Delaying the Start of Iron Until 28 Days After Antimalarial Treatment Is Associated With Lower Incidence of Subsequent Illness in Children With Malaria and Iron Deficiency
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Date
2017-08
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
We evaluated the incidence of all-cause and malaria-specific clinic visits during follow-up of a recent trial of iron therapy. In the main trial, Ugandan children 6–59 months with smear-confirmed malaria and iron deficiency [zinc protoporphyrin (ZPP > = 80 μmol/mol heme)] were treated for malaria and randomized to start a 27-day course of oral iron concurrently with (immediate group) or 28 days after (delayed group) antimalarial treatment. All children were followed for the same 56-day period starting at the time of antimalarial treatment (Day 0) and underwent passive and active surveillance for malaria and other morbidity for the entire follow-up period. All ill children were examined and treated by the study physician. In this secondary analysis of morbidity data from the main trial, we report that although the incidence of malaria-specific visits did not differ between the groups, children in the immediate group had a higher incidence rate ratio of all-cause sick-child visits to the clinic during the follow-up period (Incidence Rate Ratio (IRR) immediate/delayed = 1.76; 95%CI: 1.05–3.03, p = 0.033). Although these findings need to be tested in a larger trial powered for malaria-specific morbidity, these preliminary results suggest that delaying iron by 28 days in children with coexisting malaria and iron deficiency is associated with a reduced risk of subsequent all-cause illness.
Description
The study determined whether delaying iron until 28 days after antimalarial treatment in children with coexisting iron deficiency and malaria is associated with a difference in the risk of subsequent illness compared to the standard of care concurrent iron therapy, we analyzed morbidity data from our previous trial to investigate the frequency and incidence of physician-diagnosed episodes of illness over the 56-day follow-up period.
Keywords
Antimalarial treatment, Malaria and iron
Citation
Jaramillo EG, Mupere E, Opoka RO, Hodges JS, Lund TC, Georgieff MK, et al. (2017) Delaying the start of iron until 28 days after antimalarial treatment is associated with lower incidence of subsequent illness in children with malaria and iron deficiency. PLoS ONE 12(8): e0183977. https://doi.org/10.1371/journal. pone.0183977