title: Decline in childhood iron deficiency after interruption of malaria transmission in highland Kenya.
abstract: BACKGROUND
  Achieving optimal iron status in children in malaria-endemic areas may increase the risk of malaria. Malaria itself may contribute to iron deficiency, but the impact of an interruption in malaria transmission on the prevalence of iron deficiency is unknown.
  
  
  OBJECTIVE
  We aimed to determine whether 1) iron status improved in children living in 2 Kenyan villages with a documented cessation in malaria transmission and 2) changes in iron status correlated with changes in hemoglobin.
  
  
  METHODS
  We measured iron [hemoglobin, ferritin, soluble transferrin receptor (sTfR)] and inflammatory [C-reactive protein (CRP)] markers in paired plasma samples from 190 children aged 4-59 mo at the beginning (May 2007) and end (July 2008) of a documented 12-mo period of interruption in malaria transmission in 2 highland areas in Kenya with unstable malaria transmission and ongoing malaria surveillance.
  
  
  RESULTS
  Between May 2007 and July 2008, mean (±SD) hemoglobin increased from 10.8 ± 1.6 to 11.6 ± 1.6 g/dL. Median (25th, 75th percentile) ferritin increased from 17.0 (9.7, 25.6) to 22.6 (13.4, 34.7) μg/L (P < 0.001), whereas median sTfR decreased from 32.4 (26.3, 43.2) to 27.7 (22.1, 36.0) nmol/L (P < 0.001). Median CRP was low (<1 mg/L in both years) and did not change significantly. Iron deficiency prevalence (ferritin <12 μg/L, or <30 μg/L if CRP ≥10 mg/L) decreased from 35.9% (95% CI: 28.9%, 43.0%) to 24.9% (18.5%, 31.2%) (P = 0.005). The prevalence of iron deficiency with anemia (hemoglobin <11.0 g/dL) declined from 27.2% (20.7%, 33.8%) to 12.2% (7.4%, 17.1%) (P < 0.001). Improvement in iron status correlated with an increase in hemoglobin and was greater than explained by physiologic changes expected with age.
  
  
  CONCLUSIONS
  In this area of unstable malaria transmission, the prevalence of iron deficiency in children decreased significantly after the interruption of malaria transmission and was correlated with an increase in hemoglobin. These findings suggest that malaria elimination strategies themselves may be an effective way to address iron deficiency in malaria-endemic areas.
authors: From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ).
authors: Anne E P
authors: AE
authors: Frosch
authors: From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ).
authors: Bartholomew N
authors: BN
authors: Ondigo
authors: From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ).
authors: George A
authors: GA
authors: Ayodo
authors: From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ).
authors: John M
authors: JM
authors: Vulule
authors: From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ).
authors: Chandy C
authors: CC
authors: John
authors: From the Division of Global Pediatrics, University of Minnesota, Minneapolis, MN (AEPF, CCJ, and SEC); the Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya (BNO); and the Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya (BNO, GAA, JMV, and CCJ).
authors: Sarah E
authors: SE
authors: Cusick
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D000962:Antimalarials / Q000627:therapeutic use*; D015415:Biomarkers; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D019456:Health Transition; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D009032:Mosquito Control; D009752:Nutritional Status; D011159:Population Surveillance; D015995:Prevalence; D012423:Rural Health; D012621:Seasons
chemical_list: D000962:Antimalarials; D015415:Biomarkers; D006454:Hemoglobins