to 52.1%. We derived an IDA prevalence that ranged from 12 to 24.5% according to the different methods. The prevalence of stunting [length-for-age Z-score <-2SD] was 12.5%; while 25.1% of infants were overweight/obese [weight-for-length z-score >2SD]. Conclusion - A double burden of malnutrition was evident from the high prevalence of both overweight and ID, together with inflammation. The disconcertingly large variance in ID prevalence observed between the different methods that were employed highlights that iron supplementation interventions to treat anaemia must be based upon accurate estimates of IDA prevalence, otherwise they pose an increased risk of adverse effects to susceptible, iron-replete, but anaemic infants. Given the detrimental consequences of ID, it is imperative that governments, health care providers and parents must act to prevent or treat ID and IDA among vulnerable infants. / MSc (Dietetics), North-West University, Potchefstroom Campus, 2014

A normal pregnancy consumes 500–800 mg of iron from the mother. Premenopausal women have a high incidence of marginal iron stores or iron deficiency (ID), with or without anemia, particularly in the less developed world. Although pregnancy is associated with a “physiologic” anemia largely related to maternal volume expansion; it is paradoxically associated with an increase in erythrocyte production and erythrocyte mass/kg. ID is a limiting factor for this erythrocyte mass expansion and can contribute to adverse pregnancy outcomes. This review summarizes erythrocyte and iron balance observed in pregnancy; its implications and impact on mother and child; and provides an overview of approaches to the recognition of ID in pregnancy and its management, including clinically relevant questions for further investigation.

A deficiência de ferro e anemia ferropriva são problemas de ordem mundial. Para as mulheres no período gestacional, a preocupação com o estado do ferro no organismo deve ser ainda maior, pois a deficiência desse elemento pode causar prejuízo na formação dos bebês. O objetivo do projeto é avaliar a evolução da freqüência de deficiência de ferro e anemia ferropriva e os parâmetros de ferro no organismo de mulheres grávidas durante toda a gestação e relacionar com dados da dieta e suplementação de ferro. Também avaliamos os dados sócio-demográficos e nutricionais maternos, além dos parâmetros de ferro, com o peso dos seus recém nascidos. Participaram do estudo 183 gestantes, 103 terminaram o protocolo e das quais foram colhidas amostras de sangue nas idades gestacionais de 16, 28 e 36 semanas. Para avaliação nutricional foram aplicados três inquéritos recordatórios de 24 horas no dia da coleta. Foram realizadas as determinações de ferro sérico, saturação de transferrina, ferritina sérica, capacidade total de ligação ao ferro (CTLF) e concentração sérica do receptor de transferrina (sTfR), além da dosagem da concentração de hemoglobina. As gestantes foram classificadas em seis grupos conforme a suplementação com ferro em cada idade gestacional: as mulheres que não utilizaram essa suplementação foram incluídas no grupo 1 (N=21); enquanto as participantes que fizeram o uso de suplementação em todas as idades gestacionais, até 16 semanas de gravidez e com 28 e 36 semanas de gestação foram incluídas nos grupos 2 (N= 17), 3 (N=12) e 4 (N=24), respectivamente. Os outros 2 grupos foram constituídos por mulheres que utilizaram a suplementação somente com 28 semanas de gestação (Grupo 5, N= 19) e com 36 semanas de gestação (grupo 6 , N= 10). Não houve correlação entre os consumo de ferro da dieta e os parâmetros que avaliam o estado do ferro no sangue. Houve aumento da freqüência de deficiência de ferro em todos os grupos estudados, mas não ocorreu aumento da freqüência de anemia e nem anemia ferropriva. / Iron deficiency and iron deficiency anemia are worldwilde problems. For women during pregnancy, concern about the iron status should be even higher, because the iron deficiency may impair the formation of newborn. The objectives of this work was evaluate the frequency of iron deficiency and iron deficiency anemia and iron status markers of pregnant women during pregnancy and correlate with diet intake and iron supplementation. We also assess the socio-demographic, maternal nutrition and iron status with birth weight of their newborns. The study included 183 women, 103 completed the protocol. Blood samples was collected at gestational ages of 16, 28 and 36 weeks. Nutrient intake was assessed by 24 hour dietary recall applied at the same time of blood samples. We analyzed serum iron, transferrin saturation, serum ferritin, total iron binding capacity (TIBC), serum transferrin receptor (sTfR), and hemoglobin. Patients were classified into six groups according to iron supplementation: women who did not use this supplement were included in group 1 (N = 21), while the participants who made use of supplementation in all gestational ages, up to 16 weeks of gestation, in 28 and 36 weeks of gestation were included in group 2 (N = 17), 3 (N = 12) and 4 (N = 24), respectively. The other 2 groups consisted of women who used supplement in 28 weeks of gestation (Group 5, N = 19) and 36 weeks of gestation (group 6, N = 10). There was no correlationship between diet intake of iron and iron status markers. The frequencies of iron deficiency increased during pregnancy in all groups , however the frequencies of anemia and iron deficiency anemia did not.

