Iron supplements result in death / malaria

Discussion in 'Food and nutrition' started by [email protected], Jan 14, 2006.

  1. Study: Iron Supplements Can Make Children with Malaria Sicker
    By David McAlary
    Washington
    13 January 2006

    A new study says United Nations health guidelines recommending iron
    supplements for anemic children could be dangerous in certain
    circumstances.
    Researchers from the United States and Zanzibar say that in areas where
    malaria is intense, iron supplements can increase the risk of severe
    illness
    and death.
    U.N. data show that about 75 percent of East African children under
    five
    suffer anemia caused by iron deficiency. In areas where anemia is
    common,
    international guidelines call for iron and folic acid supplements for
    all
    children under two.
    But a study in the medical journal Lancet shows that in places where
    anemia
    and malaria coincide, the iron supplements result in increased
    hospitalizations and death.
    Johns Hopkins University physician Robert Black led the study of more
    than
    24,000 children aged one month to three years in Pemba, Zanzibar, an
    area of
    high malaria transmission.
    "For a number of years, there has been a concern about giving iron to
    populations, particularly children, that have malaria, and this seems
    to
    have been borne out in this study," said Mr. Black.
    Black's team assigned the children to randomly receive various
    combinations
    of iron, folic acid, and zinc, or no supplements at all. They stopped
    the
    study early for groups getting the iron and folic acid combination
    because
    it made some children's malaria worse. Overall, children getting those
    minerals had a 12 percent higher risk of hospitalization for severe
    disease
    or death than those receiving no supplements.
    In contrast, a companion study by Black and his colleagues in Nepal,
    where
    malaria transmission is low, shows that the supplements did not
    increase
    death and sickness among children.
    The Johns Hopkins University doctor says the Zanzibar research shows
    that
    the problem seems to be with iron, not folic acid, but the biological
    explanation is unclear.
    "It appears that there is an adverse affect of giving iron in this
    setting,
    perhaps related to the stimulation of the bone marrow to produce red
    blood
    cells that are then more readily infected with the malaria parasite,"
    he
    said. "Or perhaps there is a direct toxic effect of the iron that has
    been
    hypothesized, but the exact mechanism has not been worked out."
    The Zanzibar study shows that iron supplements did help some children,
    but
    only those who were anemic in the first place. As a result, the
    researchers
    recommend revising international guidelines to avoid blanket iron
    supplementation in places where malaria is endemic.
    "One possibility is to provide iron only when there is adequate malaria
    control or possibly iron and antimalarial drugs simultaneously so that
    the
    malaria is controlled when iron is presented to the child," he noted.
    "A
    second possibility is that there could be screening for anemia so that
    only
    children with iron deficiency anemia would be given iron."
    A Lancet commentary accompanying the Zanzibar and Nepal studies calls
    them a
    significant advance. But its authors say they represent only the
    extreme
    ends of the malaria spectrum and do not yet provide adequate evidence
    for
    global policy. The authors, from the Kenya Medical Research Institute
    in
    Nairobi, are calling for more large iron supplementation trials in
    areas of
    different levels of malaria transmission.

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