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Worries over iron guidelines for children in malaria-afflicted zones
1/19/2006
UN recommendations that infants be systematically given iron and folic acid supplements in populations where there is high incidence of anaemia could be dangerous in zones where malaria is widespread, a study says.
The World Health Organisation (WHO) and UN Children's Fund (Unicef) backed guidelines in 1998 that these supplements be given to children aged under two in areas where anaemia prevalence is strong.
But a paper published online last Saturday by the British journal The Lancet suggests that additional iron and folic acid may be perilous for some infants in countries where malaria is rampant.
Doctors led by Robert Black of Johns Hopkins University in Baltimore, Maryland, recruited more than 24,000 children aged one to thirty five months in Zanzibar, randomly assigning them either iron and folic acid; iron, folic acid and zinc; or a harmless lookalike tablet.
The study was halted after little more than a year when it was realised there was a much higher death rate among those taking iron and folic acid.
Those who took these minerals were 12 per cent likelier to die or need hospital treatment compared with those on the placebo.
The biological explanation for this is unclear. Previous research has linked supplements in malarial zones to higher levels of malarial parasites in the blood, pneumonia and diarrhoea.
The study did find that anaemic children who were specifically found to be iron-deficient benefited from the supplements.
In other words, iron and folic acid should not be administered in malarial areas unless a child has been diagnosed as lacking in iron.
"Supplementation of those who are not iron-deficient might harmful," the study says. "Current guidelines for universal supplementation with iron and folic acid should be revised."
About three-quarters of children aged under five in East Africa are anaemic because of poor nutrition, according to figures cited by Black's team.
Anaemia is a deficiency of red blood cells produced in the bone marrow, caused by lack of iron, vitamin B12 or folic acid. Symptoms of the illness are fatigue, shortness of breath and palpitations.
In another study, also published by The Lancet, doctors in Nepal -- a low-malaria area-found that iron and folic acid supplements did not lead to a rise in the death rate among infants.
AFP
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