Research Needed to Strengthen Science and Programs for the Control of Iron Deficiency and Its Consequences in Young Children

Abstract

The purpose of this article is to highlight critical research needs for the effective prevention and control of iron deficiency and its consequences in children living in low-income countries. Four types of research are highlighted: The first involves scaling up interventions that we know are effective, namely iron supplementation of pregnant women, delayed cord clamping at delivery, immediate and exclusive breast-feeding, and continued exclusive breast-feeding for approximately 6 mo. The second entails evaluation research of alternative interventions that are likely to work, to find the most cost-effective strategies for a given social, economic, and epidemiological context. This research is especially needed to expand the implementation of appropriate complementary feeding interventions. In this area, research needs to be designed to provide causal evidence, to measure cost-effectiveness, and to measure potential effect modifiers. The third is efficacy research to discover promising practices where we lack proven interventions. Examples include how to detect infants younger than 6 mo who are at high risk of iron deficiency, efficacious and safe interventions for those young high-risk infants, and best protocols for the treatment of severe anemia. The fourth includes basic research to elucidate physiological processes and mechanisms underlying the risks and benefits of supplemental iron for children exposed to infectious diseases, especially malaria. Strategic research in all 4 areas will ensure that interventions to control pediatric iron deficiency are integrated into national programs and global initiatives to make pregnancy safer, reduce newborn deaths, and promote child development, health, and survival.

Prevalence and Factors Associated with Anemia Among Children Under 5 Years of Age—Uganda, 2009

“…In the meantime, efforts to integrate iron supplementation with malaria control programs and food-based interventions, which reduce the dose of absorbable iron, have been suggested. 5,44,49 A primary limitation of our study is that we did not obtain data on iron status or other nutritional indices. However, given previous estimates of the attributable fraction of iron deficiency to the global burden of anemia, the influence of iron deficiency in our population likely remains strong.…”

“…41 However, prevention efforts for IDA are not necessarily straightforward in SSA given the interaction between malaria and iron deficiency. [42][43][44] Because of the high attributable fraction of anemia due to iron deficiency, the WHO previously recommended universal iron supplementation "in settings where the prevalence of anemia in children approximately 1 year of age is above 40% or the diet does not include foods fortified with iron, supplements of iron at a dosage of 2 mg/kg of body weight per day should be given to all children between 6 and 23 months of age." 34 However, a number of studies have highlighted the relationship between iron deficiency and sequelae from malaria infection.…”

“…49 Screening for iron deficiency in resource-limited areas is indeed challenging, controversial, and may neither be needed nor practical. 44,[49][50][51] In a hyperendemic malaria region of Tanzania, over 800 infants were randomized to one of four groups-iron supplementation with anti-malarial, iron supplementation with placebo, placebo with anti-malarial, or placebo with placebo. Infants receiving iron had lower rates of severe anemia than their counterparts without an effect on acquisition of malaria, suggesting the protective efficacy of iron supplementation in preventing anemia.…”

The politics of reducing malnutrition: building commitment and accelerating progress

“…Solid guidance now exists to bring rigour to evaluations of nutrition programmes. 52,100,[124][125][126] This guidance is needed to create solid ground for evaluation of the progress, and pathways to progress, of nutrition interventions, 110,127,128 with theory-driven and qualitative evaluations exploring the whys and hows of progress and the extent. 100,129 Analyses of eff ectiveness and operational evaluations of innovations that are introduced into scaled-up programmes, or of the process of scale up of innovative programmes from small-scale pilots to a large scale, are essential, but challenging.…”

Control of iron deficiency anemia in low- and middle-income countries

“…It is no longer necessary to undertake studies reporting iron status, hemoglobin, or anemia as primary endpoints; instead, functional outcomes (ie, in children: cognitive and physical development, growth, and morbidity from infectious diseases; in women: cognitive, psychological, and physical well-being and economic productivity; in pregnancy: maternal and fetal and infant outcomes) should be measured. 67 …”