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Effect modifiers for the safety and efficacy of iron intervention in the context of malaria: A review of data for an individual patient based meta‐analysis
Author(s) -
Namaste Sorrel,
Ashour Fayrouz,
Porter Alexandra,
Raghavan Ramkripa,
Pilch Susan,
Raiten Daniel
Publication year - 2012
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.26.1_supplement.1021.3
Subject(s) - medicine , context (archaeology) , meta analysis , malaria , psychological intervention , clinical trial , anthropometry , randomized controlled trial , biomarker , environmental health , immunology , nursing , paleontology , biochemistry , chemistry , biology
Objective To evaluate the safety and efficacy of iron interventions in regions with malaria, a review was undertaken to determine the extent of data that could be utilized in an individual patient data (IPD) meta‐analysis. IPDs are particularly useful in assessing the heterogeneity of treatment effects and thus lend themselves to examining the influence of risk modifiers. Methods Eligible randomized trials were identified using computerized and manual searches. Studies were stratified by iron status, age, malaria patterns, and iron mode. The number of studies and the upper/lower expected pooled sample size range was calculated. Results A total of 3,602 trials were screened, 523 underwent text review and 165 included. There were 106 supplementation and 50 fortification trials; mainly in meso (50%) and hyperendemic (29%) regions. Serum ferritin was the predominant iron biomarker (n=27, 12,122–17,671 >2yr; n=47, 17,891–34,305 >5yr; n=9, 3,026 pregnancy) and was rarely accompanied by CRP or AGP. Anthropometry was the most frequent health endpoint (52%), followed by morbidity (44%), and clinical malaria (12%). Conclusion There are sufficient studies to warrant an IPD. However, the limitations in the number and nature of studies highlight the need for a more robust research agenda, including well designed protocols to support nutrition programs and policy. Support: Bill & Melinda Gates Foundation; NIH