Malaria increases the burden of anemia in low-income countries, where, according to 2012 data from the World Health Organisation, 40% of children are anemic. Multiple studies have raised the concern that iron supplementation in malaria-endemic areas may put people at increased risk of acquiring malaria. In response, the WHO abandoned its recommendation for universal iron supplementation and now recommends that in malaria regions, iron supplements should only be given where malaria treatment and prevention services are available. In an effort to investigate these concerns further, the Iron and Malaria study was conducted by MRCG in Keneba from 2014-2016 by a multi-disciplinary team that included, MD/PhD student Morgan Goheen and many other scientists from MRC Unit The Gambia including Dr Rita Wegmuller, Amat Bah, Bakary Darboe, Ebrima Danso, Dr Muna Affara, Prof Andrew
Prentice and Dr Carla Cerami.

The primary objective of this study was to assess whether malaria susceptibility increases transiently during iron supplementation.The study confirmed and quantified a plausible cellular mechanism by which anemia protects African children against falciparum malaria. The team studied fresh Red Blood Cells (RBCs) from anemic children age 6-24 months with a hemoglobin level of <11g/dl. 135 children participating in the iron supplementation trial were given iron (12mg/day) as part of a micronutrient powder for 84 days. Children donated RBCs at baseline, day 49, and day 84 for use in flow cytometry-based in vitro growth and invasion assays with P.falciparum laboratory and field strains.

Study results show that anemia substantially reduced the invasion and growth of both laboratory and field strains of P.falciparum in vitro (~10% growth reduction per standard deviation shift in hemoglobin). Parasite growth was 2.4 fold higher after 49 days of iron supplementation relative to baseline (p<0.001) paralleling increases in erythropoiesis.

Read more about the study on EBioMedicine website on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161422/