e-Library of Evidence for Nutrition Actions (eLENA)

Intermittent iron supplementation in preschool and school-age children in malaria-endemic areas

It is estimated that worldwide, 600 million preschool and school-age children are anaemic, and it is assumed that at least half of these cases are attributable to iron deficiency. Children are particularly vulnerable to iron deficiency anaemia because of their increased iron requirements in the periods of rapid growth, especially in the first 5 years of life. Iron deficiency anaemia in children has been linked to increased childhood morbidity and impaired cognitive development and school performance.

Some studies in young children have suggested that iron supplementation may increase the risk of malaria and death in children living in malaria-endemic regions. However, recent evidence suggests that iron supplementation does not adversely affect children when regular malaria surveillance and treatment services are provided.

Supplementation with iron once, twice or three times per week on non-consecutive days has been proposed as an effective and safe way to increase children's iron intake. These intermittent regimens may lead to fewer side effects than the daily regimen and increase adherence to supplementation.

WHO recommendations

In settings where the prevalence of anaemia in preschool (24–59 months) or school-age (5–12 years) children is 20% or higher, WHO recommends the intermittent use of iron supplements as a public health intervention to improve iron status and reduce the risk of anaemia among children.

In malaria-endemic areas, the provision of iron supplements should be implemented in conjunction with measures to prevent, diagnose and treat malaria.


Additional information, including a suggested scheme for supplementation, can be found in the guidance summary, and in the guideline under 'WHO documents' below.

WHO documents

GRC-approved guidelines


Systematic reviews used to develop the guidelines
Related Cochrane reviews
Other related systematic reviews
Clinical trials