A deficiência de ferro e anemia ferropriva são problemas de ordem mundial. Para as mulheres no período gestacional, a preocupação com o estado do ferro no organismo deve ser ainda maior, pois a deficiência desse elemento pode causar prejuízo na formação dos bebês. O objetivo do projeto é avaliar a evolução da freqüência de deficiência de ferro e anemia ferropriva e os parâmetros de ferro no organismo de mulheres grávidas durante toda a gestação e relacionar com dados da dieta e suplementação de ferro. Também avaliamos os dados sócio-demográficos e nutricionais maternos, além dos parâmetros de ferro, com o peso dos seus recém nascidos. Participaram do estudo 183 gestantes, 103 terminaram o protocolo e das quais foram colhidas amostras de sangue nas idades gestacionais de 16, 28 e 36 semanas. Para avaliação nutricional foram aplicados três inquéritos recordatórios de 24 horas no dia da coleta. Foram realizadas as determinações de ferro sérico, saturação de transferrina, ferritina sérica, capacidade total de ligação ao ferro (CTLF) e concentração sérica do receptor de transferrina (sTfR), além da dosagem da concentração de hemoglobina. As gestantes foram classificadas em seis grupos conforme a suplementação com ferro em cada idade gestacional: as mulheres que não utilizaram essa suplementação foram incluídas no grupo 1 (N=21); enquanto as participantes que fizeram o uso de suplementação em todas as idades gestacionais, até 16 semanas de gravidez e com 28 e 36 semanas de gestação foram incluídas nos grupos 2 (N= 17), 3 (N=12) e 4 (N=24), respectivamente. Os outros 2 grupos foram constituídos por mulheres que utilizaram a suplementação somente com 28 semanas de gestação (Grupo 5, N= 19) e com 36 semanas de gestação (grupo 6 , N= 10). Não houve correlação entre os consumo de ferro da dieta e os parâmetros que avaliam o estado do ferro no sangue. Houve aumento da freqüência de deficiência de ferro em todos os grupos estudados, mas não ocorreu aumento da freqüência de anemia e nem anemia ferropriva. / Iron deficiency and iron deficiency anemia are worldwilde problems. For women during pregnancy, concern about the iron status should be even higher, because the iron deficiency may impair the formation of newborn. The objectives of this work was evaluate the frequency of iron deficiency and iron deficiency anemia and iron status markers of pregnant women during pregnancy and correlate with diet intake and iron supplementation. We also assess the socio-demographic, maternal nutrition and iron status with birth weight of their newborns. The study included 183 women, 103 completed the protocol. Blood samples was collected at gestational ages of 16, 28 and 36 weeks. Nutrient intake was assessed by 24 hour dietary recall applied at the same time of blood samples. We analyzed serum iron, transferrin saturation, serum ferritin, total iron binding capacity (TIBC), serum transferrin receptor (sTfR), and hemoglobin. Patients were classified into six groups according to iron supplementation: women who did not use this supplement were included in group 1 (N = 21), while the participants who made use of supplementation in all gestational ages, up to 16 weeks of gestation, in 28 and 36 weeks of gestation were included in group 2 (N = 17), 3 (N = 12) and 4 (N = 24), respectively. The other 2 groups consisted of women who used supplement in 28 weeks of gestation (Group 5, N = 19) and 36 weeks of gestation (group 6, N = 10). There was no correlationship between diet intake of iron and iron status markers. The frequencies of iron deficiency increased during pregnancy in all groups , however the frequencies of anemia and iron deficiency anemia did not.

