Abstract
High levels of storage iron may increase malaria susceptibility. This risk has not been investigated in semi-immune adolescents. We investigated whether baseline iron status of non-pregnant adolescent girls living in a high malaria transmission area in Burkina Faso affected malaria risk during the following rainy season. For this prospective study, we analysed data from an interim safety survey, conducted six months into a randomised iron supplementation trial. We used logistic regression to model the risk of P. falciparum infection prevalence by microscopy, the pre-specified interim safety outcome, in relation to iron status, nutritional indicators and menarche assessed at recruitment. The interim survey was attended by 1223 (82%) of 1486 eligible participants, 1084 (89%) of whom were <20 years at baseline and 242 (22%) were pre-menarcheal. At baseline, prevalence of low body iron stores was 10%. At follow-up, 38% of adolescents had predominantly asymptomatic malaria parasitaemias, with no difference by menarcheal status. Higher body iron stores at baseline predicted an increased malaria risk in the following rainy season (OR 1.18 (95% CI 1.05, 1.34, p = 0.007) after adjusting for bed net use, age, menarche, and body mass index. We conclude that routine iron supplementation should not be recommended without prior effective malaria control.
Highlights
Iron deficiency (ID) is a lack of mobilisable iron stores with a compromised supply of iron to tissues [1]
The aim of this paper was to examine the effect of adolescent iron status on malaria risk in a high transmission setting in Burkina Faso, one of 21 countries accounting for 85% of global malaria deaths in 2018 [24]
We reported no reduction in iron deficiency by trial arm in the NP cohort with weekly iron supplementation [7]
Summary
Iron deficiency (ID) is a lack of mobilisable iron stores with a compromised supply of iron to tissues [1]. Current guidelines, where anaemia prevalence is >20%, recommend intermittent oral weekly iron and folic acid (IFA) (60 mg iron and 2.8 mg FA) for a period of three months, withdrawal for three months, recommencement [4]. National government malaria control activities are based on diagnosis and treatment of suspected cases, free long lasting insecticidal bed net (LLIN) distribution, and intermittent preventive treatment for pregnant women. NP women aged 15–24 years, less than 40% of whom were literate [13], were recruited to receive either weekly ferrous gluconate (60 mg) with folic acid (2.8 mg) as intervention or folic acid alone as the control, following the WHO guidelines updated in 2016 [26].
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