Until 2006, micronutrient supplements in the order of recommended dietary allowance (RDA) dosages, including that for iron, were considered inherently safe (1). The RDA values for iron for children in this age bracket are based on estimates to cover the requirements for growth and metabolism and to replace iron losses. The corresponding upper level (UL) for safe dietary intake in children is 40 mg Fe/d (2), based on side effects after oral intake in the form of supplements; this suggests a relatively broad margin of safety for iron in children. In this context, the WHO recommendation to supplement 12.5 mg Fe + 50 μg folic acid when the prevalence of anemia exceeded 40% in children 6–36 months of age (3) seemed safe and prudent. This continuum of assumptions was severely disturbed when an excess number of hospital admissions and deaths occurred in malaria-exposed children during iron supplementation.
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