Oral iron supplementation for preventing or treating anaemia among children in malaria-endemic areas.

BACKGROUND: Iron-deficiency anaemia is common during childhood. Iron supplementation has been claimed to increase the risk of malaria. OBJECTIVES: To assess the effect of iron on malaria and deaths. SEARCH STRATEGY: We searched The Cochrane Library (2009, issue 1); MEDLINE; EMBASE; LILACS and metaRegister of Controlled Trials, all up to March 2009. We scanned references of included trials. SELECTION CRITERIA: Individually and cluster-randomized controlled trials conducted in hypoendemic to holoendemic malaria regions and including children < 18 years. We included trials comparing orally administered iron with or without folic acid vs. placebo or no treatment. Iron fortification was excluded. Antimalarials and/or antiparasitics could be administered to either group. Additional micronutrients could only be administered equally to both groups. DATA COLLECTION AND ANALYSIS: The primary outcomes were malaria-related events and deaths. Secondary outcomes included haemoglobin, anaemia, other infections, growth, hospitalizations, and clinic visits. We assessed risk of bias using domain-based evaluation. Two authors independently selected studies and extracted data. We contacted authors for missing data. We assessed heterogeneity. We performed fixed-effect meta-analysis and presented random-effects results when heterogeneity was present. We present pooled risk ratios (RR) with 95% confidence intervals (CIs). We used adjusted analyses for cluster-randomized trials. MAIN RESULTS: Sixty-eight trials (42,981 children) fulfilled the inclusion criteria. Iron supplementation did not increase the risk of clinical malaria (RR 1.00, 95% CI 0.88 to 1.13; 22,724 children, 14 trials, random-effects model). The risk was similar among children who were non-anaemic at baseline (RR 0.96, 95% CI 0.85 to 1.09). An increased risk of malaria with iron was observed in trials that did not provide malaria surveillance and treatment. The risk of malaria parasitaemia was higher with iron (RR 1.13, 95% CI 1.01 to 1.26), but there was no difference in adequately concealed trials. Iron + antimalarial was protective for malaria (four trials). Iron did not increase the risk of parasitological failure when given during malaria (three trials). There was no increased risk of death across all trials comparing iron versus placebo (RR 1.11, 95% CI 0.91 to 1.36; 21,272 children, 12 trials). Iron supplementation increased haemoglobin, with significant heterogeneity, and malaria endemicity did not affect this effect. Growth and other infections were mostly not affected by iron supplementation. AUTHORS' CONCLUSIONS: Iron does not increase the risk of clinical malaria or death, when regular malaria surveillance and treatment services are provided. There is no need to screen for anaemia prior to iron supplementation.

Neonatal septicemia in high risk babies in South-Eastern Nigeria.

BACKGROUND: Septicemia is one of the major causes of morbidity and mortality in the neonatal period and it often has a rapid and fulminant course. AIMS: To determine the incidence, predisposing factors, clinical features, bacteriologic pattern and antibiotic sensitivity of neonatal septicemia. DESIGN: A prospective study was undertaken over a 1(1/2)-year period in the neonatal unit of Ebonyi State University Teaching Hospital, Abakaliki, Southeastern Nigeria. METHODS: All newborns (age 0-28 days) admitted with clinical features and/or risk factors suggestive of neonatal septicemia were selected and screened for septicemia. RESULTS: The study identified 33 septicemic neonates of the 138 neonates (23.9%) screened, 19/92 (20.7%) for inborns and 14/46 (30.4%) for outborns, representing an incidence of 7.98/1000 live births. Prolonged/obstructed labor, severe birth asphyxia, maternal pre-partum/peripartum pyrexia and home/traditional birth attendant deliveries were the main predisposing perinatal factors. Respiratory distress, fever and jaundice were the predominant presenting clinical findings. Gram-positive organisms were cultured from 18 neonates with Staphylococcus aureus accounting for 45.5% of the cases, while Escherichia coli was the predominant Gram-negative organism accounting for 18.2% of the cases. Group B streptococcus accounted for only one case and there was no case of Listeria monocytogenes. Early onset septicemia was commoner in in born while late onset septicemia was commoner with out born (chi2 = 10.45, P < 0.05). The bacterial isolates showed a high degree of in vitro antimicrobial resistance to conventional antibiotics and the antibiotic sensitivity pattern of the organisms indicated the use of ceftriaxone and gentamicin as initial therapy while awaiting culture results. The overall mortality rate was 26.7%. Early onset septicemia and concomitant meningitis were associated with high mortality. CONCLUSION: Neonatal septicemia is a major cause of morbidity and mortality in the study site. Most of the predisposing factors were due to poor obstetric care and unsterile delivery practices which could be avoided and prevented, and the causative organisms were different from those in the developed countries. There was appreciable resistance to commonly used antibiotics. Simple and sustainable interventions such as promotion of clean and timely deliveries, modern newborn care and specialized diagnostic facilities, hand washing and barrier nursing, and restriction of antibiotics may help reduce the burden of neonatal infection in the study community.