Investigating The Causal Relationship Between Iron Status And Malaria In African Children

Iron deficiency (ID) and malaria are co-existing and common causes of ill health in African children. In this thesis, I aimed to determine: 1) a more accurate estimate of the burden of ID in African children by adjusting for the influence of infections on iron biomarkers; 2) whether malaria causes ID; 3) whether iron status influences malaria risk; and 4) whether a mutation in the ferroportin coding gene, FPN Q248H, influences iron status, anaemia and risk of malaria. Among 4,853 children from community-based cohorts across Africa, the overall prevalence of ID was 52% using an inflammation and malaria regression-corrected estimate of ID, compared to a WHO-defined estimate of 34%. This WHO unidentified burden of ID increased with age and was highest in countries with high prevalence of inflammation and malaria, where up to a quarter of iron-deficient children were misclassified as iron replete. Transferrin saturation (TSAT) was least affected by inflammation and malaria and TSAT