Multi-micronutrient-fortified biscuits decreased the prevalence of anaemia and improved iron status, whereas weekly iron supplementation only improved iron status in Vietnamese school children.

Randomized controlled trial in primary-school children aged 6 to 9 years in rural Quang Nam province, Vietnam. Children were followed for 6 months and compared across daily fortified biscuits, weekly iron tablets, and control biscuits/placebo, with outcomes focused on hemoglobin, anaemia, and iron status markers.

Daily multi-micronutrient-fortified biscuits (FB) provided five biscuits per day, about 30 g per serving, containing 8.8 mg iron as iron fumarate plus other micronutrients, and were eaten at school 5 days per week for 6 months. Weekly iron supplementation (SUP) used oral ferrous fumarate tablets once per week for 6 months, with 30 mg for children weighing <20 kg and 40 mg for those weighing ≥20 kg; the control arm received non-fortified biscuits and placebo tablet.

Daily multi-micronutrient-fortified biscuits produced the clearest benefit, markedly improving iron status and reducing anaemia; weekly iron tablets improved iron status but had a smaller effect on anaemia. In the fortified-biscuit arm, anaemia fell from 45.8% to 1.0%, compared with 10.4% in controls, and hemoglobin increased to 129 g/l, with higher ferritin and lower transferrin receptor than controls (P<0.001 and P=0.007, respectively). Weekly iron also increased ferritin and body iron, but endpoint hemoglobin remained intermediate and was not significantly different from the other groups after adjustment. Among children with baseline vitamin A deficiency, hemoglobin at 6 months was estimated to be 8.0 g/l higher with fortified biscuits than control biscuits and 7.1 g/l higher than weekly iron. No adverse events were reported.

Arm-specific baseline demographic data were not reported, and some counts were available only for evaluable or blood-sampled subsets rather than the full randomized arms. The trial lasted 6 months and was conducted in rural Vietnamese schoolchildren, which limits generalizability, and the vitamin A-deficient subgroup analyses were based on smaller numbers and are less precise.