High Iron Levels Are Associated with Increased Malaria Risk in Infants during the First Year of Life in Benin

Violeta Moya-Alvarez UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Université Pierre et Marie Curie, Paris, France
Réseau doctoral de l'Ecole des Hautes Etudes en Santé Publique, Rennes, France

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Gilles Cottrell UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Cotonou, Benin

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Smaila Ouédraogo Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Cotonou, Benin
Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO), Public Health Department, Ouagadougou, Burkina Faso

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Manfred Accrombessi Université Pierre et Marie Curie, Paris, France
Réseau doctoral de l'Ecole des Hautes Etudes en Santé Publique, Rennes, France
Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Cotonou, Benin

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Achille Massougbodgi Faculté des Sciences de la Santé (FSS), Université d'Abomey Calavi, Cotonou, Benin

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Michel Cot UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Université Pierre et Marie Curie, Paris, France

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The World Health Organization (WHO) estimates that 40% of children in low-income countries are anemic. Therefore, iron supplements are recommended by WHO in areas with high anemia rates. However, some studies have set into question the benefits of iron supplementation in malaria-endemic regions. In Benin, a west African country with high prevalence of anemia and malaria, no iron supplements are given systematically to infants so far despite the WHO recommendations. In this context, we wanted to investigate the effect of iron levels during the first year of life on malarial risk in Benin considering complementary risk factors. We followed 400 women and their offspring between January 2010 and June 2012 in Allada (Benin). Environmental, obstetric, and numerous clinical, maternal, and infant risk factors were considered. In multilevel models, high iron levels were significantly associated with the risk of a positive blood smear (adjusted odds ratio = 2.90, P < 0.001) and Plasmodium falciparum parasitemia (beta estimate = 0.38, P < 0.001). Infants with iron levels in the lowest quartile were less likely to have a positive blood smear (P < 0.001), and the risk increased with higher iron levels. Our results appeal for additional evaluation of the effect of different doses of iron supplements on the infant health status, including malaria incidence. Thus, the health status of infants should be compared between cohorts where iron is given either for prevention or anemia treatment, to better understand the effect of iron supplements on infant health.

Author Notes

Address correspondence to Violeta Moya-Alvarez, UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, 4 avenue de l'Observatoire, Paris 75270, France. E-mail: vmoyaalvarez@gmail.com

Financial support: This work was supported by the European and Developing Countries Clinical Trials Partnership (EDCTP-IP.07.31080.002) (MiPPAD study “Malaria in Pregnancy Preventive Alternative Drugs,” http://clinicaltrials.gov/ct2/show/NCT00811421), and the Malaria in Pregnancy (MiP) Consortium, which is funded through a grant from the Bill & Melinda Gates Foundation to the Liverpool School of Tropical Medicine). Violeta Moya-Alvarez was funded by the Réseau doctoral de l'Ecole des Hautes Etudes en Santé Publique and the Direction Générale de l'Armement grant.

Authors' addresses: Violeta Moya-Alvarez, UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, Paris, France, Université Pierre et Marie Curie, Paris, France, and Réseau doctoral de l'Ecole des Hautes Etudes en Santé Publique, Rennes, France, E-mail: vmoyaalvarez@gmail.com. Gilles Cottrell, UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, Paris, France, E-mail: gilles.cottrell@ird.fr. Smaila Ouédraogo, Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Cotonou, Benin, Unité de Formation et de Recherche en Sciences de la Santé, Université de Ouagadougou, Ouagadougou, Burkina Faso, and Public Health Department, Centre Hospitalier Universitaire Yalgado Ouédraogo (CHU-YO), Ouagadougou, Burkina Faso, E-mail: smaila11@yahoo.fr. Manfred Accrombessi, Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Cotonou, Benin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France, Réseau doctoral de l'Ecole des Hautes Etudes en Santé Publique, Rennes, France, and Université Pierre et Marie Curie, Paris, France, E-mail: accrombessimanfred@yahoo.fr. Achille Massougbodgi, Faculté des Sciences de la Santé (FSS), Université d'Abomey Calavi, Cotonou, Benin, E-mail: massougbodjiachille@yahoo.fr. Michel Cot, UMR 216 Institut de Recherche pour le Développement, Mère et enfant face aux infections tropicales (MERIT), Université Paris Descartes, Sorbonne Paris Cité, Paris, France, and Université Pierre et Marie Curie, Paris, France, E-mail: michel.cot@ird.fr.

  • 1.

    World Health Organization (WHO), 2014. Crude Death Rate by Broad Cause Group, 2000 and 2012, by WHO Region. Geneva, Switzerland: WHO.

  • 2.

    Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE, 2014. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385: 430440.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    World Health Organization (WHO), 2015. World Malaria Report 2015. Geneva, Switzerland: WHO.

  • 4.

    Grantham-McGregor S, Ani C, 2001. Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem: a review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 131: 649668.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Kassebaum NJ et al., 2014. A systematic analysis of global anemia burden from 1990 to 2010. Blood 123: 615624.

  • 6.

    World Health Organization, 1998. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Stoltzfus RJ, Dreyfuss ML, eds. Washington, DC: ILSI Press.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Murray MJ, Murray AB, Murray MB, 1978. The adverse effect of iron repletion on the course of certain infections. Br Med J 2: 11131115.

  • 8.

