Effect of iron and zinc supplementation in the treatment of malaria in children
Keywords:
reticulocyte, iron, zinc, malaria, Plasmodium falciparum
Abstract
Background Iron and zinc administration for children withmalaria in endemic area were known to decrease parasitemia but
data on their effectiveness when given together to increase
reticulocytes as erythropoiesis parameter and hemoglobin is
insufficient.
Objective To determine the effect of zinc to increase iron
absorption in the treatment of Plasmodium falciparum malaria in
children.
Methods Children with positive Plasmodium falciparum on their
blood smear (n=86) examination were randomly assigned to daily
supplementation of iron 6 mg per kg body weight per day plus
placebo or iron plus zinc 10 mg per day for 30 days. Venous blood
specimens were collected at the start and at the end of the study.
Results Sixty-nine children completed the supplementations and
had both baseline and follow-up blood specimen study. After 30-
day supplementation, the iron plus placebo and iron plus zinc
groups showed significant difference on hemoglobin concentration
(0.58 and 0.09 g/dl; P<0.05). There was no significant difference
in reticulocyte production index and reticulocyte count before
and after intervention in both groups. There was only significant
difference in red blood cells concentration after supplementation
of iron plus placebo and iron plus zinc (4.7 in 4.5 million/μl;
P<0.05).
Conclusions Iron supplementation with or without zinc shows
significant increase of hemoglobin concentration. It is slightly
higher in iron plus placebo group.
References
1. Stoltzfus RJ, Chwaya HM, Albonico M. Serum ferritin,
erythrocyte protoporphyrin and hemoglobin are valid
indicators of iron status of school children in a malaria-
holoendemic population. J Nutr 1997;127:293-8.
2. Hastka J, Lasserre JJ, Schwarzbeck A, R Hehlmann. Central
role of zinc protoporphyrin in staging iron deficiency. Clinical
Chemistry 1994;40:768-73.
3. Israels LG, Israels ED. Iron metabolism. In: Israels LG, Israels
ED, editors. Mechanisms in hematology. 3 rd ed. Concord:
Core Publishing; 2002. p. 157–80.
4. Iyer JK, Shi L, Shankar AH, Sullivan DJ. Zinc protoporphyrin
IX binds heme crystal to inhibit the process of crystallization
in Plasmodium falciparum. Molecular Medicine 2003;9:175-82.
5. The Zinc Against Plasmodium Study Group. Effect of zinc on
the treatment of Plasmodium falciparum malaria in children: a
randomized controlled trial. Am J Clin Nutr 2002;76:805-12.
6. Brabin BJ. The role of malaria in nutritional anemias. In:
Fomon SJ, Zlotkins S, editors. Nutritional Anemias. New
York: Nestec/Raven Press; 1992. p. 65-80.
7. Fomon SJ. Iron. In: Fomon SJ, editor. Infant nutrition. 2 nd
ed. Philadelphia: WB Saunders; 1974. p. 299-317.
8. Rettmer RL, Carlson TH, Origenes ML, Jack RM, Labbe RF.
Zinc protoporphyrin/heme ratio for diagnosis of preanemic
iron deficiency. Pediatrics 1999;104:37-41.
9. Will AM. Iron metabolism, sideroblastic anemia and iron
overload. In: Lilleyman JS, Hann IM, Blanchette VS, editors.
Pediatric Hematology. 2 nd ed. London: Churchill Livingstone;
2000. p. 105-26.
10. Lind T, Lonnerdal B, Stenlund H, Ismail D, Seswandhana R,
Eva-Charlotte Ekstrom EC, et al. A community-based
randomized controlled trial of iron and zinc supplementation
in Indonesian infants: interactions between iron and zinc. Am
J Clin Nutr 2003;77:883-90.
11. Verhoef H, West CE, Nzyuko SM, de Vogel S, van der Valk
R, Wanga MA, et al. Intermittent administration of iron and
sulfadoxine-pyrimethamine to controle anaemia in Kenyan
children: a randomized controlled trial. Lancet 2002;360:984-
14.
12. Verhoef H. Iron deficiency and malaria as determinants of
anaemia in African children [Thesis]. Wageningen:
Wageningen University; 2001.
13. Shankar AH. Nutritional modulation of malaria morbidity
and mortality. J Infect Dis 2000;182:S37-53.
14. Hoffbraund AV, Pettit JE, Haemopoiesis. Essential
haematology. 2 nd ed. Jakarta: EGC. p. 127.
15. Wintrobe MM, Lee GR, Boggs DR, Bithell TC, Foerster J,
Athens JW, et al. Clinical Hematology. Philadelphia: Lea &
Febiger; 1974. p. 731–2.
