Volume 71, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Iron deficiency and 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 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 ( < 0.01 at 5 months and < 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.


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  1. Fleming AF, 1981. Iron deficiency in the tropics. Clin Haematol 11 : 365–388. [Google Scholar]
  2. Schellenberg D, Menendez C, Kahigwa E, Font F, Galindo C, Acosta C, Armstrong-Schellenberg J, Aponte JJ, Kimario J, Urassa H, Mshinda H, Tanner M, Alonso P, 1999. African children with malaria in an area of intense Plasmodium falciparum transmission: features on admission to the hospital and risk factors for death. Am J Trop Med Hyg 61 : 431–438. [Google Scholar]
  3. Menendez, C, Kahigwa E, Hirt R, Vounatsou P, Aponte JJ, Font F, Acosta CJ, Schellenberg DS, Galindo C M, Kimario J, Urassa H, Brabin B, Smith TA, Kitua AY, Tanner M, Alonso PL, 1997. Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anemia and malaria in Tanzanian infants. Lancet 350 : 844–850. [Google Scholar]
  4. Provan D, 1999. Mechanisms and management of iron deficiency anemia. Br J Haematol 105 : 19–26. [Google Scholar]
  5. Oski FA, 1993. Current concepts: iron deficiency in infancy and childhood. N Eng J Med 329 : 190–193. [Google Scholar]
  6. Brabin B, 1992. Fetal anemia in malarious areas: its causes and significance. Ann Trop Paediat 12 : 303–310. [Google Scholar]
  7. Stoltzfus R, Dreyfuss ML, 1998. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Washington, DC: INACG/WHO/UNICEF, ILSI Press.
  8. Bojang KA, Palmer A, Van Hensbroek MB, Banya WAS, Greenwood BM, 1997. Management of severe malarial anemia in Gambian children. Trans R Soc Trop Med Hyg 91 : 557–561. [Google Scholar]
  9. Van Hensbroek MB, Morris-Jones S, Meisner S, Jaffar S, Bayo L, Dackour R, Phillips C, Greenwood BM, 1995. Iron, but not folic acid, combined with effective antimalarial therapy promotes haematological recovery in African children after acute falciparum malaria. Trans R Soc Trop Med Hyg 89 : 672–676. [Google Scholar]
  10. Willcox MC, Bjorkman A, Brohult J, 1985. The effect of persistent malarial infection on haemoglobin A2 levels in Liberian children. Trans R Soc Trop Med Hyg 79 : 242–245. [Google Scholar]
  11. Molyneux MES, Looareesuwan IS, Menzies SL, Grainger SL, Phillips RE, Wattanagoon Y, Thompson RP, Warrell DA, 1989. Reduced hepatic blood flow and intestinal malabsorption in severe falciparum malaria. Am J Trop Med Hyg 40 : 470–476. [Google Scholar]
  12. Filteau SM, Tomkins AM, 1994. Micronutrients and tropical infections. Trans R Soc Trop Med Hyg 88 : 1–3. [Google Scholar]
  13. Abdalla SH, 1990. Iron and folate status in Gambian children with malaria. Ann Trop Paediat 10 : 265–272. [Google Scholar]
  14. Weinberg ED, 1978. Iron and infection. Microbiol Rev 42 : 45–66. [Google Scholar]
  15. Smith T, Charlwood JD, Kihonda J, Mwankusye S, Billingsley P, Muwissen J, Lyimo E, Takken W, Teuscher T, Tanner M, 1993. Absence of seasonal variation in malaria parasitaemia in an area of intense seasonal transmission. Acta Trop 54 : 55–72. [Google Scholar]
  16. Schellenberg D, Aponte J, Kahigwa E, Mshinda H, Tanner M, Menendez C, Alonso PL, 2003. The incidence of clinical malaria detected by active case detection in children in Ifakara, southern Tanzania. Trans R Soc Trop Med Hyg 97 : 1–8. [Google Scholar]
  17. Gascon J, Vargas M, Schellenberg D, Urassa H, Casals C, Ka-higwa E, Aponte JJ, Mshinda H, Vila J, 2000. Diarrhea in children under 5 years of age from Ifakara, Tanzania: a case-control study. J Clin Microbiol 38 : 4459–4462. [Google Scholar]
  18. Alonso PL, Smith T, Armstrong Schellenberg JRM, Masanja H, Mwankusye S, Urassa H, Bastos de Azevedo I, Chongela J, Kobero S, Menendez C, Hurt N, Thomas MC, Lyimo E, Weiss N, Hayes R, Kitua A, Lopez MC, Kilama WC, Teuscher T, Tanner M, 1994. Randomised trial of efficacy of SPf66 vaccine against Plasmodium falciparum malaria in children in southern Tanzania. Lancet 344 : 1175–1181. [Google Scholar]
  19. Meites S, 1989. Reference (normal) values. Meites S, ed. Pediatric Clinical Chemistry. Third edition. Washington, DC: Amercian Association for Clinical Chemistry Press, 119–120.
  20. Dacie JV, Lewis SM, 1995. Reference ranges and normal values. Dacie JV, Lewis SM, eds. Practical Haematology. Eighth edition. Edinburgh: Churchill Livingstone, 17.
  21. Das BS, Thurnham DI, Das DB, 1997. Influence of malaria on markers of iron status in children: implications for interpreting iron status in malaria-endemic communities. Br J Nutr 78 : 751–760. [Google Scholar]
  22. Ayatse JO, Ekanem EE, 1994. Plasmodium falciparum malaria: its effects on some haematological parameters in normal and sickle cell Nigerian children. Trop Med Parasitol 45 : 219–222. [Google Scholar]
  23. Ferguson BJ, Skikne BS, Simpson KM, Baynes RD, Cook JD, 1991. Serum transferrin receptor distinguishes the anemia of chronic disease from iron deficiency anemia. J Lab Clin Med 119 : 385–390. [Google Scholar]
  24. Menendez C, Quinto LL, Kahigwa E, Alvarez L, Fernandez R, Gimenez N, Schellenberg D, Tanner M, Alonso PL, 2001. Malaria infection increases soluble transferrin receptors in Tanzanian infants. Am J Trop Med Hyg 65 : 138–142. [Google Scholar]

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  • Received : 29 May 2003
  • Accepted : 18 Feb 2004

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