Oral iron supplements for children in malaria-endemic areas

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Oral iron supplementation or fortification for children living in malaria-endemic countries, in a daily dose of 80% or more of the recommended daily allowance for prevention of anaemia by age, does not cause an excess of clinical malaria. This is probably true both in populations where anaemia is common and those in which anaemia is uncommon. In areas where malaria prevention and management services are unavailable, iron, with or without folic acid, may increase the incidence of malaria. Iron treatment increases haemoglobin levels.

Children in low-resource countries are commonly given iron supplements to prevent or treat anaemia. The Plasmodium parasite that causes malaria requires free iron, which is lacking in iron-deficient persons. Hence the theory that iron deficiency may be protective (“nutritional immunity”) and in countries where malaria is common, it has been suggested that iron supplementation increases the risk of malaria. This review assesses the safety of iron supplementation for children in malaria-endemic areas with respect to malaria, severe malaria, clinic and hospital admissions or deaths and its effects on the prevalence of anaemia and hemoglobin levels.

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