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Clin Infect Dis. 2019 May 17;68(11):1807-1814. doi: 10.1093/cid/ciy791.

Iron Status and Associated Malaria Risk Among African Children.

Author information

1
KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
2
Wellcome Centre for Human Genetics, Nuffield Department of Medicine, University of Oxford.
3
London School of Hygiene and Tropical Medicine, United Kingdom.
4
Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
5
Department of Clinical Biochemistry, Oxford University Hospitals.
6
Centre for Clinical Vaccinology and Tropical Medicine and the Jenner Institute Laboratories, University of Oxford.
7
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford.
8
Department of Medicine, Imperial College, London.
9
Department of Paediatrics, University of Oxford, United Kingdom.

Abstract

BACKGROUND:

It remains unclear whether improving iron status increases malaria risk, and few studies have looked at the effect of host iron status on subsequent malaria infection. We therefore aimed to determine whether a child's iron status influences their subsequent risk of malaria infection in sub-Saharan Africa.

METHODS:

We assayed iron and inflammatory biomarkers from community-based cohorts of 1309 Kenyan and 1374 Ugandan children aged 0-7 years and conducted prospective surveillance for episodes of malaria. Poisson regression models were fitted to determine the effect of iron status on the incidence rate ratio (IRR) of malaria using longitudinal data covering a period of 6 months. Models were adjusted for age, sex, parasitemia, inflammation, and study site.

RESULTS:

At baseline, the prevalence of iron deficiency (ID) was 36.9% and 34.6% in Kenyan and Ugandan children, respectively. ID anemia (IDA) affected 23.6% of Kenyan and 17.6% of Ugandan children. Malaria risk was lower in children with ID (IRR, 0.7; 95% confidence interval [CI], 0.6, 0.8; P < .001) and IDA (IRR, 0.7; 95% CI, 0.6, 0.9; P = .006). Low transferrin saturation (<10%) was similarly associated with lower malaria risk (IRR, 0.8; 95% CI, 0.6, 0.9; P = .016). However, variation in hepcidin, soluble transferrin receptors (sTfR), and hemoglobin/anemia was not associated with altered malaria risk.

CONCLUSIONS:

ID appears to protect against malaria infection in African children when defined using ferritin and transferrin saturation, but not when defined by hepcidin, sTfR, or hemoglobin. Additional research is required to determine causality.

CLINICAL TRIALS REGISTRATION:

ISRCTN32849447.

KEYWORDS:

African children; iron deficiency; iron status; malaria risk

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