TITLE

Effect of Iron Fortification on Malaria Incidence in Infants and Young Children in Ghana

AUTHOR(S)
Zlotkin, Stanley; Newton, Samuel; Aimone, Ashley M.; Azindow, Irene; Amenga-Etego, Seeba; Tchum, Kofi; Mahama, Emmanuel; Thorpe, Kevin E.; Owusu-Agyei, Seth
PUB. DATE
September 2013
SOURCE
JAMA: Journal of the American Medical Association;9/4/2013, Vol. 310 Issue 9, p938
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
IMPORTANCE In sub-Saharan Africa, malaria is a leading cause of childhood morbidity and iron deficiency is among the most prevalent nutritional deficiencies. In 2006, the World Health Organization and the United Nations Children's Fund released a joint statement that recommended limiting use of iron supplements (tablets or liquids) among children in malaria-endemic areas because of concern about increased malaria risk. As a result, anemia control programs were either not initiated or stopped in these areas. OBJECTIVE To determine the effect of providing a micronutrient powder (MNP) with or without iron on the incidence of malaria among children living in a high malaria-burden area. DESIGN, SETTING, AND PARTICIPANTS Double-blind, cluster randomized trial of children aged 6 to 35 months (n = 1958 living in 1552 clusters) conducted over 6 months in 2010 in a rural community setting in central Ghana, West Africa. A cluster was defined as a compound including 1 or more households. Children were excluded if iron supplement use occurred within the past 6 months, they had severe anemia (hemoglobin level <7 g/dL), or severe wasting (weight-for-length z score <-3). INTERVENTIONS Children were randomized by cluster to receive a MNP with iron (iron group; 12.5 mg/d of iron) or without iron (no iron group). The MNP with and without iron were added to semiliquid home-prepared foods daily for 5 months followed by 1-month of further monitoring. Insecticide-treated bed nets were provided at enrollment, as well as malaria treatment when indicated. MAIN OUTCOMES AND MEASURES Malaria episodes in the iron group compared with the no iron group during the 5-month intervention period. RESULTS In intention-to-treat analyses, malaria incidence overall was significantly lower in the iron group compared with the no iron group (76.1 and 86.1 episodes/100 child-years, respectively; risk ratio (RR), 0.87 [95% CI, 0.79-0.97]), and during the intervention period (79.4 and 90.7 episodes/100 child-years, respectively; RR, 0.87 [95% CI, 0.78-0.96]). In secondary analyses, these differences were no longer statistically significant after adjusting for baseline iron deficiency and anemia status overall (adjusted RR, 0.87; 95% CI, 0.75-1.01) and during the intervention period (adjusted RR, 0.86; 95% CI, 0.74-1.00). CONCLUSION AND RELEVANCE In a malaria-endemic setting in which insecticide-treated bed nets were provided and appropriate malaria treatment was available, daily use of a MNP with iron did not result in an increased incidence of malaria among young children. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01001871
ACCESSION #
90089803

 

Related Articles

  • Iron Fortification and Malaria Risk in Children. Prentice, Andrew M.; Verhoef, Hans; Cerami, Carla // JAMA: Journal of the American Medical Association;9/4/2013, Vol. 310 Issue 9, p914 

    The authors discuss the results of a study of the iron fortification intervention trial among Ghanaian children. They note that iron deficiency affects immune function, cognitive development and physical capacity, making it one of the most prevalent nutritional problems worldwide. The study...

  • Putting a dent in iron deficiency. Lesperance, Leann; Wu, Ann Chen; Bernstein, Henry // Contemporary Pediatrics;Jul2002, Vol. 19 Issue 7, p60 

    Focuses on ways to detect, prevent and treat iron deficiency in children. Measurement of the varying degrees of iron deficiency; Definition of anemia; Factors attributed to the high prevalence of iron deficiency anemia in developing countries; Types of iron provided by diet. INSETS: Iron:...

  • Linear Growth in Children with Iron Deficiency Anemia Before and After Treatment. Soliman, Ashraf T.; Dabbagh, Muhamad M. Al; Habboub, Alia Hussein; Adel, Ashraf; Humaidy, Noura Al // Journal of Tropical Pediatrics;Oct2009, Vol. 55 Issue 5, p324 

    We measured growth [length (L) standard deviation score (SDS), growth velocity (GV) SDS and body mass index (BMI)] and hematological (hemoglobin, hematocrit, MCV and MCH) parameters in 40 children (aged 17.2 ± 12.4 months) with iron deficiency anemia (IDA) before and after iron therapy....

  • Effectiveness of intermittent iron treatment of two- to six-year-old Jordanian children with iron-deficiency anemia. Faqih, Ahmad M.; Kakish, S. B.; Izzat, M. // Food & Nutrition Bulletin;Sep2006, Vol. 27 Issue 3, p220 

    Background: Iron deficiency is a common nutritional problem in young children among vulnerable populations in Jordan. Several studies have shown the effectiveness of intermittent iron supplementation in improving iron status. Such a study has not been carried out in 2- to-6-year-old...

  • Micronutrient Supplementation and Deworming in Children with Geohelminth Infections. Rajagopal, Selvi; Hotez, Peter J.; Bundy, Donald A. P. // PLoS Neglected Tropical Diseases;Aug2014, Vol. 8 Issue 8, p1 

    The article looks at the two key micronutrient deficits linked to geohelminthiases in children, which are the iron and vitamin A deficiencies. It looks at the relative benefits of vitamin A supplementation and deworming in children with geohelminth infections as well as discusses the financial...

  • Iron deficiency in children with mitochondrial disease. Hye Eun Kwon; Jung Hun Lee; Young Mock Lee; Hoon Chul Kang; Joon Soo Lee; Heung Dong Kim // Metabolic Brain Disease;Jun2010, Vol. 25 Issue 2, p185 

    Mitochondrial disease is an energy metabolic disorder with various organ involvement. Iron is widely known to be one of the most important nutriments required for normal brain development and several essential metabolic functions. We retrospectively studied the laboratory data on iron deficiency...

  • Iron Deficiency in Massachusetts Communities: Socioeconomic and Demographic Risk Factors among Children. Sargent, James D.; Stukel, Therese A.; Dalton, Madeline A.; Freeman, Jean L.; Brown, Mary Jean // American Journal of Public Health;Apr96, Vol. 86 Issue 4, p544 

    Objectives. This study examined the association between community rates of iron deficiency in children and sociodemographic characteristics of Massachusetts communities. Methods. Between April 1990 and March 1991, 238273 Massachusetts children 6 through 59 months of age were screened; iron...

  • Malnutrition and the burden of disease. Lopez, A. // Asia Pacific Journal of Clinical Nutrition;2004 Supplement, Vol. 13, pS7 

    Malnutrition is a major cause of disease burden in many developing regions, and is a principal factor inhibiting further rapid declines in child mortality. Almost 50% of children in India and neighbouring countries are clinically underweight (<2 SD weight for age), as are about one-third of...

  • IRON DEFICIENCY ANEMIA. Kishwar, Farzana; Ashraf, Tahira; Hanif, Islam; Hanif, Asif; Kalsoom, Samia // Professional Medical Journal;2015, Vol. 22 Issue 9, p1122 

    Objective: The objective of this study was to determine prevalence of iron deficiency anemia in children of Lahore. Study Design: Cross sectional survey. Setting: Hospitals in different areas of Lahore. Period: 3 months. Methodology: A total sample of three hundred and sixty children was taken...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics