Oral iron supplements for children in malaria-endemic areas

Abstract

Iron alone or with antimalaria treatment does not increase the risk of clinical malaria or death when regular malaria surveillance and treatment services are provided. There is no need to screen for anaemia prior to iron supplementation.

Prevalence and Factors Associated with Anemia Among Children Under 5 Years of Age—Uganda, 2009

“…49 Screening for iron deficiency in resource-limited areas is indeed challenging, controversial, and may neither be needed nor practical. 44,[49][50][51] In a hyperendemic malaria region of Tanzania, over 800 infants were randomized to one of four groups-iron supplementation with anti-malarial, iron supplementation with placebo, placebo with anti-malarial, or placebo with placebo. Infants receiving iron had lower rates of severe anemia than their counterparts without an effect on acquisition of malaria, suggesting the protective efficacy of iron supplementation in preventing anemia.…”

“…A subsequent Cochrane review in 2011 confirmed the earlier findings and found that while the risk of clinical malaria among children receiving iron supplementation was higher in regions without access to malaria surveillance and treatment, concluded that "when regular malaria surveillance and treatment services are provided" the risk of malaria is not increased. 51 As such, these researchers concluded that screening for anemia was unnecessary prior to oral iron supplementation in such situations.…”

Etiology of Anemia Among Infants, School-Aged Children, and Young Non-Pregnant Women in Different Settings of South-Central Côte d'Ivoire

“…It has been shown that iron fortification can prevent anemia in infants free of malaria, 41 and a recent meta-analysis showed that iron supplementation is recommended in areas where malaria is endemic when regular malaria surveillance and treatment services are provided. 42 Of note, sTfR is a marker of cellular iron demand, and there are mid-to-moderate forms of iron deficiency where anemia is absent. These forms of iron deficiency often lead to anemia if they remain untreated.…”

Effects of daily iron supplementation in primary-school–aged children: systematic review and meta-analysis of randomized controlled trials

“…*Two included studies 52,53,54 used clustered randomization at the school level but the reported data were not clearly adjusted for clustering. We imputed the design effect for hemoglobin from a recent Cochrane review, 8 and the intra-cluster correlation coefficient for physical activity and cognitive assessment from other cluster RCTs reporting these outcomes; 59,60 sample size was then adjusted by dividing by the design effect.…”