Oral iron supplementation for preventing or treating anaemia among children in malaria-endemic areas

Abstract

Children commonly develop anaemia (low haemoglobin) after birth. Anaemia is associated with several ill-effects, including hindering motor development and learning skills, and it may have an adverse effect on immunity. Babies and children are therefore commonly given iron supplements to prevent or treat anaemia. In countries where malaria is prevalent, it has been suggested that iron supplementation increases the risk of malaria and deaths. The high dose of iron which is given as medicine may result in free iron circulating in the blood and available to the malaria parasite, which promotes its growth. We therefore aimed to assess the effects of iron administered to children living in countries where malaria is prevalent. We included only randomized controlled trials that compared iron given orally as a medicinal product (and not as food or drink fortification) with placebo or no treatment. Iron did not increase the risk of malaria disease, indicated by fever and presence of parasites in the blood. The presence of parasites in the blood was slightly higher with iron overall, but not in trials with adequate randomization methods. There was no increased risk of death among iron-treated children. Although more than 70 trials were identified for this review, malaria-related outcomes and deaths were reported in only 16 and 11 trials, respectively. Iron supplementation increased haemoglobin by about 1 g/dL in areas where malaria is highly prevalent. At the end of follow up, which varied between two weeks and six months after the end of iron supplementation, the gain was smaller but still present at 0.4 g/dL. Iron did not increase the risk of respiratory infections, but episodes of diarrhoea were more frequent with iron when it was administered with zinc. Children given iron visited medical clinics less than children given placebo, but the rate of hospitalization was similar. Weight and height at the end of treatment were similar. Iron did not adversely affect rates of cure when given together with antimalarial treatment in three trials that examined this issue. Our conclusions are that iron supplementation does not adversely affect children living in malaria-endemic areas. The evidence shown in our review is limited by the lack of trials examining the relevant outcomes and the limited information allowing us to analyse factors that can affect our results, such as the children's baseline level of haemoglobin. Based on our review, routine iron supplementation should not be withheld from children living in countries where malaria is prevalent