Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
Adv Nutr. 2012 Jul 1;3(4):560-9. doi: 10.3945/an.111.001149.
Universal oral iron supplementation, undertaken according to 1998 WHO guidelines, produced adverse consequences among some children in malaria-endemic areas. Prompted by the Pemba trial, which revealed excessive hospitalizations and deaths, WHO advised that iron supplementation in such regions be accompanied by previous screening for iron deficiency. This agenda, however, poses issues of cost, benefit, acceptability, technical feasibility, and reliability of such screening. The cost of equipment and personnel is balanced against savings from iron supplements spared and treatment for morbidity averted. Costs aside, the most efficacious acceptable screening approach for avoiding hospitalization and deaths must be fielded. Screening before supplementation can be used to assess hematological, iron, and possible inflammatory status to differentiate the source of decreased hemoglobin concentration. Iron deficiency has often been inferred from hematological status markers. The need for extraction of blood, albeit capillary in origin, and high assay costs limit the use of validated methods in screening. Noninvasive methods, i.e., not requiring the extraction of blood, provide the most acceptable and potentially least expensive approach for determining hematological or iron status. Although a noninvasive technique for iron and inflammatory status would be the ideal, it is unattained. Field-friendly, skin-probe hemoglobin devices, derived from instruments for clinical settings, are being developed and tested for eventual rollout in malarial areas. Given a firm grounding for the theoretical requirements needed to advance the screening agenda, evaluation and monitoring of the performance of screening devices can proceed hand in hand.
根据 1998 年世界卫生组织（WHO）指南，在疟疾流行地区普遍进行口服补铁，这对一些儿童产生了不良后果。彭巴试验（Pemba trial）揭示了补铁导致住院和死亡人数过多，因此，世界卫生组织建议，在这些地区进行补铁时应先进行缺铁筛查。然而，该方案在成本、效益、可接受性、技术可行性和筛查的可靠性方面存在问题。设备和人员成本与节省下来的铁补充剂以及避免发病的治疗费用相平衡。撇开 成本因素，必须采用最有效的可接受的筛查方法来避免住院和死亡。在补充铁之前进行筛查可以评估血液学、铁和可能的炎症状况，以区分血红蛋白浓度降低的原因。缺铁通常是从血液学状态标志物推断出来的。需要提取血液，尽管来源是毛细血管，但检测费用高昂，限制了验证方法在筛查中的应用。非侵入性方法，即不需要提取血液，为确定血液学或铁状态提供了最可接受和潜在最便宜的方法。虽然能够同时确定铁和炎症状态的非侵入性技术是理想的，但目前还无法实现。正在开发和测试源自临床仪器的、适用于现场的、皮肤探头式血红蛋白设备，最终将在疟疾地区推出。鉴于为推进筛查计划而需要的理论要求有了坚实的基础，可以同时进行筛查设备性能的评估和监测。
