Malaria is a cause of iron deficiency in African children.

John Muthii Muriuki ORCID logo; Alexander J Mentzer ORCID logo; RuthMitchell; Emily L Webb ORCID logo; Anthony OEtyang; CatherineKyobutungi; Alireza Morovat ORCID logo; WandiaKimita; Francis M Ndungu ORCID logo; Alex WMacharia; +34 more... Caroline JNgetsa; JohnstoneMakale; Swaib A Lule ORCID logo; Solomon KMusani; Laura MRaffield; Clare LCutland; Sodiomon B Sirima ORCID logo; AmidouDiarra; Alfred BTiono; MichalFried; MosesGwamaka; Seth Adu-Afarwuah ORCID logo; James P Wirth ORCID logo; Rita Wegmüller ORCID logo; Shabir AMadhi; Robert WSnow; Adrian VS Hill ORCID logo; Kirk A Rockett ORCID logo; Manjinder SSandhu; Dominic P Kwiatkowski ORCID logo; Andrew M Prentice ORCID logo; Kendra AByrd; AlexNdjebayi; Christine PStewart; ReinaEngle-Stone; Tim JGreen; Crystal DKarakochuk; Parminder SSuchdev; PhilipBejon; Patrick E Duffy ORCID logo; George Davey Smith ORCID logo; Alison M Elliott ORCID logo; Thomas NWilliams; Sarah H Atkinson ORCID logo; (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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