Iron-deficiency anaemia and its response to oral iron: report of a study in rural Gambian children treated at home by their mothers

Abstract

Haematological and iron parameters, measured in 907 children aged from 6 months to 5 years in rural Gambia at the start of the rainy season, differed from those in American reference populations as follows: mean haemoglobin levels were much lower at ages 1 and 2 years and mean levels of mean corpuscular volume (MCV) were lower at all ages (at age 1 year mean haemoglobin was 11.2 g/dl and mean MCV 68.2 fl); in a sample of 249 children randomly selected from the whole study population, mean serum iron levels were similar but mean transferrin saturation and mean serum ferritin levels were lower, especially at ages 1-3 years (at age 1 year mean serum iron was 11.1 mumol/l, mean transferrin saturation 16.9%, and geometric mean serum ferritin 8.8 ng/ml. A total of 213 children (23%) whose haemoglobin and mean corpuscular volume were both less than the 3rd percentile of the reference population received oral iron or placebo from their mothers during the rainy season when malaria transmission is maximal. Mean levels of haemoglobin, mean corpuscular volume, serum iron, transferrin saturation and serum ferritin rose in the iron-treated group and fell in the placebo group at all ages, except under 1 year for serum ferritin, to produce significant differences between the groups by the end of the study. Total iron-binding capacity showed no significant changes during the study. We concluded that oral iron given by the mother during the rainy season can be used to treat iron-deficiency anaemia in Gambian children who would otherwise become more anaemic.

Host haematological factors influencing the transmission of Plasmodium falciparum gametocytes to Anopheles gambiae s.s. mosquitoes

“…We investigated the effect of host haematological and parasitological parameters on the density of gametocytes and their infectivity to mosquitoes. Our in vivo data show that the density of gametocytes correlated with a number of Normal values obtained from * Dacie and Lewis (1975), † Smith et al (1989), ‡ Shaper and Lewis (1971). , significance tested using 2 ; t, significance tested using Students t-test.…”

“…The observation that individuals of blood group B were less infectious to mosquitoes was of borderline significance ( Table 5). Haematological measurements were redefined as abnormal or normal using standard values for each age group ( Dacie & Lewis 1975; Smith et al . 1989 ; Shaper & Lewis 1971); again there were no significant associations with TS ( Table 5), MP or MOB (data not shown).…”

Effects of Daily Iron Supplementation in 2- to 5-Year-Old Children: Systematic Review and Meta-analysis

“…Malaria control was not specifically addressed. However, Smith et al 40 found that treatment with iron increased risk of fever related to malarial parasitemia (fever and $10 positive fields per 100 high power fields: 12/700 health worker visits in iron supplemented vs 2/682 in controls, P , .025; fever and $50 positive fields per 100 high power fields: 9/700 health worker visits in iron supplemented vs 0/682 in controls, P , .01). Children with malaria were screened for malaria 2 weeks before the end of the study and referred if clinical malaria was detected.…”

Anemia Offers Stronger Protection Than Sickle Cell Trait Against the Erythrocytic Stage of Falciparum Malaria and This Protection Is Reversed by Iron Supplementation

“…Multiple studies have raised concern that iron supplementation in malaria-endemic areas may put people at increased risk of acquiring malaria (Murray et al, 1978, Murray et al, 1975, Oppenheimer et al, 1986, Smith et al, 1989, Veenemans et al, 2011). Most importantly, a large childhood nutritional supplementation study in Zanzibar was halted due to increased morbidity and mortality in children receiving iron (Sazawal et al, 2006).…”