Iron-containing cookware for the reduction of iron deficiency anemia among children and females of reproductive age in low- and middle-income countries: A systematic review

BACKGROUND & OBJECTIVE: There is limited evidence regarding the efficacy of iron-containing pots and ingots in reducing iron deficiency (ID) and iron deficiency anemia (IDA) in low- and middle-income countries (LMICs). The objective of this systematic review is to summarize the evidence regarding the effect of iron-containing cookware on ID and IDA among children and females of reproductive age (FRA) in LMICs. METHODS: Searches were last conducted in May 2019 in PubMed, Embase, Cochrane Library, Web of Science, Scopus, CAB Abstracts, POPLINE, LILACS, ProQuest Dissertations & Theses Global, WHO ICTRP and ClinicalTrials.gov. Hand searching was also conducted. Selection criteria included randomized-controlled trials (RCTs), quasi-experimental studies and observational studies with control groups that studied the effect of iron-containing cookware in children (4 months-11 years) and females of reproductive age (12–51 years). RESULTS: Eleven studies were eligible for inclusion in the review. Statistically significant increases in hemoglobin and/or iron indices (p < 0.05) were observed in 50% (4/8) of studies on pots (relative change/mean difference in Hb: -0.4–1.20 g/dL), and 33.3% (1/3) of studies on ingots (relative change/mean difference in Hb: 0.32–1.18 g/dL). Positive outcomes (p < 0.05) were observed among children in 50% (4/8) of studies and among FRA in 28.6% (2/7) of studies. Compliance ranged from 26.7–71.4% daily use of pots to 90–93.9% daily use of ingots. CONCLUSIONS: There are indications that, with reasonable compliance, iron-containing cookware could serve as a means of reducing IDA, especially among children. The potential advantages of iron-containing cookware include relative cost-effectiveness and complementary combination with other interventions. However, further research is needed regarding both the efficacy and safety of this intervention.