Decline in Childhood Iron Deficiency After Interruption of Malaria Transmission in Highland Kenya

Abstract

In malaria‐endemic areas, recurrent malaria may contribute to functional iron deficiency (ID) in children. In a highland area of Kenya, we previously showed that children <5 y had increased hemoglobin (Hb) levels after interruption of malaria transmission from April 2007 to July 2008. In the present study, we sought to determine prevalence of ID and its relationship to changes in Hb in these children. Iron status markers were measured in 189 children aged 4–59 mos in plasma samples collected in May 2007 and July 2008. Indicative of improved iron status, median (IQ range) plasma ferritin (PF) increased from 17.0 μg/L (9.7, 25.6) to 22.6 μg/L (13.1, 34.7; P < 0.001), while median (IQ range) soluble transferrin receptor decreased from 5.8 mg/L (4.8, 7.5) to 5.0 mg/L (4.1, 6.3; P < 0.001). ID prevalence (PF <12 μg/L or PF <30 μg/L if C‐reactive protein >; 10 mg/L) decreased from 34.4% to 23.8% (P = 0.005), and prevalence of ID + anemia (Hb < 11.0 g/dL) declined from 25.6% to 11.6% (P < 0.001). Children with ID in 2007 had a greater increase in Hb (mean, g/dL [95% CI], 1.15 [0.72, 1.57]) than children without ID (0.51 [0.26, 0.76], P=0.007). In this highland area, prevalence of ID in children decreased after interruption of malaria transmission, and this decrease contributed in part to a concurrent increase in Hb levels. Malaria elimination could lead to a decrease in ID and ID‐related anemia in malaria‐endemic areas. Support: NIAID U01 AI056270.