|NIH Receives Gates Foundation Grant to Investigate
Role of Iron Supplements in Malaria
Do iron supplements worsen the course of malaria? Researchers
aren't sure, and the uncertainty has jeopardized efforts to treat
the debilitating effects of iron deficiency in parts of the world
where malaria and other infectious diseases are common.
The National Institutes of Health has received a grant from the
Bill and Melinda Gates Foundation to establish a research program
to find the best ways to diagnose and treat iron deficiency and
better understand its interaction with malaria and infectious diseases
in parts of the world where such diseases are common. The Gates
Foundation grant is $9.3 million over a five-year period.
In the past, public health officials have treated iron deficiency
in these areas by distributing iron supplements to local populations.
Although a few people who had received the supplements were not
iron deficient, it was assumed that the extra iron would not do
them any harm.
Recently, a few studies have indicated that extra iron may in
fact place individuals who are not iron deficient at greater risk
for death from malaria or another infectious disease, and at greater
risk for hospitalization from the complications of malaria. Consequently,
public health officials have become hesitant to continue giving
iron supplements to entire populations in parts of the world where
malaria rates are high, depriving large numbers of iron-deficient
people of the health benefits of iron supplementation.
"Previously, public health officials would provide iron supplements
to entire populations, assuming that they would do no harm to those
few individuals who didn't require them," said Dr. Elias A.
Zerhouni, M.D., director of the National Institutes of Health. "The
purpose of this project is to find ways to identify those people
who need iron supplements and the most efficient ways to provide
it to them."
"To improve global health, effective health interventions
are critical," said Ellen Piwoz, Sc.D., M.H.S., senior program
officer at the Gates Foundation. "By addressing important
unanswered questions about the relationship between iron supplements
and malaria, this research will help guide public health practice
in developing countries."
Iron deficiency can result from insufficient iron in the diet
or from blood loss, explained the project officer for the initiative,
Daniel J. Raiten, Ph.D., a health scientist administrator at NIH's
National Institute of Child Health and Human Development. Among
its roles in the body, iron is an essential component of red blood
cells. Iron deficiency can progress to anemia, the shortage of
red blood cells. As a result, people with iron deficiency may feel
weak and fatigued.
"Iron deficiency is a tremendous economic and social problem," Dr.
Raiten said. "The fatigue and weakness hinder adults' ability
to work and function, and the neurological complications of iron
deficiency can have a negative impact on children's ability to
Although iron is found in vegetables, fruits, grain, and legumes,
iron in plant-based foods is not absorbed as readily by the body
as iron from red meat, liver, and egg yolks. As a result, vegetarians
and other people who consume little or no red meat or eggs are
at risk for iron deficiency. Women who have heavy menstrual periods,
as well as pregnant women who must supply blood to meet the needs
of the fetus, are also at high risk for iron deficiency.
Dr. Raiten said that by some estimates, there are two billion
people worldwide who may be anemic, and about half of those cases
are due to iron deficiency.
Iron deficiency commonly occurs in parts of the world where malaria
and other major infectious diseases are also common, Dr. Raiten
said. Malaria, caused by a parasite transmitted through the bite
of an infected mosquito, can result in severe headache, high fever,
chills, and vomiting, and can be fatal. The World Health Organization
estimates that 300 million cases of malaria occur around the world
each year. More than a million of these result in death, most often
Dr. Raiten explained that the objectives of this project are:
- to test the safety and effectiveness of various methods and
strategies for preventing or treating iron deficiency;
- to identify screening tests and other measures to gauge how
much iron a person has (for example, levels of iron in the blood)
and how it's being used by the body;
- to understand the biological processes by which iron might
affect a person's response to malaria or other infections;
- to translate information gained from these studies into practical
means for providing sources of iron to communities with a high
proportion of iron-deficient people. This transfer of information
will be accomplished through a partnership with the World Health
To begin this work, the project will constitute a technical working
group to review the current evidence and identify the most significant
research questions to be pursued.
The NICHD sponsors research on development, before and after birth;
maternal, child, and family health; reproductive biology and population
issues; and medical rehabilitation. For more information, visit
the Institute's Web site at http://www.nichd.nih.gov/.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.