OTTAWA, July 20, 2012 - In 2006, World Health Organization (WHO) revised its recommendations on iron supplementation for young children from universal to supplementation targeted at children who are iron-deficient in malaria-endemic areas. This change came after research findings in a high malaria transmission area showed that iron and folic acid supplementation increased the risk of hospitalization and mortality among children who were not iron-deficient. These research findings and the revised guidance caused debate and uncertainty among the scientific, policy and program communities, which resulted in years of inaction that left millions of children at risk of impaired cognitive development and other negative consequences of iron deficiency and anemia.

A number of efforts were initiated to address this, including research to further clarify the mechanism of the negative effects. In the mean time, programs continued to stagnate. In response to this, the Micronutrient Initiative (MI) organized a symposium at the 2011 American Society for Nutrition Annual Meeting which focused on exploring options for addressing iron deficiency and anemia among infants and young children in malaria-endemic areas, now, with safe, effective and feasible interventions that provide iron. Proceedings from this symposium, “Tackling Iron Deficiency and Anemia in Infants and Young Children in Malaria-Endemic Areas: Moving from Controversy towards Guidance for Safe, Effective and Feasible Policies and Programs”, are published as a supplement in the July 2012 issue of Advances in Nutrition: An International Review Journal, guest edited by MI's Director of Technical Services, Dr. Lynnette Neufeld, and Dr. Rafael Flores-Ayala from the U.S. Centers for Disease Control and Prevention. The entire supplement is open access, meaning anyone can access the content online for free.

The first paper in the supplement, authored by Kim Harding, Program Officer (Research) at MI, and Dr. Lynnette Neufeld, “Iron deficiency and anemia control for infants and young children in malaria-endemic areas: a call to action and consensus among the research community” concludes:

“Despite imperfect knowledge on the risks and benefits of providing iron to infants and young children in malaria-endemic areas, the nutrition and malaria research communities must work together to provide country policy and program decision-makers feasible advice that is based on the best available evidence. Findings from current and future research can help improve this advice but, as with most topics in health and nutrition, we must be willing to work with incomplete knowledge and not let it impede the progress of programs that save and improve children´s lives.”

Other articles in the supplement review the relationship between iron and malaria, special considerations for targeting iron supplementation, the safety of providing universal iron through home fortification products, pending research issues, and feasible approaches to move programs forward. The paper on moving programs forward recommends using the following programmatic approaches, in combination, to reduce the risk and maximize the benefits of iron interventions for young children at risk of iron deficiency and malaria:

• Shift from supplements to food-based interventions with lower doses of iron: Using a lifecycle approach, provide young children with the lowest possible adequate dose of iron in or with foods.
• Coordinate iron interventions with malaria control: At the community and/or individual level, iron interventions should be coordinated with key malaria interventions such as intermittent presumptive treatment for infants. Strong and successful global efforts to control malaria are underway around the world.

MI will continue to work in collaboration with the scientific, policy and program communities to encourage the progress of programs that address iron deficiency and anemia among young children with the knowledge at hand, alongside the necessary research to improve the safety and effectiveness of future programs.

Two new WHO guidelines (one on multiple micronutrient powders for children 6 to 23 mo of age and one on intermittent iron supplementation for preschool and school-age children) provide options for iron interventions in conjunction with measures to control malaria. A WHO guideline on iron supplementation for children in malaria-endemic settings is expected to be published soon.

A summary of the symposium proceedings was published in Sight and Life magazine in December 2011.