Oral iron supplements for children in malaria-endemic areas


Neuberger A1, Okebe J2, Yahav D3, Paul M4

1. Rambam Health Care Campus and The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Division of Infectious Diseases, Tel Aviv, Israel
2. Medical Research Council Unit, Banjul, Gambia
3. Beilinson Hospital, Rabin Medical Center, Department of Medicine E, Petah Tikva, Israel
4. Rambam Health Care Campus, Division of Infectious Diseases, Haifa, Israel

Neuberger A, Okebe J, Yahav D, Paul M. Oral iron supplements for children in malaria-endemic areas. Cochrane Database of Systematic Reviews 2016, Issue 2. Art. No.: CD006589. DOI: 10.1002/14651858.CD006589.pub4

Access the full-text article here: DOI/10.1002/14651858.CD006589.pub4

Why the review is important

Children living in malarial areas commonly develop anaemia. Long-term anaemia is thought to delay a child's development and make children more likely to get infections. In areas where anaemia is common, health providers may give iron to prevent anaemia, but there is a concern amongst researchers that this may increase the risk of malaria. It is thought that the iron tablets will increase iron levels in the blood, and this will promote the growth of the Plasmodium parasite that causes malaria. We aimed to assess the effects of oral iron supplementation in children living in countries where malaria is common.

Main findings of the review

Cochrane researchers searched the available evidence up to 30 August 2015 and included 35 trials (31,955 children). Iron did not increase the risk of malaria, indicated by fever and the presence of parasites in the blood (high quality evidence). There was no increased risk of death among children treated with iron, although the quality of the evidence for this was low. Among children treated with iron, there was no increased risk of severe malaria (high quality evidence). Although it is hypothesized that iron supplementation might harm children who do not have anaemia living in malarial areas, there is probably no increased risk for malaria in these children (moderate quality evidence). In areas where health services are sufficient to help prevent and treat malaria, giving iron supplements (with or without folic acid) may reduce clinical malaria. In areas where these services are not available, iron supplementation (with or without folic acid) may increase the number of children with clinical malaria (low quality evidence). Overall, iron resulted in fewer anaemic children at follow up, and the end average change in haemoglobin from base line was higher with iron.


Our conclusions are that iron supplementation does not adversely affect children living in malaria-endemic areas. Based on our review, routine iron supplementation should not be withheld from children living in countries where malaria is prevalent and malaria management services are available.