Anaemia caused by iron deficiency is widespread in the developing world and is especially common in children younger than 5 years. International guidelines recommend supplementation with iron and folic acid in children younger than age 2 years in areas with a high prevalence of anaemia. However, there is concern that this policy might be harmful in areas of high malaria transmission.

To investigate this, Robert Black (Johns Hopkins University, Baltimore, USA) and colleagues randomly assigned over 24, 000 children aged 1-35 months from Pemba, Zanzibar, to receive iron and folic acid, or iron, folic acid and zinc, or placebo. The iron and folic-acid groups of the trial were stopped early because, during follow-up, the investigators found that those who received iron and folic acid with or without zinc had a 12% higher risk of hospitalisations for severe disease or death than those on placebo. The research team found that only children whose anaemia was associated with iron deficiency benefited from supplementation with iron and folic acid.

Professor Black concludes: "In the presence of an active programme to detect and treat malaria and other infections, iron deficient and anaemic children can benefit from supplementation. However, supplementation of those who are not iron deficient might be harmful. As such, current guidelines for universal supplementation with iron and folic acid should be revised."

In a parallel trial, also published in The Lancet this week, James Tielsch (Johns Hopkins University, Baltimore, USA), Robert Black and colleagues, randomly assigned over 25, 000 children aged 1-36 months in Nepal--an area of low malaria transmission--to receive iron and folic acid, or iron, folic
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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
12-Jan-2006