Iron supplements for preventing or treating anemia among children in malaria-endemic areas

Iron supplements do not increase the likelihood of contracting malaria and should not be withheld from children at risk of the disease, despite World Health Organisation (WHO) guidelines to the contrary, a new review by Cochrane Researchers suggests.

"Based on our review, children should not be denied iron supplements, even if they are living in areas where malaria is prevalent," says lead researcher, Juliana Ojukwu of the Department of Paediatrics at the Ebonyi State University in Ebonyi State, Nigeria. "Iron is important for growth and development, and maintaining a healthy immune system."

Until 2007, WHO guidelines recommended that all children should be given iron supplements to help prevent iron deficiency and anemia, which are significant public health problems in developing countries. It is estimated that iron deficiency is the cause of 726,000 childhood deaths each year. However, a recent large trial in Zanzibar prompted the WHO to change its guidelines, which now recommend that iron supplements are withheld from children under two years in areas where they are at high risk of contracting malaria. The argument against giving iron is that it could help promote the growth of malarial parasites circulating in the blood.

In response to this, Cochrane researchers reviewed data from 68 different trials involving 42,981 children. They concluded that iron did not increase the risk of malaria, as long as regular malaria surveillance and treatment services were available, and that there should not be any need to screen for anemia before giving supplements. They say WHO guidelines rely too heavily a single recent trial, whereas this current research drew its conclusions after giving appropriate weight to a wide range of studies.

Although the benefits of giving iron are greater for children with anemia, any decision to withhold iron supplements should be carefully considered. "Any potential negative effects of giving iron have to be weighed against the quite serious implications of not giving it, namely anemia and its contribution to childhood infection and death, especially in Sub-Saharan Africa," says Ojukwu.

Full citation: Ojukwu JU, Okebe JU, Yahav D, Paul M. Oral iron supplementation for preventing or treating anemia among children in malaria-endemic areas. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006589. DOI: 10.1002/14651858.CD006589.pub2.