    Oppenheimer SJ, Gibson FD, Macfarlane SB, Moody JB, Harrison C, Spencer A, Bunari O, 1986. Iron supplementation increases prevalence and effects of malaria: report on clinical studies in Papua New Guinea. Trans R Soc Trop Med Hyg 80: 603612.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A, Dhingra U, Kabole I, Deb S, 2006. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet 367: 133143.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Sangaré L, van Eijk AM, Ter Kuile FO, Walson J, Stergachis A, 2014. The association between malaria and iron status or supplementation in pregnancy: a systematic review and meta-analysis. PLoS One 9: e87743.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Okebe JU, Yahav D, Shbita R, Paul M, 2011. Oral iron supplements for children in malaria-endemic areas (review). Cochrane Database Syst Rev 10: CD006589.

  • 12.

    Neuberger A, Okebe J, Yahav D, Paul M, 2016. Oral iron supplements for children in malaria-endemic areas. Cochrane Database Syst Rev 2: CD006589.

  • 13.

    González R et al., 2014. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-negative women: a multicentre randomized controlled trial. PLoS Med 11: e1001733.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Planche T, Krishna S, Kombila M, Engel K, Faucher JF, Ngou-Milama E, Kremsner PG, 2001. Comparison of methods for the rapid laboratory assessment of children with malaria. Am J Trop Med Hyg 65: 599602.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Thurnham DI, Mccabe LD, Haldar S, Wieringa FT, Northrop-clewes CA, Mccabe GP, 2010. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr 92: 546555.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Omumbo J, Hay S, Snow R, Tatem AJ, Rogers DJ, 2004. Modelling malaria risk in east Africa at high-spatial resolution. Trop Med Int Health 10: 557566.

  • 17.

    Machault V, Vignolles C, Pagès F, Gadiaga L, Tourre YM, Gaye A, Sokhna C, Trape JF, Lacaux JP, Rogier C, 2012. Risk mapping of Anopheles gambiae s.l. densities using remotely-sensed environmental and meteorological data in an urban area: Dakar, Senegal. PLoS One 7: e50674.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Abiodun GJ, Maharaj R, Witbooi P, Okosun KO, 2016. Modelling the influence of temperature and rainfall on the population dynamics of Anopheles arabiensis. Malar J 15: 364.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Dambach P, Machault V, Lacaux J-P, Vignolles C, Sié A, Sauerborn R, 2012. Utilization of combined remote sensing techniques to detect environmental variables influencing malaria vector densities in rural west Africa. Int J Health Geogr 11: 8.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Cortinovis I, Vella V, Ndiku J, 1993. Construction of a socio-economic index to facilitate analysis of health data in developing countries. Soc Sci Med 36: 10871097.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Batista-Foguet JM, Fortiana J, Currie C, Villalbí JR, 2004. Socio-economic indexes in surveys for comparisons between countries. Soc Indic Res 67: 315332.

  • 22.

    Burté F et al., 2013. Circulatory hepcidin is associated with the anti-inflammatory response but not with iron or anemic status in childhood malaria. Blood 121: 30163022.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Zlotkin S, Newton S, Aimone AM, Azindow I, Amenga-Etego S, Tchum K, Mahama E, Thorpe KE, Owusu-Agyei S, 2013. Effect of iron fortification on malaria incidence in infants and young children in Ghana: a randomized trial. JAMA 310: 938947.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Moya-Alvarez V, Cottrell G, Ouédraogo S, Accrombessi M, Massougbodgi A, Cot M, 2015. Does iron increase the risk of malaria in pregnancy? Open Forum Infect Dis 2: ofv038.

  • 25.

    Nyakeriga AM, Troye-blomberg M, Dorfman JR, Alexander ND, Ba R, Kortok M, Chemtai AK, Marsh K, Williams TN, 2004. Iron deficiency and malaria among children living on the coast of Kenya. J Infect Dis 190: 439447.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Weiss G, Werner-Felmayer G, Werner ER, Grünewald K, Wachter H, Hentze MW, 1994. Iron regulates nitric oxide synthase activity by controlling nuclear transcription. J Exp Med 180: 969976.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Turner GD et al., 1998. Systemic endothelial activation occurs in both mild and severe malaria. Correlating dermal microvascular endothelial cell phenotype and soluble cell adhesion molecules with disease severity. Am J Pathol 152: 14771487.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Kartikasari AER, Georgiou NA, Visseren FLJ, van Kats-Renaud H, van Asbeck BS, Marx JJM, 2006. Endothelial activation and induction of monocyte adhesion by nontransferrin-bound iron present in human sera. FASEB J 20: 353355.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Hurrell R, 2010. Iron and malaria: absorption, efficacy and safety. Int J Vitam Nutr Res 80: 279292.

  • 30.

    Sanchez-Lopez R, Haldar K, 1992. A transferrin-independent iron uptake activity in Plasmodium falciparum-infected and uninfected erythrocytes. Mol Biochem Parasitol 55: 920.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Slavic K, Krishna S, Lahree A, Bouyer G, Hanson KK, Pittman JK, Staines HM, Mota MM, 2015. A vacuolar iron-transporter homologue acts as a detoxifier in Plasmodium. Nat Commun 2016: 110.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Clark MA, Goheen MM, Fulford A, Prentice AM, Elnagheeb MA, Patel J, Fisher N, Taylor SM, Kasthuri RS, Cerami C, 2014. Host iron status and iron supplementation mediate susceptibility to erythrocytic stage Plasmodium falciparum. Nat Commun 5: 4446.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Pasricha SR, Hayes E, Kalumba K, Biggs BA, 2013. Effect of daily iron supplementation on health in children aged 4–23 months: a systematic review and meta-analysis of randomised controlled trials. Lancet Glob Health 1: e77e86.

    • PubMed
    • Search Google Scholar
    • Export Citation
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