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Background: Malaria and iron deficiency (ID) are major public health problems in Ghana, especially among children under five years. Iron is an essential micronutrient required during childhood development. Though ID is detrimental, it could also be a protective state against severe Plasmodium falciparum infection, as parasites need host iron for oogenesis. Thus, it is important to determine the relationship between these conditions for efficient management. This study investigated the hypothesis that iron deficient children under 5 are at a reduced risk of severe malaria infection.
Objectives: compare iron profile biomarkers between malaria-infected and uninfected groups; determine plasmodium parasitaemia in malaria-infected children and correlate levels of parasitaemia to iron biomarkers; determine threshold levels of host iron and the associated risk of severe malaria infection.
Methodology: This case-control study took place within three hospitals across northern Ghana. 182 children aged 6-59 months were recruited by purposive sampling; 87 cases and 95 controls. FBCs were measured and iron biomarkers determined by ELISA technique. Parasite densities were calculated and related to the iron biomarkers.
Key findings: malaria severity was significantly associated with ID (P<0.05). Serum iron was lower in the cases than controls. Ferritin predicted severe malaria infection without adjustment. Serum iron and TSAT levels decreased with increasing parasitemia while ferritin and TIBC levels increased with increasing parasitemia. Participation in SMC and the presence of fever varied significantly between the cases and controls. Clinical and socioeconomic factors assessed had no significant association with iron status (P>0.05).
Implications: malaria infection caused depleted serum iron with high iron stores, reflecting functional iron deficiency anaemia in participants. Children in endemic regions are more prone to the effects of malarial anaemia and being iron deficient does not protect children from severe forms of malaria. Thus, mass iron supplementation is safe among iron deficient children within malaria-endemic zones.