Iron supplementation did not improve cognitive development among infants in southern Malawi, according to a randomised clinical trial involving 2168 infants enrolled at 6 months of age.
The trial evaluated whether routine supplementation with iron syrup or iron-containing micronutrient powders, alongside malaria chemoprevention, improved functional outcomes. The study population included a high proportion of infants with anaemia, with 71% affected at enrolment.
Participants received one of the interventions for 6 months, with outcomes compared with malaria chemoprevention alone and placebo. Cognitive development was assessed when children were 1 year and 18 months of age.
The data showed no effect on cognitive development from either form of iron supplementation when compared with malaria chemoprevention alone.
Infants receiving iron syrup alongside malaria chemoprevention did not demonstrate improved cognitive outcomes at either assessment point. Similarly, iron-containing micronutrient powders given with malaria chemoprevention produced no improvement in cognitive development at 1 year or 18 months.
The study also found no cognitive benefit when malaria chemoprevention alone was compared with placebo alone.
These findings were observed despite the high prevalence of anaemia among the infants enrolled, suggesting that routine supplementation during the intervention period did not translate into measurable improvements in the cognitive outcomes assessed.
The findings indicated that routine iron supplementation from 6 months to 1 year of age did not provide short or medium-term cognitive benefits in this malaria-endemic setting.
The results are relevant to approaches that use iron supplementation as part of interventions intended to improve developmental outcomes among infants living in areas where malaria is prevalent.
However, the findings specifically addressed cognitive outcomes measured at 1 year and 18 months and did not demonstrate benefits from the tested supplementation strategies over this period. The trial therefore provided no evidence that routine iron syrup or iron-containing micronutrient powders improved cognitive development in this population.
Further consideration of supplementation strategies should take account of the specific clinical and epidemiological context in which they are used, including the high burden of anaemia and malaria represented in this study.
Reference
Phiri KS et al. Iron or multiple micronutrient powder supplements with malaria chemoprevention in rural malawian children: the IRMA randomized clinical trial. JAMA. 2026; doi: 10.1001/jama.2026.12242.
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