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Few studies have investigated the simultaneous effect of individual and contextual factors on the occurrences of anemia. This study aims to evaluate the variability of children's hemoglobin levels from municipalities in social vulnerability and its association with factors of individual and municipal nature. This is a cross-sectional, multi-center study, with children data (12-59 months) collected from 48 municipalities of the Southern region of Brazil, that were included in the Brazil Without Poverty Plan. Individuals' data were collected using a structured questionnaire, and secondary and ecological data of children's municipalities were collected via national surveys and institutional websites. The outcome was defined as the hemoglobin level obtained by HemoCue. A multilevel analysis was performed using Generalized Linear Models for Location Scale and Shape using R, with a 5% significance level. A total of 1,501 children were evaluated. The mean hemoglobin level was 12.8g/dL (95%CI: 12.7-12.8), with significant variability between municipalities. Lower values of hemoglobin were observed in children who lived in municipalities with a higher urbanization rate and a lower number of Community Health Agents, in relation to the reference categories. At the individual level, lower hemoglobin values were identified for children under 24 months, not enrolled at daycares, who were beneficiaries of the conditional cash transfer program and diagnosed with underweight. The results shed light on important factors at the municipal and the individual levels that were associated to the hemoglobin levels of children living in municipalities in social vulnerability.

This was a systematic review and meta-analysis of studies evaluating the effectiveness of ferrous sulfate supplementation in the prevention of anemia in children under five. The database search included PubMed, Scopus, LILACS, and SciELO. Articles published between 1980 and 2011 in Spanish, English, or Portuguese were included, using the keywords child, preschool, infant, anemia, prevention, and iron supplementation. The authors selected 13 studies, which showed that regardless of dose and duration of supplementation, daily regimen was more consistently related to improvement in hemoglobin levels (pooled effect 0.56mg/dL, 95%CI: 0.31; 0.81, p < 0.001) as compared to weekly intervention (pooled effect 0.28mg/dL, 95%CI: -0.22; 0.78, p = 0.273). Iron supplementation was not associated with decreased prevalence of anemia, even with daily doses, and administration with other micronutrients did not bring additional benefits compared to the exclusive administration of iron supplement. Daily supplementation of ferrous sulfate was more effective than weekly doses in improving hemoglobin levels.