Targeted Provision of Oral Iron: The Evolution of a Practical Screening Option

Around one-quarter of the world’s children suffer from iron deficiency anemia, and many of them live in malaria-endemic areas. However, there is evidence that iron supplements can increase risk of severe malaria morbidity. The dilemma is how to move forward with interventions to prevent iron deficiency and its consequences in young children, using strategies that minimize risks of malaria and related infections. Screening for iron deficiency is problematic for several reasons. Two complementary strategies are suggested for moving forward with interventions to prevent iron deficiency in children exposed to malaria. The first is to reduce exposure to iron in the form of supplements by: adopting a lifecycle approach to pediatric iron deficiency beginning in utero, using the lowest adequate dose, and giving iron in or with foods. The second is to coordinate iron interventions with malaria control efforts. To stop all iron interventions in malaria-endemic areas is an unreasonable policy option. While research findings continue to increase our understanding, there are also programmatic ways forward with the knowledge at hand.

Section: Why the Recommended Solution Of Screening Is Problematicmentioning

confidence: 99%

Iron and Malaria Interactions: Programmatic Ways Forward

Stoltzfus

2012

“…This symposium revealed ambivalence on this matter. Crowley et al (6) were asked to summarize the current prospects for field-friendly methods for such screening, yet other papers implicitly concluded that screening is not really a practical option because a) it would be too costly and complicated to administer within the sorts of health systems where the need is greatest and b) by definition, screening implies treatment as opposed to prevention and may leave millions of children vulnerable to the debilitating effects of ID.…”

Section: Clinical Science and Epidemiologymentioning

confidence: 99%

“…A decade ago, malaria dipsticks were newly on the market, yet WHO recently evaluated no fewer than 41 brands, indicating the pace at which technological developments can occur. In the accompanying paper, Crowley et al (6) discuss the current state-of-play regarding field assessment of tools for ID. Their paper focuses mostly on field-friendly transdermal methods for assessing hemoglobin because no other methods are yet available for testing.…”

Section: Technological Developmentsmentioning

confidence: 99%

Iron and Malaria Interactions: Research Needs From Basic Science to Global Policy

Prentice

Cox

2012

The resurgence in interest and concern regarding the potentially malign interactions between iron administration and malaria infections, especially in young children and pregnant women, has generated a research agenda that is both broad and deep. This paper highlights some of the key questions under 5 headings: basic science; clinical science and epidemiology; technological developments; country level planning; and global policy. At a time of unparalleled progress in basic science, which is illuminating the mechanisms by which iron interacts with infectious organisms, it is concluded that there are good medium-term prospects for achieving policy breakthroughs based on a secure foundation of disease-nutrient interactions. However, it is also stressed that there is much that can be done in the interim, especially in relation to health systems and implementation research that can empower systems to integrate iron interventions with programs for malaria prevention, surveillance, and treatment.

“…Thus, strategies to increase iron intake during this period are essential to avoid the deleterious effects of iron deficiency and iron-deficiency anemia on behavioral development and other outcomes. The question is whether it is better to take a targeted approach by providing iron only to those who have already become iron deficient, potentially avoiding deleterious effects of iron on those who are iron replete (2), or to provide iron to all children within a certain age range (“universal” or “blanket” provision) regardless of their iron status.…”

Section: Introductionmentioning

confidence: 99%

Safety of Universal Provision of Iron through Home Fortification of Complementary Foods in Malaria-Endemic Areas

Dewey

Baldiviez

2012

Home fortification of complementary foods with iron and other micronutrients is a low-cost strategy for filling nutrient gaps in the diets of infants and young children, but there has been uncertainty about the safety of universal provision of iron via home fortification in malaria-endemic areas. Based on the current understanding of the potential mechanisms of adverse effects of iron, the risk can probably be minimized by using the lowest possible efficacious dose of iron, preferably delivered in small amounts throughout the day with food, to minimize spikes in plasma nontransferrin-bound iron and large amounts of unabsorbed iron in the gastrointestinal tract. Results from 6 home fortification studies in malaria-endemic areas showed no increased risk of morbidity (including malaria), but these studies were not powered to rule out a modest increase in the risk of severe adverse events. At present, the safest option is to implement home fortification in the context of comprehensive malaria control strategies, as recommended in recent WHO guidelines.