Anemia And Iron Supplementation Is Not Associated with Malaria in Young Burkinabe Children

Abstract

Iron (Fe) supplementation may increase the malaria risk. Using data from a randomized clinical trial on lipid-based nutrient supplements (LNS) in young Burkinabe children, we compared the incidence of malaria in children with hemoglobin concentration (Hb) < 80 g/L who received Fe supplements in addition to LNS vs. children with Hb 蠅 80 g/L who received only LNS. 2364 children received 20 g LNS daily with 6 mg Fe from 9-12 mo of age. At 9 mo, Hb was assessed. Children with Hb < 80 g/L were given Fe supplements (2-3 mg/kg/d as FeSO4) for 1 mo and anthelminthic treatment. Children with positive malaria rapid diagnostic test (RDT) received antimalarial treatment. Malaria and fever data were collected during weekly morbidity surveillance home visits, and children were treated if indicated. At baseline, 611 children had moderate-to-severe anemia (MSA, Hb < 80 g/L) and received iron treatment, 1541 had mild-to-moderate anemia (MMA, 80 g/L 蠄 Hb < 110 g/L) and 212 were non-anemic (NA, Hb 蠅 110 g/L). The prevalence of baseline positive RDTs was 83%, 53% and 33% in children with MSA, MMA, and NA, respectively. During the 3-mo follow-up, 99% of malaria episodes were treated and malaria incidence was 0.67 ± 0.86, 0.63 ± 0.86 and 0.60 ± 0.88 episodes per 100 child-days for MSA, MMA and NA, respectively (p=0.632). In the context of high coverage of malaria diagnosis and treatment, providing Fe supplements and LNS poses no additional risk of malaria. Funded by the Bill & Melinda Gates Foundation.