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

PLoS One. 2019 Sep 3;14(9):e0221094. doi: 10.1371/journal.pone.0221094. eCollection 2019.


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 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.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anemia, Iron-Deficiency / epidemiology*
  • Anemia, Iron-Deficiency / etiology
  • Anemia, Iron-Deficiency / prevention & control
  • Anemia, Iron-Deficiency / therapy
  • Child
  • Child, Preschool
  • Cooking*
  • Developing Countries
  • Early Medical Intervention
  • Female
  • Follow-Up Studies
  • Humans
  • Income
  • Infant
  • Iron*
  • Outcome Assessment, Health Care
  • Poverty
  • Puberty*
  • Sex Factors


  • Iron

Grants and funding

The authors received no specific funding for this work.