Malaria control reduces iron deficiency

February 24, 2021

Researchers led by a team at the KEMRI-Wellcome Trust research programme have found that malaria-control may be an effective strategy for reducing the burden of iron deficiency in African children. The analyses led by Prof Sarah Atkinson and former IDeAL PhD student, Dr John Muriuki suggest that interventions that halve the risk of malaria would reduce the burden of iron deficiency by approximately 50% in African children. Malaria is likely to cause iron deficiency by increasing the iron-hormone hepcidin, which blocks iron absorption.

Iron deficiency is an important public health problem for children living in sub-Saharan Africa. It affects approximately half of children and is a leading cause of years lived with disability due to its long-term effects on brain development. Giving iron supplements is the primary intervention to manage iron deficiency in children. However, there are concerns regarding the safety of iron supplements in malaria-endemic countries where it may predispose children to malaria and other infections and be poorly absorbed. This has led to confusion in public health policy and a new strategy for the management of iron deficiency is needed.

The team examined whether malaria itself may be causing iron deficiency. Small studies in Kenya and The Gambia show that iron deficiency increases over the malaria season and interrupting malaria transmission reduces iron deficiency. However, these observational studies are limited by confounding factors and it is not possible to know whether it is malaria that is causing iron deficiency. To determine whether malaria causes iron deficiency, the researchers used sickle cell trait (a genetic mutation that protects against malaria) to proxy malaria exposure. They found that sickle cell trait was associated with protection against iron deficiency in 7453 children living in malaria endemic areas across Africa. In malaria-free areas, sickle cell trait was not associated with iron deficiency in 611 Nairobian children and 3207 African Americans.

These findings have major public health implications for the management of iron deficiency.

They will also be of significant interest to policymakers in shifting thinking away from concern that iron supplements may do harm and towards the benefits of controlling malaria in managing iron deficiency.