THE EFFECT OF ORAL IRON THERAPY DURING TREATMENT FOR PLASMODIUM-FALCIPARUM MALARIA WITH SULFADOXINE-PYRIMETHAMINE ON MALAWIAN CHILDREN UNDER 5 YEARS OF AGE

In sub-Saharan countries, although malaria and malaria-associated anae mia are major public health problems, the usefulness of supplementary iron treatment for children with malaria-associated anaemia is unknown . In a 6-week period during the 1995 rainy season, 222 Malawian childr en aged <5) ears, who sought treatment for malaria, had greater than o r equal to 500 parasites/mu l blood and at least 5 g haemoglobin (HB)/ dl blood and whose parents gave consent, were randomized into a prospe ctive study comparing the efficacy of sulphadoxine-pyrimethamine only (SP), SP plus daily iron (SPD) and SP plus weekly iron (SPD)) as treat ment for malaria-associated anaemia. The patients had their HE concent rations measured on enrolment (day 0), just before antimalarial treatm ent, and on days 3, 7, 14, 21 and 28; 215 (96.8%) completed the 28-day study. Among the children with 5-8 g HB/dl on enrolment, HE gain by t he end of the study was significantly greater than in the children wit h >8 g HB/dl initially (4.1 v 2.2 g/dl; P<0.05), and those in the SPD group gained significantly more HE by days 21 and 28 (36 and 4.9 g/dl, respectively) than those in either the SPW (2.7 and 3 7 g/dl, respect ively) or the SP groups (2.6 and 3.5 g/dl, respectively); there was no difference in HE gain between the SP and SPW groups. Type of treatmen t had no apparent effect, at any time during the study, on HE gains in those patients who had >8 n HB/dl on enrolment. Thus the children wit h 5-8 g HB/dl on enrolment benefited from daily iron therapy whereas t hose with >8 g HB/dl derived no significant benefit; improvement in HE depended most on whether enrolment HE was less than or equal to 8.0 g /dl. As treatment with an effective antimalarial drug resulted in HE g ains, irrespective of treatment group or HE concentration at enrolment , the anaemia observed may be mostly related to malaria. However, as a larger proportion of the iron-treated patients failed to clear their parasitaemias than of those given SP alone, oral iron map inhibit SP a ction. It is therefore recommended that, for children with both malari a and malaria-associated anaemia, the malaria should first be cleared with an effective antimalarial drug, such as SP, before the anaemia, i f it still persists, is treated with iron.