16. Oski FA. Nutritional anemias. In: Walker WA, Watkins JB,
editors. Nutrition in pediatrics basic science and clinical
application. 1 st ed. Toronto: Little Brown. p. 107-26.
17. Labbe RF, Vreman HJ, Vreman, Stevenson DK. Zinc
protoporphyrin: a metabolite with a mission. Clinical
Chemistry 1999;12:2060-72.
18. INACG Expert Panel. Safety of iron supplementation
programs in malaria-endemic regions. INACG consensus
statement. Washington: International Nutritional Anaemia
Consultative Group; 1999.
erythrocyte protoporphyrin and hemoglobin are valid
indicators of iron status of school children in a malaria-
holoendemic population. J Nutr 1997;127:293-8.
2. Hastka J, Lasserre JJ, Schwarzbeck A, R Hehlmann. Central
role of zinc protoporphyrin in staging iron deficiency. Clinical
Chemistry 1994;40:768-73.
3. Israels LG, Israels ED. Iron metabolism. In: Israels LG, Israels
ED, editors. Mechanisms in hematology. 3 rd ed. Concord:
Core Publishing; 2002. p. 157–80.
4. Iyer JK, Shi L, Shankar AH, Sullivan DJ. Zinc protoporphyrin
IX binds heme crystal to inhibit the process of crystallization
in Plasmodium falciparum. Molecular Medicine 2003;9:175-82.
5. The Zinc Against Plasmodium Study Group. Effect of zinc on
the treatment of Plasmodium falciparum malaria in children: a
randomized controlled trial. Am J Clin Nutr 2002;76:805-12.
6. Brabin BJ. The role of malaria in nutritional anemias. In:
Fomon SJ, Zlotkins S, editors. Nutritional Anemias. New
York: Nestec/Raven Press; 1992. p. 65-80.
7. Fomon SJ. Iron. In: Fomon SJ, editor. Infant nutrition. 2 nd
ed. Philadelphia: WB Saunders; 1974. p. 299-317.
8. Rettmer RL, Carlson TH, Origenes ML, Jack RM, Labbe RF.
Zinc protoporphyrin/heme ratio for diagnosis of preanemic
iron deficiency. Pediatrics 1999;104:37-41.
9. Will AM. Iron metabolism, sideroblastic anemia and iron
overload. In: Lilleyman JS, Hann IM, Blanchette VS, editors.
Pediatric Hematology. 2 nd ed. London: Churchill Livingstone;
2000. p. 105-26.
10. Lind T, Lonnerdal B, Stenlund H, Ismail D, Seswandhana R,
Eva-Charlotte Ekstrom EC, et al. A community-based
randomized controlled trial of iron and zinc supplementation
in Indonesian infants: interactions between iron and zinc. Am
J Clin Nutr 2003;77:883-90.
11. Verhoef H, West CE, Nzyuko SM, de Vogel S, van der Valk
R, Wanga MA, et al. Intermittent administration of iron and
sulfadoxine-pyrimethamine to controle anaemia in Kenyan
children: a randomized controlled trial. Lancet 2002;360:984-
14.
12. Verhoef H. Iron deficiency and malaria as determinants of
anaemia in African children [Thesis]. Wageningen:
Wageningen University; 2001.
13. Shankar AH. Nutritional modulation of malaria morbidity
and mortality. J Infect Dis 2000;182:S37-53.
14. Hoffbraund AV, Pettit JE, Haemopoiesis. Essential
haematology. 2 nd ed. Jakarta: EGC. p. 127.
15. Wintrobe MM, Lee GR, Boggs DR, Bithell TC, Foerster J,
Athens JW, et al. Clinical Hematology. Philadelphia: Lea &
Febiger; 1974. p. 731–2.
16. Oski FA. Nutritional anemias. In: Walker WA, Watkins JB,
editors. Nutrition in pediatrics basic science and clinical
application. 1 st ed. Toronto: Little Brown. p. 107-26.
17. Labbe RF, Vreman HJ, Vreman, Stevenson DK. Zinc
protoporphyrin: a metabolite with a mission. Clinical
Chemistry 1999;12:2060-72.
18. INACG Expert Panel. Safety of iron supplementation
programs in malaria-endemic regions. INACG consensus
statement. Washington: International Nutritional Anaemia
Consultative Group; 1999.
Published
2016-09-24
How to Cite
1.
Dasraf D, Lubis B, Lubis B, Rosdiana N, Lubis M, Pasaribu S. Effect of iron and zinc supplementation in the treatment of malaria in children. PI [Internet]. 24Sep.2016 [cited 7Jan.2025];47(6):256-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/426
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Received 2016-09-01
Accepted 2016-09-01
Published 2016-09-24
Accepted 2016-09-01
Published 2016-09-24
