Malaria is a cause of iron deficiency in African children.

Muriuki, JMORCID logo; Mentzer, AJORCID logo; Mitchell, R; Webb, ELORCID logo; Etyang, AO; Kyobutungi, C; Morovat, AORCID logo; Kimita, W; Ndungu, FMORCID logo; Macharia, AW; +34 more...Ngetsa, CJ; Makale, J; Lule, SAORCID logo; Musani, SK; Raffield, LM; Cutland, CL; Sirima, SBORCID logo; Diarra, A; Tiono, AB; Fried, M; Gwamaka, M; Adu-Afarwuah, SORCID logo; Wirth, JPORCID logo; Wegmüller, RORCID logo; Madhi, SA; Snow, RW; Hill, AVORCID logo; Rockett, KAORCID logo; Sandhu, MS; Kwiatkowski, DPORCID logo; Prentice, AMORCID logo; Byrd, KA; Ndjebayi, A; Stewart, CP; Engle-Stone, R; Green, TJ; Karakochuk, CD; Suchdev, PS; Bejon, P; Duffy, PEORCID logo; Davey Smith, GORCID logo; Elliott, AMORCID logo; Williams, TN; Atkinson, SHORCID logo and (2021) Malaria is a cause of iron deficiency in African children. Nature medicine, 27 (4). pp. 653-658. ISSN 1078-8956 DOI: 10.1038/s41591-021-01238-4
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Malaria and iron deficiency (ID) are common and interrelated public health problems in African children. Observational data suggest that interrupting malaria transmission reduces the prevalence of ID1. To test the hypothesis that malaria might cause ID, we used sickle cell trait (HbAS, rs334 ), a genetic variant that confers specific protection against malaria2, as an instrumental variable in Mendelian randomization analyses. HbAS was associated with a 30% reduction in ID among children living in malaria-endemic countries in Africa (n = 7,453), but not among individuals living in malaria-free areas (n = 3,818). Genetically predicted malaria risk was associated with an odds ratio of 2.65 for ID per unit increase in the log incidence rate of malaria. This suggests that an intervention that halves the risk of malaria episodes would reduce the prevalence of ID in African children by 49%.


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