Comparison of iron status 28 d after provision of antimalarial treatment with iron therapy compared with antimalarial treatment alone in Ugandan children with severe malaria.
Study Goal
The researchers aimed to compare iron and inflammatory markers in children with severe malarial anemia (SMA), cerebral malaria (CM), and community children (CC), and assess the effects of iron supplementation during antimalarial treatment.
Results Summary
Children with CM and SMA had higher inflammation markers at baseline. Iron supplementation did not significantly affect hemoglobin or ZPP levels but increased ferritin and hepcidin levels at day 28 compared to no iron.
Population
Children with severe malarial anemia (SMA), cerebral malaria (CM), and community children (CC) in Uganda.
Effective Dosage
Not specified
Duration
28 days
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
iron supplementation | no change | hemoglobin | children with CM or SMA and iron-deficient community children | 115 compared with 113 g/L | had similar mean values | #1 |
iron supplementation | no change | zinc protoporphyrin (ZPP) | children with CM or SMA and iron-deficient community children | 124 compared with 124 μmol/mol heme | had similar mean values | #2 |
iron supplementation | decrease | ferritin | children with CM or SMA and iron-deficient community children | 101.0 μg/L compared with 152.9 μg/L | had lower median | #3 |
iron supplementation | decrease | hepcidin | children with CM or SMA and iron-deficient community children | 45.8 ng/mL compared with 83.1 ng/mL | had lower median | #4 |
- | increase | C-reactive protein | children with CM and SMA | - | had greater values | #5 |
- | increase | ferritin | children with CM and SMA | - | had greater values | #6 |
- | increase | hepcidin | children with CM and SMA | - | had greater values | #7 |
BACKGROUND: The provision of iron with antimalarial treatment is the standard of care for concurrent iron deficiency and malaria. However, iron that is given during a malaria episode may not be well absorbed or used, particularly in children with severe malaria and profound inflammation. OBJECTIVES: We aimed to 1) determine baseline values of iron and inflammatory markers in children with severe malarial anemia (SMA), children with cerebral malaria (CM), and community children (CC) and 2) compare markers in iron-deficient children in each group who received 28 d of iron supplementation during antimalarial treatment with those in children who did not receive iron during treatment.. DESIGN: Seventy-nine children with CM, 77 children with SMA, and 83 CC who presented to Mulago Hospital, Kampala, Uganda, were enrolled in a 28-d iron-therapy study. Children with malaria received antimalarial treatment. All children with CM or SMA, as well as 35 CC, had zinc protoporphyrin (ZPP) concentrations ≥80 μmol/mol heme and were randomly assigned to receive a 28-d course of iron or no iron. We compared iron markers at day 0 among study groups (CM, SMA, and CC groups) and at day 28 between children in each group who were randomly assigned to receive iron or to not receive iron. RESULTS: At day 0, children with CM and SMA had greater values of C-reactive protein, ferritin, and hepcidin than those of CC. At day 28, interactions between study and treatment group were NS. Children in the no-iron compared with iron groups had similar mean values for hemoglobin (115 compared with 113 g/L, respectively; P = 0.73) and ZPP (124 compared with 124 μmol/mol heme, respectively; P = 0.96) but had lower median ferritin [101.0 μg/L (95% CI: 84.2, 121.0 μg/L) compared with 152.9 μg/L (128.8, 181.6 μg/L), respectively; P ≤ 0.001] and hepcidin [45.8 ng/mL (36.8, 56.9 ng/mL) compared with 83.1 ng/mL (67.6, 102.2 ng/mL), respectively; P < 0.011]. CONCLUSIONS: Severe inflammation is a characterization of children with CM and SMA. The withholding of iron from children with severe malaria is associated with lower ferritin and hepcidin at day 28 but not a lower hemoglobin concentration. This trial was registered at clinicaltrials.gov as NCT01093989.