e-Library of Evidence for Nutrition Actions (eLENA)


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Daily iron supplementation in children 24–59 months of age in malaria-endemic areas

Intervention | Last updated: 9 August 2023


Approximately 300 million children globally had anaemia in 2011. The most common cause of anaemia is thought to be deficiency in iron, an essential nutrient for development and cell growth in the immune and neural systems, as well as in regulation of energy metabolism and exercise. Iron deficiency can result from inadequate intake or absorption of dietary iron, increased need during periods of growth, and blood loss from helminth* infection.

Children are particularly vulnerable to iron deficiency anaemia because of their increased iron requirements in the periods of rapid growth, especially in the first five years of life. Iron deficiency anaemia in children has been linked to increased childhood morbidity and impaired cognitive development and school performance.

Malaria is a leading cause of morbidity and mortality in children in sub-Saharan Africa and is an important contributor to anaemia in other endemic regions, through direct rupture of infected red blood cells, the body’s immune destruction of both parasitized and uninfected red blood cells, and temporary dysfunction of the bone marrow.

Results of 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.

Evidence has shown that daily iron supplementation in children 24-59 months of age is associated with increased ferritin (an indicator of iron stores and a biomarker for iron deficiency) and haemoglobin** levels.

* Helminths are a group of parasites commonly referred to as worms and include schistosomes and soil-transmitted helminths
** Haemoglobin is a molecule that allows red blood cells to transport oxygen throughout the body

WHO Recommendations


Daily iron supplementation is recommended as a public health intervention in preschool-age children aged 24–59 months, living in settings where the prevalence of anaemia in infants and young children is 40% or higher, for increasing haemoglobin concentrations and improving iron status.

In malaria–endemic areas, the provision of iron supplementation in infants and children should be done in conjunction with public health measures to prevent, diagnose and treat malaria.



Evidence


Systematic reviews used to develop the guidelines


Oral iron supplements for children in malaria-endemic areas

Neuberger A, Okebe J, Yahav D, Paul M. Cochrane Database of Systematic Reviews. 2016; Issue 2. Art. No.: CD006589.

Summary of this review Alternate Text

Effects of daily iron supplementation in 2- to 5-year-old children: systematic review and meta-analysis

Thompson J, Biggs BA, Pasricha SR. Pediatrics. 2013;131(4):739-53.


Related systematic reviews


Effect of iron supplementation on haemoglobin response in children: systematic review of randomised controlled trials

Gera T, Sachdev HPS, Nestel P, Sachdev SS. Journal of Pediatric Gastroenterology & Nutrition. 2007; 44:468–486.


Cost-effectiveness Learn More Alternate Text


Relevant cost-effectiveness analyses have not yet been identified.