用于疟疾流行地区儿童的口服铁补充剂
Michael Itzkovich1,2, Ami Neuberger3, Itai Harris4,5
1Infectious Diseases Unit, Sheba Medical Center, Ramat Gan, Israel.
The Cochrane database of systematic reviews
|January 9, 2026
概括
在疟疾流行地区的儿童中补充铁对临床疟疾几乎没有影响,但如果疟疾预防服务有限,可能会增加风险. 将铁与抗疟疾治疗结合起来,可显著降低疟疾发病率.
科学领域:
- 公共卫生和热带医学
- 营养科学 营养科学
- 儿科 儿科 儿科
背景情况:
- 缺铁性贫血是居住在疟疾流行地区的儿童中普遍存在的营养障碍,与不利的健康和发育结果有关.
- 人们担心铁补充剂可能会通过促进寄生虫生长而加剧疟疾风险,特别是在疟疾预防和治疗不足的地方.
研究的目的:
- 评估铁补充剂的有效性和安全性,包括叶酸或没有叶酸,在生活在疟疾传播强烈,全年持续的地区的儿童中.
- 评估铁补充剂对临床疟疾,严重疟疾,死亡率和疟疾流行区儿科人口住院病例的影响.
主要方法:
- 一个系统的审查和对个人和集群随机对照试验 (RCTs) 的元分析,涉及疟疾流行地区的18岁以下儿童.
- 搜索了多个数据库 (CENTRAL,MEDLINE,Embase,Global Index Medicus) 和试验登记册,直到2024年4月,包括2025年5月的搜索更新.
- 包括的试验比较了铁 (单独或与叶酸) 与安慰剂/不治疗,或铁加抗疟疾治疗与安慰剂/不治疗,临床疟疾,严重疟疾和死亡等关键结果.
主要成果:
- 仅铁补充剂对临床疟疾风险几乎没有差异 (高确定性证据),但略有降低了严重疟疾风险 (高确定性证据).
- 在有疟疾预防服务的地区,补充铁可能会略微减少临床疟疾;然而,在缺乏这些服务的地区,它可能会略微增加临床疟疾风险 (低确定性证据).
- 结合铁和抗疟疾预防,显著减少了临床疟疾 (高确定性证据) 和住院/诊所访问 (中等确定性证据).
结论:
- 补充铁通常对临床疟疾风险几乎没有影响,但其管理需要仔细考虑当地疟疾预防和管理能力.
- 在资源有限的环境中,如果有有效的疟疾控制措施,可以在没有先前贫血查的情况下提供铁.
- 结合抗疟疾预防的铁补充剂在减少儿童疟疾发病率和相关医疗保健利用方面非常有效.
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