e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Daily iron supplementation in children 6-23 months of age in malaria-endemic areas

Intervention | Last updated: 20 June 2023


Approximately 300 million children globally had anaemia in 2011. The most common cause of anaemia is thought to be deficiency in iron, an essential nutrient for development and cell growth in the immune and neural systems, as well as in regulation of energy metabolism and exercise. Iron deficiency can result from inadequate intake or absorption of dietary iron, increased need during periods of growth, and blood loss from helminth* infection.

Children are particularly vulnerable to iron deficiency anaemia because of their increased iron requirements in the periods of rapid growth, especially in the first five years of life. Iron deficiency anaemia in children has been linked to increased childhood morbidity and impaired cognitive development and school performance.

Malaria is a leading cause of morbidity and mortality in children in sub-Saharan Africa and is an important contributor to anaemia in other endemic regions, through direct rupture of infected red blood cells, the body’s immune destruction of both parasitized and uninfected red blood cells, and temporary dysfunction of the bone marrow.

Results of some studies in young children have suggested that iron supplementation may increase the risk of malaria and death in children living in malaria-endemic regions. However, recent evidence suggests that iron supplementation does not adversely affect children when regular malaria surveillance and treatment services are provided.

Evidence has shown that daily iron supplementation in children 6–23 months of age is associated with a reduced risk of iron deficiency and anaemia.

* Helminths are a group of parasites commonly referred to as worms and include schistosomes and soil-transmitted helminths

WHO Recommendations


Daily iron supplementation is recommended as a public health intervention in infants and young children aged 6–23 months, living in settings where the prevalence of anaemia in this age group is 40% or higher*, for preventing iron deficiency and anaemia.

In malaria–endemic areas, the provision of iron supplementation in infants and children should be done in conjunction with public health measures to prevent, diagnose and treat malaria.

* In the absence of prevalence data in this group, consider proxies for high risk of anaemia. For the most recent estimates, visit the WHO-hosted Vitamin and Mineral Nutrition Information System (VMNIS).



Evidence


Systematic reviews used to develop the guidelines


Effect of daily iron supplementation on health in children aged 4–23 months: a systematic review and meta-analysis of randomised controlled trials

Pasricha SR, Hayes E, Kalumba K, Biggs BA. Lancet Glob Health. 2013;1(2):e77-86.


Oral iron supplements for children in malaria-endemic areas

Neuberger A, Okebe J, Yahav D, Paul M. Cochrane Database of Systematic Reviews. 2016; Issue 2. Art. No.: CD006589.

Summary of this review Alternate Text

Other related systematic reviews


Effect of iron supplementation on haemoglobin response in children: systematic review of randomised controlled trials

Gera T, Sachdev HPS, Nestel P, Sachdev SS. Journal of Pediatric Gastroenterology & Nutrition. 2007;44:468–486.