Conclusions and recommendations of the WHO Consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas.

Iron deficiency and iron-deficiency anemia are common in young children, and there is substantial evidence that iron deficiency has adverse effects on child health and development. Therefore, provision of additional iron to infants and young children who are iron deficient should be a public health priority. Two large trials, coordinated and supported by the World Health Organization (WHO), were conducted in Zanzibar, Tanzania, and in Nepal to evaluate the impact of zinc and/or iron–folic acid supplementation on the mortality and severe morbidity of preschool children [1, 2]. In Zanzibar, an area of stable, perennial, and intense transmission of Plasmodium falciparum malaria, routine iron–folic acid supplements given with or without zinc resulted in an increased rate of severe adverse events in children (morbidity and mortality). A concurrent substudy suggested that the adverse events occurred in supplemented children who were not iron deficient. In Nepal, the trial showed no difference in mortality or the incidence of the common infections between children receiving iron–folic acid with or without zinc, and those who received zinc alone or a placebo. The results from the study in Zanzibar, Tanzania [1], raised the issue of the safety of administering additional iron to infants and young children in areas of malaria endemicity and its public health implications. An Expert Consultation was convened by WHO to examine this issue in Lyon, France, 12–14 June 2006. Specifically, the objectives of the Consultation, which focused on infants and young children in malaria-endemic areas, were to review the scientific evidence on the safety and efficacy of different ways of administering iron to control iron deficiency and iron-deficiency anemia, and to provide guidance on the safest, most feasible, and most effective ways of delivering additional iron to control iron deficiency and anemia in such areas.