IRON, BUT NOT FOLIC-ACID, COMBINED WITH EFFECTIVE ANTIMALARIAL THERAPY PROMOTES HEMATOLOGICAL RECOVERY IN AFRICAN CHILDREN AFTER ACUTE FALCIPARUM-MALARIA

Whether children with malarial anaemia should receive supplementation with iron or folic acid is uncertain. Therefore, the effects of supple mentary treatment with iron or folic acid, given together with chloroq uine or pyrimethamine-sulfadoxine (Fansidar(R)), has been assessed in 600 Gambian children with uncomplicated falciparum malaria. After one month, haematological recovery was significantly better in the group t reated with Fansidar(R) than in the chloroquine-treated group (differe nce in mean haemoglobin level=0.54 g/dL, P=0.01). Children who receive d iron had a significantly better response than those given placebo (d ifferences in mean haemoglobin level after one month and at dry season follow-up=0.70 g/dL, P=0.006, and 0.81 g/dL, P=0.001, respectively). Iron supplementation was not associated with increased prevalence of m alaria. Supplementation with folic acid did not improve the haematolog ical response but, among children who received Fansidar(R), the treatm ent failure rate was significantly higher among those given folic acid than among those given placebo. Thus, supplementation with iron, but not folic acid, improves haematological recovery without increasing su sceptibility to malaria.