Abstract
Iron deficiency affects one quarter of the world's population and causes significant morbidity, including detrimental effects on immune function and cognitive development. Accordingly, the World Health Organization (WHO) recommends routine iron supplementation in children and adults in areas with a high prevalence of iron deficiency. However, a large body of clinical and epidemiological evidence has accumulated which clearly demonstrates that host iron deficiency is protective against falciparum malaria and that host iron supplementation may increase the risk of malaria. Although many effective antimalarial treatments and preventive measures are available, malaria remains a significant public health problem, in part because the mechanisms of malaria pathogenesis remain obscured by the complexity of the relationships that exist between parasite virulence factors, host susceptibility traits, and the immune responses that modulate disease. Here we review (i) the clinical and epidemiological data that describes the relationship between host iron status and malaria infection and (ii) the current understanding of the biological basis for these clinical and epidemiological observations.
Highlights
Iron deficiency and malaria are significant co-morbidities in large portions of the developing world, and both maladies disproportionately affect pregnant women and children
The wisdom of universal iron supplementation campaigns in malaria endemic regions has recently been questioned due to clinical evidence that suggests iron deficiency protects against malaria, and that iron supplementation of women and children may increase the incidence of malaria when given without malaria prophylaxis or access to adequate health care (Nyakeriga et al, 2004; Sazawal et al, 2006; Tielsch et al, 2006; Kabyemela et al, 2008; Senga et al, 2011; Veenemans et al, 2011; Gwamaka et al, 2012; Jonker et al, 2012; Esan et al, 2013; Zlotkin et al, 2013)
Trial stopped early because of safety concerns. Those who received iron and folic acid with or without zinc were 12% more likely to die or need hospital treatment for an adverse event and 11% more likely to be admitted to hospital; there were 15% more deaths in these groups
Summary
Iron deficiency and malaria are significant co-morbidities in large portions of the developing world, and both maladies disproportionately affect pregnant women and children. The wisdom of universal iron supplementation campaigns in malaria endemic regions has recently been questioned due to clinical evidence that suggests iron deficiency protects against malaria, and that iron supplementation of women and children may increase the incidence of malaria when given without malaria prophylaxis or access to adequate health care (Nyakeriga et al, 2004; Sazawal et al, 2006; Tielsch et al, 2006; Kabyemela et al, 2008; Senga et al, 2011; Veenemans et al, 2011; Gwamaka et al, 2012; Jonker et al, 2012; Esan et al, 2013; Zlotkin et al, 2013).
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