O ferro (Fe) é um oligoelemento capaz de aceitar e doar elétrons. Tal propriedade o torna extremamente útil em diversos componentes importantes ao bom funcionamento do organismo e da célula. O Fe está associado a algumas proteínas, está presente em citocromos, em moléculas que se ligam ao oxigênio (hemoglobina e mioglobina) e em uma grande variedade de enzimas. O aumento e a diminuição da sua oferta levam a alterações na expressão de RNAs mensageiros e proteínas responsáveis pela sua própria homeostase. Sabe-se que a expressão de vários genes envolvidos no metabolismo do Fe é regulada pós-transcricionalmente, por meio de mecanismo que é desencadeado por sua ligação em regiões não traduzíveis presentes em mRNAs específicos, o que interfere no seu grau de poliadenilação, e por conseguinte, na estabilidade e na tradução do transcrito. A Mb é uma heme-proteína de 18,8 kDa, altamente expressa no tecido muscular esquelético e cardíaco, e que pertence a mesma família da hemoglobina. Sabendo-se que cerca de 15% do Fe existente no organismo está presente nos músculos, no presente trabalho avaliamos se a suplementação e restrição de Fe, a curto e longo prazo, alteram a expressão gênica da Mb no músculo oxidativo Soleus (S), glicolítico Extensor Digital Longo (EDL) e no cardíaco. Observamos que a restrição de Fe, a longo prazo, provocou um aumento na expressão gênica e protéica da Mb, apenas no músculo Soleus, sem alterar o grau de poliadenilação do transcrito, enquanto a suplementação não alterou os parâmetros avaliados em nenhum dos tecidos. A administração aguda de Fe não alterou a expressão gênica e protéica da Mb, nem o grau de poliadenilação do transcrito em nenhum dos tecidos estudados. Estes resultados sugerem que a regulação da expressão da Mb pelo Fe se dá apenas transcricionalmente, e de maneira tecido específica. / Iron is a trace element that can accept and donate electrons. This property makes iron extremely important to several components involved with the proper functioning of the organism and cells. Iron is associated with some proteins, is present in cytochromes, molecules that bind to oxygen (hemoglobin and myoglobin) and a variety of enzymes. The increase and decrease of its offer lead to changes in the expression of mRNAs and proteins responsible for their own homeostasis. It is known that the expression of several genes involved in the metabolism of iron is regulated post-transcriptionally through a mechanism that is triggered by its binding in non-translatable regions of specific mRNAs, which interferes with their polyadenylation, and as a consequence, with the stability and translation of the transcripts. Mb is a heme-protein with 18,8 kDa, highly expressed in skeletal and cardiac muscle, and it belongs to the same family of hemoglobin. About 15% of iron in the body is present in muscle tissue. Thus, this study aimed to investigate if long- and short-term Fe supplementation and restriction affect Mb gene expression in the oxidative Soleus (S), glycolitic Extensorum Digitalis Longus (EDL), and cardiac muscles. It was shown that long- term Fe restriction increased Mb mRNA and protein expression only in S muscle, without interfering in the transcript polyadenylation, whereas Fe supplementation did not alter any parameter evaluated in the three tissues. The short-term iron administration did not change the Mb mRNA, polyadenylation and protein expression in any of the tissues studied. The present results indicate that the regulation of Mb gene expression by iron occurs only at transcriptional level and in a tissue specific manner.

Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-10-18T00:08:48Z No. of bitstreams: 1 DISSERTA??O FINAL - SAMILLA.pdf: 1387105 bytes, checksum: f821206b516e711d5bcb67ee1107c82e (MD5) / Made available in DSpace on 2016-10-18T00:08:48Z (GMT). No. of bitstreams: 1 DISSERTA??O FINAL - SAMILLA.pdf: 1387105 bytes, checksum: f821206b516e711d5bcb67ee1107c82e (MD5) Previous issue date: 2014-04-03 / The Iron-Deficiency Anemia (FA) has high prevalence in Brazil being associated with low birth weight, growth retardation, cognitive impairment and lower resistance to infections in children, and increased perinatal mortality in pregnant women. In response to this problem the National Program of Iron Supplementation (NPIS) created tools to record, evaluate and monitoring regularly and permanently, the process of establishing and implementing the three levels of the National Health System management and their results, forming what is called Management Module, which is nothing more than its Information System (IS). This article aimed to perform a descriptive and critique analysis of this system performance using as research outline the generation and use of data at the municipal level. The retrospective design used as the primary data interviews with health professionals, managers and users of the program, and as a secondary material, SI PNSF data and reports from the General Commission of Food and Nutrition, the state and municipal management, among other documents. The quality and relevance of the information was analyzed through the categories: completeness, reliability, timeliness, access, correction of goals and consistency of the information with the goals of health politics. Despite the SI have easily accessible data, the results showed errors in setting national goals and program coverage, in addition to wrong data input by local coordinators. Accessibility was also affected, disallowing the use of data for decision making at the local, intermediate and national levels. Finally, there was serious planning problems arising, at least in part, the institutional culture that underpins health practices and maintains the information as secret or as political and bureaucratic power resource. Studies and interventions towards the clearing and settlement of these issues could contribute to the improvement of health information systems, and in particular the PNSF, so as to allow the control and reduction of iron deficiency anemia in children and pregnant Brazilian women. / Este estudo objetivou avaliar a implanta??o do PNSF em um munic?pio baiano no per?odo de 2005 a 2012, atrav?s de uma pesquisa avaliativa. Para que se possa chegar o mais pr?ximo da apreens?o da realidade da realidade do objeto foi utilizada tanto a abordagem quantitativa baseada na tr?ade estrutura-processo-resultado a qual foi sistematiza por Donabedian (1980), quanto a qualitativa, fundamentada na avalia??o por triangula??o de m?todos (MYNAYO, 2008). Os achados da pesquisa foram divididos em dois artigos: 1) O Sistema de Informa??o do Programa nacional de suplementa??o de ferro e 2) Avalia??o do Programa Nacional de Suplementa??o de Ferro em um munic?pio da Bahia. ? ineg?vel a importa??o do PNSF como uma das estrat?gias voltadas para controle e redu??o da anemia por defici?ncia de ferro no pa?s, visto que suas a??es propostas de suplementa??o e educa??o alimentar e nutricional devem resolver a principal causa dessa defici?ncia que ? a quantidade insuficiente de ferro na dieta para satisfazer as necessidades nutricionais individuais. O presente estudo traz informa??es que permitem ter um diagn?stico do PNSF, considerando-se a diversidade de fontes utilizadas para obten??o dos dados e conclus?o dos achados. Ap?s quase uma d?cada de cria??o nota-se que o mesmo n?o consegue atingir seu objetivo geral que ? o de suplementar todas as crian?as de 6 meses a 18 meses de idade, gestantes a partir da 20? semana e mulheres at? o 3? m?s p?s-parto. Devido aos problemas encontrados e discutidos na estrutura e no processo de algumas das suas a??es. Sugere-se, ainda, que novas e continuas avalia??es governamentais e n?o governamentais sejam realizadas, no sentido de compreender melhor os fatores quem comprometem a implementa??o efetiva do programa, e que sobretudo ajude na reorganiza??o e aprimoramento do programa para que finalmente atinja o seu objetivo.

Anemia is a common deficiency throughout the world, its main cause, iron deficiency, is the most prevalent nutritional deficiency in the world. Were studied twelve municipalities in the region North of the State of Alagoas, having intended to investigate the prevalence of anaemia in pregnant women and children and to investigate the reasons for (in) effectiveness of the national programme of iron supplementation (PNSF).The data collection occurred in three modules: population receiving the PNSF, children 6 to 18 months and pregnant women blood sample collection, and held the determination of hemoglobin to assess the prevalence of anaemia in the Group; Programme Manager, Coordinator of the PNSF in the municipality; and finally, health care professionals who work in basic care. In all modules were applied questionnaires drawn up in the search following the Manual of the PNSF. Were interviewed 1,446 families, totaling a sample of 6,446 individuals residing in the northern municipalities of Alagoas. Of the total of 90 individuals, pregnant women, 157 children were in the range from 0 to 60 