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What is the Project?
Why is there a need for the Project?
What are the goals of the Project?

What is the Project?

In November 2007, the NICHD launched the Iron and Malaria Project to identify and examine factors that affect the safety and effectiveness of interventions to prevent iron deficiency in the context of malaria and other infections. 

The Project is funded, in part, by the Bill and Melinda Gates Foundation with additional support from the NIH Office of Dietary Supplements. The Project aims not only to generate new data to address this high-priority global health issue, but also to support efforts of the World Health Organization (WHO) to develop evidence-based guidelines with specific regard to the use of iron interventions.

The Project and its goals grew out of new research that examined historical concerns about the safety of iron supplementation and, in particular, evidence of an increased risk for poor health outcomes among those (primarily young children) who were not iron deficient, but who received iron supplementation as part of “universal” supplementation programs in regions where malaria and other infections are common.

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Why is there a need for the Project?

The Iron and Malaria Project is needed because current research evidence does not provide a clear consensus for best practices related to the prevention of iron deficiency in malaria-prone areas.

By some estimates, nearly 1 billion people in the world are iron deficient, a condition that—in women, pregnant women, and children—can cause problems with:

  • Production of healthy red blood cells that carry oxygen throughout the body;
  • Neurological function (resulting in poor learning and behavioral development);
  • Immune function; and
  • Physical development.

To combat the negative health effects of iron deficiency, the global health community, led by the WHO, recommends iron interventions to prevent and treat iron deficiency particularly among women and children. These policies External Web Site Policy are widely implemented as part of global health and nutrition programs.

Recent research findings have cast doubt on whether universal iron supplementation is the best approach for preventing and treating iron deficiency. Research suggests potential adverse effects of iron supplementation, especially in malaria-prone regions and especially among those who were not iron deficient prior to receiving supplements (particularly as pills/liquids). 

In 2006, a WHO-convened consultation group determined that “universal iron supplementation (i.e., use of medicinal iron such as tablets or syrups) should not be implemented without the screening of individuals for iron deficiency, because this mode of iron administration may cause severe adverse events in iron-sufficient children.” The group’s full recommendations are available at: Conclusions and recommendations of the WHO Consultation on prevention and control of iron deficiency in infants and young children in malaria-endemic areas. Food and Nutrition Bulletin. 2007 Dec;28(4 Suppl):S621-27.
Implementing this recommendation is difficult because no clear consensus currently exists on the best methods of screening for iron deficiency in the context of infection and inflammation. Testing for iron status is also not widely available, and lack of resources further limits the feasibility of this approach.
The Iron and Malaria Project was created to respond to these issues and concerns by generating new data to identify:

  • The potential mechanisms to explain potential adverse effects of iron in the context of infections including malaria;
  • Biomarkers that would be most effective for assessing iron status particularly in the context of infections and inflammation; and
  • Safe and effective interventions for preventing and treating iron deficiency particularly in infants, young children, and women.

Ultimately the goal of the Project is to support the global health community’s efforts to develop a clear consensus for best practices related to the assessment, prevention, and treatment of iron deficiency in areas prone to malaria and other infections.

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What are the goals of the Project?

The primary focus of the Iron and Malaria Project is to establish best practices with regard to preventing and treating iron deficiency in populations that live in regions where malaria and other infections are endemic.

Project scientists will evaluate the current information and generate new data to address gaps in the field’s knowledge about iron, malaria, and their interactions and to support efforts to translate those data into new evidence based programs and policies. To achieve its goals, the Project includes two parallel tracks: the Research track will support high-quality research to fill urgent scientific and knowledge gaps related to iron and malaria; the Translational track will integrate and evaluate findings and contribute to evidence-based policies issued by the WHO.
The Research track focuses on the following three research objectives:

  • Defining plausible mechanisms of immune function and mechanisms by which iron may interact with infections, particularly malaria
  • Identifying biomarkers of exposure (i.e., diet and disease), status, and function that could be most useful for preventing and treating iron deficiency, particularly in resource-limited settings
  • Determining the safety and effectiveness of different iron preparations and iron-related interventions for preventing and treating iron deficiency

To address these research priorities, the NICHD issued a Funding Opportunity Announcement (FOA) in 2008 related to iron and malaria. The FOA was re-issued in 2009:

Information on projects funded through these FOAs is available through the NIH’s Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) Web site:

The Project leadership established a Technical Working Group (TWG) to synchronize the aims of the project and provide scientific oversight. The TWG includes researchers and representatives from partnering agencies. The TWG was subsequently expanded to create a Research Review Committee (RRC), which includes additional experts and investigators funded under the Iron and Malaria Project. Together, these bodies provide: scientific advice and guidance to the NICHD Iron and Malaria Project staff on the Project’s overall research directions; specific input regarding progress of funding project; and advice about potential new areas that might be relevant to the Project.

Within the translational track, a major focus has been the TWG drafting a Full Technical Report, which includes comprehensive reviews of the three core research areas: mechanisms, biomarkers, and interventions. An executive summary of the Full Technical Report was published in the International Journal of Vitamin and Nutrition Research. As new data become available from studies supported under the Iron and Malaria Project and other sources, the TWG will update the Full Technical Report. In addition to informing the research community about the current state of the science on iron and malaria, the Full Technical Report was also delivered to the WHO in support of its efforts to create new guidelines for the safe and effective use of iron interventions in malaria-endemic areas.

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Last Reviewed: 12/08/2011
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