Are Infants Less than 6 Months of Age a Neglected Group for Anemia Prevention in Low-Income Countries?

Cinta Moraleda,Clara Menéndez,N Regina Rabinovich

doi:10.4269/ajtmh.17-0487

Abstract

.Anemia is a major public health problem that affects mainly children, predominantly in low-income countries and most often due to iron deficiency (ID). Administration of iron supplements to prevent and treat ID anemia in malaria endemic areas has been controversial for decades; however, recent World Health Organization guidelines recommend universal iron supplementation for children in highly prevalent anemia settings, including those where malaria is endemic. However, infants younger than 6 months of age have been exempted from this recommendation because ID is not considered prevalent at this age and because of assumptions—without evidence—that they are protected from ID through breast milk. To achieve full impact of anemia prevention targeting infants less than 6 months of age who are at highest risk of ID, operational studies that conclusively demonstrate the effectiveness and safety of delivering iron supplements to young infants in settings with a high burden of infectious diseases, including malaria, are needed.

Highlights

Anemia of any etiology increases the risk of child mortality and morbidity, and iron deficiency (ID) anemia has been associated with harmful effects on cognitive and physical development and on the immune function of children.[2,3,4]
Children less than 5 years of age, especially those living in low- and middleincome countries, have the highest frequency of anemia, and it is the only age group in which anemia prevalence increased from 1990 to 2010.1,2 In these countries, the etiology of anemia is often multifactorial, including a combination of nutritional deficiencies, genetic disorders, and infectious diseases, ID remains the main cause of anemia globally.[1,2]
Previous World Health Organization (WHO) anemia prevention guidelines for children living in malaria-endemic areas recommended targeting only iron-deficient children[6]; this implied screening children for ID, something logistically difficult in resource-limited settings

Summary

Introduction

Anemia is a major public health problem that affects over a third of the global population, causing 68 million disabilityadjusted life years (nearly 9% of total).[1,2] Anemia of any etiology increases the risk of child mortality and morbidity, and iron deficiency (ID) anemia has been associated with harmful effects on cognitive and physical development and on the immune function of children.[2,3,4] Children less than 5 years of age, especially those living in low- and middleincome countries, have the highest frequency of anemia, and it is the only age group in which anemia prevalence increased from 1990 to 2010.1,2 In these countries, the etiology of anemia is often multifactorial, including a combination of nutritional deficiencies, genetic disorders, and infectious diseases, ID remains the main cause of anemia globally.[1,2] Prevention and treatment of ID are based on the administration of iron supplements and/or food fortification.[4,5] for decades, iron supplementation in malaria-endemic areas has been controversial because of reports of increased risk of malaria episodes or severe morbidity in individuals receiving iron supplements.[4].

Results

Conclusion