months. The prevalence of anaemia in pregnant women was 46.8%, there were no cases of severe anaemia, 41.8% were cases of mild anemia and 5.1% of moderate anaemia. In children 6 to 60 months, the prevalence of anemia was 51.7%, 39.4% of mild anemia, 9.8% from moderate anaemia and 2.5% of children with severe anaemia. In pregnant women there were not significant risk factors. The child's age was a significant factor for occurrence of anemia, children under one year are eight times more likely to be anemic that children over one year. The questionnaires of the PNSF in pregnant women and children demonstrated little knowledge about the programme, the importance of supplementation and information about food sources of iron, as well as foods that interfere with the absorption of iron, positively or negatively. The coordinators of the PNSF are mostly healthcare professionals (90%) that Act on other programs in the municipality, half operate also in vitamin A supplementation program, any other act in basic care or outside a Coordinator acts in school meals. The involvement in all activities of the PNSF occurs with only two of the coordinators. The causes of the inefficiency of the programme for coordinators: the lack of interest of the population; the lack of the supplement; lack of training of health staff and lack of supervision in the implementation of the programme. Helth professionals belive that the PNSF has not been effective: lack of the supplement; lack of interest of the population; lack of interest of local and/or federal managers; lack of training of the teams; lack of health professionals with a commitment to the objectives of the programme. Both coordinators as health workers blamed the lack of success of the programme to beneficiaries and the lack of the add-in, as the two most cited. Despite the importance of nutritional guidance to the PNSF the minority of the population received this type of guidance. It has been suggested from this study that systematically a Food guidance programme staff of the family health Programme aimed at increasing access of the population with adequate information and directed to fight this nutritional deficiency. / Fundação de Amparo a Pesquisa do Estado de Alagoas / A anemia é uma carência comum em todo o mundo, sua principal causa, a deficiência de ferro, é a deficiência nutricional mais prevalente no mundo. Foram estudados doze municípios da região Norte do estado de Alagoas, tendo por objetivo investigar a prevalência de anemia em gestantes e crianças e investigar as razões da (in) efetividade do Programa Nacional de Suplementação de Ferro (PNSF). A coleta dos dados ocorreu em três módulos: população beneficiária do PNSF, crianças de 6 a 18 meses e gestantes coletas amostra de sangue e realizada a dosagem de hemoglobina para avaliar a prevalência de anemia no grupo; gestor do programa, coordenador do PNSF no município; e por fim, profissionais de saúde que atuam na atenção básica. Em todos os módulos foram aplicados questionários elaborados na pesquisa seguindo o Manual do PNSF. Foram entrevistadas 1.446 famílias, totalizando uma amostra de 6.446 indivíduos residentes nos municípios do Norte de Alagoas. Do total de indivíduos, 90 eram gestantes, 157 crianças na faixa de 0 a 60 meses. A prevalência de anemia em gestante foi de 46,8%, não houveram casos de anemia grave, 41,8% foram de casos de anemia leve e 5,1% de anemia moderada. Nas crianças de 6 a 60 meses, a prevalência de anemia foi de 51,7%, 39,4% de anemia leve, 9,8% de anemia moderada e 2,5% de crianças com anemia grave. Nas gestantes não houveram fatores de riscos significativos. A idade da criança foi fator significativo para ocorrência de anemia, os menores de um ano possuem oito vezes mais chances de estarem anêmicos que crianças maiores de um ano. Os questionários do PNSF nas gestantes e crianças demonstraram pouco conhecimento sobre o programa, a importância da suplementação e informações sobre alimentos fontes de ferro, bem como alimentos que interfiram na absorção do ferro, positiva ou negativamente. Os coordenadores do PNSF são na maioria profissionais da área da saúde (90%) que atuam em outros programas no município, metade atuam também no programa de suplementação de vitamina A, os demais atuam na atenção básica ou fora dela e uma coordenadora atua na merenda escolar. O envolvimento com todas as atividades do PNSF ocorre com apenas dois dos coordenadores. As causas da ineficiência do programa para os coordenadores: a falta de interesse da população; a falta do suplemento; falta de capacitação da equipe de saúde e falta de supervisão na execução do programa. Os profissionais de saúde acreditam que o PNSF não tem sido eficiente: falta do suplemento; falta de interesse da população; falta de interesse dos gestores federais e/ou locais; falta de capacitação das equipes; falta de profissionais de saúde com compromisso com os objetivos do programa. Tanto os coordenadores quanto os profissionais de saúde responsabilizaram a falta de sucesso do programa aos beneficiários e a falta de do suplemento, como os dois pontos mais citados. Apesar da importância da orientação nutricional para o PNSF a minoria da população recebeu esse tipo de orientação. Sugere-se a partir deste estudo que haja sistematicamente um Programa de Orientação Alimentar à equipe do Programa de Saúde da Família visando aumentar o acesso da população a informação adequada e direcionada ao combate dessa carência nutricional.