Risks of routine iron and folic acid supplementation for young children.
BACKGROUND
Almost 70% of young children in India are anemic. Current policy recommends routine iron-folic acid (IFA) supplementation to all under 5 children. A potential risk of this approach is an increase in infectious diseases in general, and malaria in particular.


METHODS
An extensive literature search including PubMed, the World Health Organization (WHO) document library, and the Indian Government database, for documents regarding IFA supplementation in under-5 children.


RESULTS
Previously, systematic reviews had suggested adverse effects of IFA supplementation in malaria endemic settings. However, a recent large trial in Tanzania has found clear evidence of increased mortality, chiefly due to malaria, among children receiving routine IFA, whilst a simultaneous study in Nepal (a non-malarious region) found no adverse effects on morbidity or mortality from infectious disease attributable to IFA. These findings have prompted the World Health Organization to revise recommendations regarding IFA supplementation in malaria endemic areas.


CONCLUSIONS
India has a non-homogenous distribution of malaria endemicity. We propose that although no change to IFA supplementation be made in non-malarious regions, routine IFA should be provided in malarious regions once malaria control and primary health care infrastructure are functioning well.
Pasricha
S
S
St Johns Research Institute, St Johns National Academy of Health Sciences, Bangalore, India.
Shet
A
A
Sachdev
H P S
HP
Shet
A S
AS
D000740:Anemia / Q000188:drug therapy / Q000453:epidemiology*; D002675:Child, Preschool; D005492:Folic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects*; D008288:Malaria / Q000453:epidemiology*; D018673:Nutrition Policy; D012307:Risk Factors; D014944:World Health Organization
D005492:Folic Acid; D007501:Iron