Iron supplements 'increase malaria threat'
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Iron supplements 'increase malaria threat'
Source: SciDev.Net
Children at risk of malaria are more likely to die of the dis-
ease if they are given dietary supplements of iron and folic
acid, according to a study in the latest issue of The Lancet.
The researchers who carried out the study say the World Health
Organization (WHO) needs to revise its guidelines on iron sup-
plements as a result of their findings.
The WHO says all children in areas where anaemia is a problem
should be given the supplements. Anaemia is a blood disease that
can stunt mental and physical development and is usually caused
by eating too little iron.
But this has been controversial as some research suggests that
iron deficiency can protect against malaria.
Robert Black of Johns Hopkins University, United States, and
colleagues gave more than 24,000 Tanzanian children under three
either a placebo or a supplement of iron and folic acid every
day for a year and a half.
The study showed that only children who had anaemia because of
iron deficiency benefited from the supplement.
Generally, however, children receiving iron and folic acid had a
12 per cent greater risk of being hospitalised or dying. The
difference was big enough to make the researchers end the trial
early.
A parallel trial also published in The Lancet last week showed
that in Nepal, where malaria is rare, infants who received the
supplements were no more likely to die than those who did not.
Putting the two studies together, Black's team concludes that
iron deficient and anaemic children can benefit from the supple-
ments as long as there are active programmes in place to detect
and treat malaria and other infections.
But they warn that giving the supplements to infants who are not
iron deficient would be harmful.
"Such studies are rare and the study teams are to be applauded,"
write Mike English and Robert Snow of the Kenya Medical Research
Institute and Wellcome Trust Collaborative Programme, in an ac-
companying article in The Lancet.
Both papers "are far superior to any previous examination of the
survival benefits and risks of supplementation with iron and
[folic acid]", they add.
English and Snow say the risks associated with giving the sup-
plements to children exposed to malaria "seem to outweigh any
immediate benefits".
Anaemia is widespread in the developing world and is especially
common in children younger than five years.
Reference: The Lancet 367, 133 (2006)
Reference: The Lancet 367, 144 (2006)
Reference: The Lancet 367, 90 (2006)