Iron Supplementation in the Clinical Management of Malarial Anaemia: A Systematic Review

Emily Whitaker*
Brighton & Sussex Medical School*
Iron supplementation has been found to increase the risk of malaria in areas where suitable malaria prevention programmes are not in place. The WHO now recommends children at high risk of anaemia in malaria endemic countries can receive iron supplements alongside effective malaria prevention programmes. The safety and efficacy of iron as supportive treatment during an acute malaria episode is unknown. Therefore, we carried out a systematic review in order to determine the effect of iron supplementation in the management of diagnosed childhood malarial anaemia with the aim to inform policy makers for future interventions.
Databases searched for this review were EMBASE, CINAHL, MEDLINE, The Cochrane Library and Global Health database. A manual search of Google Scholar was conducted and reference lists of included papers were scanned. We used as selection criteria the use of iron supplementation in treatment of children <18 years of age that were diagnosed with malaria. Any study examining the effectiveness or safety of iron in the management of malarial anaemia was included. Studies where iron used as prevention of anaemia or in children who were not diagnosed with malaria were excluded. The outcomes examined were haematological, parasitological and clinical outcomes. Risk of bias was assessed using SIGN and GRADE criteria.
Eight trials fulfilled the inclusion criteria. Iron supplementation did not increase the risk of morbidity or mortality with adequate supervision following administration (five studies). Two papers did not examine safety of iron treatment and one study found iron significantly increased the risk of morbidity in children. Two other studies suggested iron is not an effective treatment for malarial anaemia. Two trials found iron could be effective depending on the way it was administered. Four trials found iron was effective in management of childhood malarial anaemia.
The heterogeneity and small amount of studies that fulfilled our systematic review hypothesis have meant no clear recommendations can be made with current data available. However, the studies included in this systematic review lightly suggest that iron could be a safe and effective option during the acute treatment of malarial anaemia. Larger and more standardised studies are needed to support a change in current policy regarding iron therapy for malarial anaemia.
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