Effects of weekly iron and folic acid supplements on malaria risk in nulliparous women in Burkina Faso: a periconceptional, double-blind, randomized controlled noninferiority trial

Sabine Gies, Salou Diallo, Stephen A. Roberts, Adama Kazienga, Matthew Powney, Loretta Brabin, Sayouba Ouedraogo, Dorine W. Swinkels, Anneke J. Geurts-Moespot, Yves Claeys, Umberto D'Alessandro, Halidou Tinto, Brian Faragher, Bernard Brabin

Research output: Contribution to journalA1: Web of Science-articlepeer-review


Background. The safety of iron supplementation for young women is uncertain in malaria-endemic settings.

Methods. This was a double-blind, randomized controlled noninferiority trial in rural Burkina Faso.

Results. A total of 1959 nulliparae were assigned to weekly supplementation (60 mg iron and 2.8 mg folic acid) (n = 980) or 2.8 mg folic acid (n = 979) until first antenatal visit (ANC1), or 18 months if remaining nonpregnant. Three hundred fifteen women attended ANC1, and 916 remained nonpregnant. There was no difference at ANC1 in parasitemia prevalence (iron, 53.4% [95% confidence interval {CI}, 45.7%-61.0%]; control, 55.3% [95% CI, 47.3%-62.9%]; prevalence ratio, 0.97 [95% CI,.79-1.18]; P=.82), anemia (adjusted effect, 0.96 [95% CI,.83-1.10]; P=.52), iron deficiency (adjusted risk ratio [aRR], 0.84 [95% CI,.46-1.54]; P=.58), or plasma iron biomarkers. Outcomes in nonpregnant women were parasitemia (iron, 42.9% [95% CI, 38.3%-47.5%]; control, 39.2% [95% CI, 34.9%-43.7%]; prevalence ratio, 1.09 [95% CI,.93-1.28]; P=.282); anemia (aRR, 0.90 [95% CI,.78-1.05]; P=.17), and iron deficiency (aRR, 0.99 [95% CI,.77-1.28]; P=.96), with no iron biomarker differences.

Conclusions. Weekly iron supplementation did not increase malaria risk, improve iron status, or reduce anemia in young, mostly adolescent menstruating women, nor in early pregnancy. World Health Organization Guidelines for universal supplementation for young nulliparous women may need reassessment.

Original languageEnglish
JournalJournal of Infectious Diseases
Issue number7
Pages (from-to)1099-1109
Number of pages11
Publication statusPublished - 2018


  • iron
  • malaria
  • adolescents
  • nonpregnant
  • pregnant

Cite this