Okebe Joseph U, Yahav Dafna, Shbita Rana, Paul Mical
Medical Research Council Unit, P.O. Box 273, Banjul, Gambia.
Cochrane Database Syst Rev. 2011 Oct 5(10):CD006589. doi: 10.1002/14651858.CD006589.pub3.
Iron-deficiency anaemia is common during childhood. Iron supplementation has been claimed to increase the risk of malaria.
To assess the effect of iron on malaria and deaths.
We searched The Cochrane Library, PUBMED, MEDLINE, LILACS; and trial registry databases, all up to June 2011. We scanned references of included trials.
Individually and cluster randomized controlled trials conducted in hypoendemic to holoendemic malaria regions and including children below 18 years of age. We included trials comparing orally administered iron, iron with antimalarial treatment, or iron with folic acid versus placebo or no treatment. Iron fortification was excluded. Antihelminthics could be administered to either group. Additional micronutrients had to be administered equally to both groups.
The primary outcomes were clinical (symptomatic) malaria, severe malaria, and death. Two authors independently selected the studies and extracted the data. We assessed heterogeneity and conducted subgroup analyses by the presence of anaemia at baseline, age, and malaria endemicity. We assessed risk of bias using domain-based evaluation. We performed a fixed-effect meta-analysis for all outcomes and random-effects meta-analysis for hematological outcomes. We adjusted analyses for cluster randomized trials.
Seventy-one trials (45,353 children) were included. For clinical malaria, no significant difference between iron alone and placebo was detected, (risk ratio (RR) 0.99, 95% confidence intervals (CI) 0.90 to 1.09, 13 trials). The results were similar in the subgroups of non-anaemic children and children below 2 years of age. There was no significant difference in deaths in hyper- and holoendemic areas, risk difference +1.93 per 1000 children (95% CI -1.78 to 5.64, 13 trials, 17,898 children). Iron administered for treatment of anaemia resulted in a larger increase in haemoglobin than iron given for prevention, and the benefit was similar in hyper- or holoendemic and lower endemicity settings. Iron and folic acid supplementation resulted in mixed results for severe malaria. Overall, the risk for clinical malaria was higher with iron or with iron plus folic acid in trials where services did not provide for malaria surveillance and treatment. Iron with antimalarial treatment significantly reduced malaria. Iron supplementation during an acute attack of malaria did not increase the risk for parasitological failure, (RR 0.96, 95% CI 0.74 to 1.24, three trials) or deaths.
AUTHORS' CONCLUSIONS: Iron alone or with antimalaria treatment does not increase the risk of clinical malaria or death when regular malaria surveillance and treatment services are provided. There is no need to screen for anaemia prior to iron supplementation.
缺铁性贫血在儿童时期很常见。有人声称补充铁剂会增加患疟疾的风险。
评估铁对疟疾和死亡的影响。
我们检索了截至2011年6月的考克兰图书馆、PUBMED、MEDLINE、LILACS以及试验注册数据库。我们浏览了纳入试验的参考文献。
在疟疾低度流行至高度流行地区进行的个体和整群随机对照试验，纳入18岁以下儿童。我们纳入了比较口服铁剂、铁剂与抗疟治疗、铁剂与叶酸与安慰剂或不治疗的试验。排除铁强化。两组均可使用抗蠕虫药。额外的微量营养素必须两组同等给予。
主要结局为临床（有症状）疟疾、重症疟疾和死亡。两位作者独立选择研究并提取数据。我们评估了异质性，并按基线贫血情况、年龄和疟疾流行程度进行亚组分析。我们使用基于领域的评估方法评估偏倚风险。我们对所有结局进行固定效应荟萃分析，对血液学结局进行随机效应荟萃分析。我们对整群随机试验的分析进行了调整。
纳入71项试验（45353名儿童）。对于临床疟疾，未检测到单独使用铁剂与安慰剂之间有显著差异（风险比（RR）0.99，95%置信区间（CI）为从0.90至1.09，13项试验）。在非贫血儿童和2岁以下儿童亚组中结果相似。在高度流行和全流行地区，死亡无显著差异，每1000名儿童风险差为+1.93（95%CI为-1.78至5.64，13项试验，17898名儿童）。用于治疗贫血的铁剂比预防性给予的铁剂使血红蛋白升高幅度更大，且在高度流行或全流行以及低度流行地区获益相似。补充铁剂和叶酸对重症疟疾的结果不一。总体而言，在未提供疟疾监测和治疗服务的试验中，使用铁剂或铁剂加叶酸时临床疟疾风险更高。铁剂与抗疟治疗显著降低疟疾。在疟疾急性发作期间补充铁剂不会增加寄生虫学治疗失败风险（RR 0.96，95%CI为0.74至1.24，3项试验）或死亡风险。
当提供常规疟疾监测和治疗服务时，单独使用铁剂或与抗疟治疗联合使用不会增加临床疟疾或死亡风险。在补充铁剂前无需筛查贫血。
