A study has questioned previous assertions that iron supplementation significantly increases incidence of malaria in endemic communities.
The report published today in The Journal of the American Medical Association found that children in a malaria-endemic community in Ghana who received a micronutrient powder with iron did not experience a significant increase in incidence of malaria as previous studies had suggested.
Dr Stanley Zlotkin and his colleagues at the Hospital for Sick Children in Toronto looked at the influence of providing micronutrient powder (MNP) with or without iron on the occurrence of malaria among children living in a high malaria-burden area.
The researchers found that “the overall incidence of malaria was lower in the iron group compared with the no iron group, but after adjustment for baseline values for iron deficiency and moderate anaemia, these differences were no longer statistically significant”.
The 6 month trials were conducted with 1,958 children aged 6 to 35 months in 2010 in rural, central Ghana. The children were selected from 1,552 different clusters- a compound including one or more households- from which the iron or no iron participants were randomised.
Children were not included if they had taken iron supplements within the previous 6 months or if severe anaemia or wasting was a problem.
The researchers ensured that all participants were not denied existing malaria prevention such as insecticide-treated bed nets or malaria treatment during the trials. As such, the researchers say that the results could most likely be applied to other malaria-endemic locations where similar measures are in place.
During the initial 5 month intervention period, similar associations were found only for patients with severe malaria, i.e. parasite counts greater than 5000/µL. Secondary analysis showed that the risk of malaria had been reduced within the subgroup of the iron group who had iron deficiency and anaemia at baseline.
Overall the research suggested that the overall incidence of malaria was lower in the iron group compared with the no iron group, but that these differences were no longer statistically significant after adjustment for baseline values for iron deficiency and moderate anaemia were made.
Health policy implications
Malaria is a leading cause of childhood morbidity and mortality in sub-Saharan Africa, whilst iron deficiency is among the most prevalent preventable nutritional deficiencies in this area.
Yet due to previous links drawn between malaria and iron supplementation, the World Health Organization and the United Nations Children’s Fund released a joint statement in 2006 recommending the reduction of iron supplement use among children in malaria-endemic areas. Consequently anaemia control programs in these areas were cut short or cancelled.
The researchers hope that their findings - coupled with new guidelines from WHO concerning iron fortification for the prevention and treatment of anaemia among children younger than 2 years - will generate renewed interest in the implementation of iron fortification in Ghana as part of national nutrition policy.
Source: The Journal of the American Medical Association
"Iron Fortification and Malaria Risk in Children"
Authors: Andrew M. Prentice, Hans Verhoef and Carla Cerami