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THE EFFECTS OF SHORT-TERM IRON SUPPLEMENTATION ON IRON STATUS IN INFANTS IN MALARIA-ENDEMIC AREAS

Iron deficiency and Plasmodium falciparum malaria are the two main causes of anemia in young children in region endemic for this disease. The impact on iron status of prophylactic oral iron supplementation (2 mg/kg/day from two to six months of age) and the duration of this effect were assessed in a group of 832 Tanzanian infants exposed to P. falciparum malaria. Iron parameters and red blood cell indices were assessed at 2, 5, 8, and 12 months of age. Infants who received iron supplements had a significantly lower prevalence of iron deficiency (P < 0.01 at 5 months and P < 0.001 at 8 and 12 months). Red blood cell indices (mean corpuscular volume, mean cell hemoglobin, and mean cell hemoglobin concentration) were increased in children receiving iron supplementation and they did not differ between those protected and unprotected against malaria. The prevalence of ferropenia was similar in children protected against malaria and in those who were not protected and did not receive iron supplements (34.7% versus 37.3% at 12 months of age). We concluded that iron supplementation between the ages of 2–6 months improves iron status at least up to 12 months of age. Malaria infection does not contribute to iron deficiency.

Received May 29, 2003. Accepted for publication February 18, 2004.

Acknowledgments: We are indebted to the parents and guardians of the children involved in the study. We thank the staff of the Ifakara Health Research and Development Centre and the St. Francis Designated District Hospital, Dr. F. Lwilla, and the District Health Management Team for their support in facilitating the study team to carry out the study. We are also grateful to Dr. R. Fernandez and the staff of the Nuclear Medicine Laboratory of the Hospital Clinic for testing the plasma ferritins and to Professor Alan Fleming for his comments on the manuscript.

Financial support: This study was supported by grants from the UNDP/World Bank/World Health Organization Special Program for Research and Training in Tropical Diseases, the Spanish Agency for International Cooperation, and the Fondo de Investigaciones Sanitarias. The Ifakara Health Research and Development Centre and St. Francis Designated District Hospital receive funding from the Swiss Agency for Development and Cooperation and the Government of Tanzania.

Author’s addresses: Clara Menendez, David Schellenberg, Llorenç Quinto, Luisa Alvarez, John J. Aponte, and Pedro L. Alonso, Center for International Health, Hospital Clinic/University of Barcelona, Villarroel 170, E-08036, Barcelona, Spain, Telephone: 34-93-227-5706, Fax: 34-93-451-5272, E-mails: cmenende{at}medicina.ub.es, DMSchellenberg{at}aol.com, llquinto{at}medicina.ub.es, lalvarez{at}clinic.ub.es, Japonte{at}medicina.ub.es, and alonso{at}medicina.ub.es. Elizeus Kahigwa, Ifakara Research and Development Center, Ifakara Tanzania and St. Francis District Designated Hospital, Ifakara, Tanzania. E-mail: ekahigwa{at}yahoo.com.