Anemia, Iron Supplementation and Susceptibility to Plasmodium falciparum Malaria

Anemia and malaria constitute major health problems worldwide, especially in tropical countries with low resources (WHO, 2008a, 2008b; Black et al., 2003). Although there are several potential causes of anemia, iron deficiency constitutes approximately half of all cases (WHO, 2008a, 2008b). Other important causal factors include parasitic infections such as malaria or helminth infections, hemoglobinopathies and G6PD deficiency, traumatic childbirth, as well as other nutritional deficiencies (WHO/UNICEF/UNU, 2001). Most severe malaria infections are caused by Plasmodium falciparum, and this remains a leading cause of morbidity and mortality among children in sub-Saharan Africa (WHO, 2008a, 2008b). Malaria causes anemia primarily through haemolysis, the destruction of red blood cells (RBCs), although other factors can be involved, such as long term subclinical malaria infection inducing anemia of inflammation. (Gasim and Adam, 2016). In truth, the relationship between the host iron status and malaria susceptibility is quite complicated. It has been suggested that iron deficiency may offer protection against malaria infection (Gwamaka et al., 2012; Kabyemela et al., 2008; Jonker et al., 2012). Furthermore, it has been documented that providing iron supplements to young children living in a malaria en-demic area who are iron replete may increase the risk of malaria-related hospitalization and mortality (Sazawal et al., 2006), among other studies , suggesting possible increased morbidity following iron supplemen-tation in malaria endemic areas. Subsequently, the WHO now recommends that in malaria endemic regions, iron supplements should only be given where malaria management and preventive measure are available (Neuberger et al., 2016; World Health Organization, 2016). However, a complete understanding of the cellular relationship between iron and malaria susceptibility has been lacking, and iron supple-mentation trials are not possible to conduct without providing appropriate antimalarial countermeasures which could mask results and make interpretations difficult. Furthermore, the degree of protection against malaria infection offered by iron deficiency is not definitively understood. Given its prevalence and health consequences, there remains an important need to address anemia in children in the developing world – in fact this has become one of WHO Global Targets For Nutrition 2025. The current policy of the WHO does not reflect the difficulties of measuring an individual's iron status in the developing world, nor does it provide practical, tangible guidelines for what constitutes adequate antimalarial health services or for how long malaria risk may be elevated following iron administration. Goheen et al. (2016) have recently assessed the magnitude of protection from anemia against …