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[ABUJA] Iron supplements should not be withheld from children in regions at a high risk of malaria — and the WHO was too hasty in changing its guidelines on this, say the authors of a new study.

Until 2007, the WHO recommended that children be given iron supplements to prevent iron deficiency and anaemia. But a large Zanzibar-based trial found that iron supplementation may be associated with increased risk of hospitalisation — predominantly because of malaria and infectious disease — and mortality, leading the WHO to change its guidelines.

Previously it was thought that iron supplements could promote the growth of malaria parasites in the blood.

Researchers from the non-profit Cochrane Collaboration analysed data from 68 different trials involving a total of 42,981 children. They found that malaria-related outcomes and deaths were reported in only 16 and 11 trials, respectively.

They conclude that iron supplements do not increase the risk of malaria if regular surveillance and treatment services are provided, and say that the WHO relied too heavily on a single trial in changing its recommendations.

Lead researcher Juliana Ojukwu of the department of paediatrics at Ebonyi State University, Nigeria, told SciDev.Net that the WHO rushed into judgement.

"Our conclusion is that once the child needs iron supplements, they should not be denied them — even if they are living in areas where malaria is prevalent. Iron is important for growth and development, and maintaining a healthy immune system."

When asked whether the WHO's caution was justified until proper malaria surveillance infrastructure is in place, Ojukwu explained: "Whether you give a child iron or not, there is that need for a child living in malaria-endemic areas to be surveyed. We need to put an infrastructure in place to survey children either at baseline or six months for malaria parasites whether you give them iron or not."

"In our opinion, it doesn't seem justified to withhold iron supplements from children if the surveillance infrastructure does not exist. Even if we don't have any surveillance infrastructure in place, based on the overall evidence from our review, iron should not be withheld from children."

Bayo Fatunmbi of the WHO Global Malaria Programme told SciDev.Net that the Cochrane research will be carefully considered, and that the WHO will change its guidelines back if the evidence is strong enough.

"We will definitely take this research seriously — and if the evidence warrants it, we will respond promptly and appropriately," Fatunmbi says.

Link to summary in Cochrane Reviews

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