Science - February 15, 2011

Malaria strikes when iron is present

Food supplements containing iron may increase the chances of severe attacks of Malaria in young children who are suffering from iron deficiency. This is the conclusion from research carried out by Jacobien Veenemans, who will defend her thesis on 18 February under the Cell Biology and Immunology Group. Her findings contradict the guidelines of the World Health Organization (WHO) concerning iron supplements. 'This recommendation may cause harm', the PhD candidate contends.

Veenemans, trained as a doctor, carried out her research work in a poor region in the Tanzanian countryside. Two thirds of the young children there suffer from anaemia, often caused by iron deficiency. As this affects their health, WHO has recommended that this group be given food supplements with iron and other nutrients. An earlier study carried out on the island of Pemba, off the coast of Tanzania, had in fact cast doubts as to the safety of this move.
Plasmodium parasite
During her study, Veenemans concentrated on children between six months and six years old, a group highly vulnerable to Malaria. The immune systems in these children are not yet responsive enough to keep the disease - caused by the Plasmodium parasite - in check. Veenemans prescribed a mix of vitamins and minerals including iron or a placebo daily to 612 children. The children who had iron deficiency at the start of the study suffered in particular from more frequent and more severe attacks of Malaria as a result of the supplements. Veenemans did not encounter these effects in children who did not have iron deficiency.  She therefore suspects that giving iron to those who are lacking in it can lead to extra iron intake in the intestines, followed by an increase of iron in the blood stream. This also benefits the Plasmodium parasite: extra iron means more food.
Health posts
Will this bring about more deaths? Veenemans' study cannot ascertain this. In the region where she worked, sufficient medical aid was available. 'For its population, a major spinoff from the research was also the construction of a health post, which continues to function even after the study ended. Whenever we come across children with Malaria, we treat them immediately', added the PhD candidate. 'It all depends on the situation. Children who do not get primary care where they live - which is the case in large parts of Tanzania - are probably very vulnerable.'
Advice
Should WHO now withdraw its advice to supply more food supplements with iron to areas affected by Malaria? 'I believe that some measure of restraint is required. Based on follow-up analyses of the Pemba study, WHO had at that time considered that it could be safe to give these supplements to children with iron deficiency. My research results point in another direction. I think that it is wise to compare all such studies that have been carried out.'

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