The effect of timing of iron supplementation on iron absorption and haemoglobin in post-malaria anaemia: a longitudinal stable isotope study in Malawian toddlersReportar como inadecuado

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Malaria Journal

, 13:397

First Online: 10 October 2014Received: 07 August 2014Accepted: 02 October 2014


BackgroundIn sub-Saharan Africa, children with Plasmodium falciparum malaria and anaemia are often given iron supplementation at the time of malaria treatment. Inflammation during and after malaria may decrease iron absorption, thus, absorption might be improved if the start of supplementation is delayed. The study objective was to measure iron absorption from iron supplements started immediately or delayed by two weeks after completion of therapy against uncomplicated P. falciparum malaria.

MethodsMalawian toddlers n = 48; age 12–24 months were alternatively assigned to two groups according to their appearance at the health centre: group A was provided iron supplements 30 mg Fe daily as a FeSO4-containing syrup for eight weeks starting immediately after malarial treatment; group B was given the iron after a two-week delay. Iron absorption from the syrup was measured on the first day of iron supplementation, and after two and eight weeks in both groups. Haemoglobin Hb, iron status and inflammation were assessed every two weeks. Fractional iron absorption at each time point and cumulative absorption was quantified by measuring erythrocyte incorporation of Fe and compared using mixed models.

ResultsComparing group A and B, geometric mean iron absorption did not differ on the first day of supplementation 9.0% vs. 11.4%, P = 0.213 and cumulative iron absorption from the three time points did not differ 6.0% vs. 7.2%, P = 0.124. Hb concentration increased in both groups two weeks after malaria treatment P < 0.001 and did not differ after eight weeks of supplementation P = 0.542.

ConclusionsIn anaemic toddlers after uncomplicated malaria, a two-week delay in starting iron supplementation did not significantly increase iron absorption or Hb concentration. Iron absorption is sufficiently high in the immediate post-malaria period to warrant supplementation. These findings suggest there is no need to change the current practice of immediate iron supplementation in this setting.

Trial registrationThis trial was registered at Pan African Clinical Trials Registry as PACTR2010050002141682.

KeywordsAnaemia Iron supplementation Toddlers Malaria Plasmodium falciparum Stable iron isotope Haemoglobin Malawi Inflammation AbbreviationsAGPα1-acid glycoprotein

CRPC-reactive protein


PFPlasma ferritin.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-13-397 contains supplementary material, which is available to authorized users.

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Autor: Dominik Glinz - Moses Kamiyango - Kamija S Phiri - Francis Munthali - Christophe Zeder - Michael B Zimmermann - Richard F


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