| The assessment of the true burden of iron deficiency (ID) has been plagued by influence of infection, especially in developing countries. Common and recurrent infections, such as malaria and human immunodeficiency virus (HIV) infection may impact the evaluation of iron status of the population. This makes ID monitoring in these areas difficult, as inflammation influences hemoglobin (Hb), ferritin (SF), zinc protoporphyrin (ZP), and to some extent soluble transferrin receptors (TfR). Further, in the absence of a non-invasive or feasible gold standard, the stages of ID are best characterized by use of multiple-indices. However, the choice of an appropriate single iron biomarker to replace the multiple-criteria model (use of ≥3 tests of iron status) for screening for ID at population level in resource poor and remote field settings continues to be a critical need.;Diarrhea and respiratory illnesses are leading causes of death in children less than 5 years. Sprinkles have been shown to be effective against diarrhea and febrile illnesses. However, issues surrounding the use of sprinkles in resource poor settings include the need for daily supplementation.;Our study suggests that subclinical inflammation (indicated by C-reactive protein/CRP and alpha-1-acid-glycoprotein/AGP) affects TfR, ZP and SF and not correcting for such inflammation alters the measures of ID. In the absence of a gold standard for iron status indicator the multiple-criteria model can be used to assess iron deficiency, and that TfR was as accurate as the multiple-criteria model in assessing the prevalence of ID in preschool children. Additionally, when multiple-micronutrient powder, Sprinkles, is distributed under non-experimental conditions it helps reduce the incidence of both diarrhea and fever in preschool children.;Studies aimed at assessing the iron status of children in resource poor, high inflammation settings should include both CRP and AGP as inflammatory biomarkers to accurately determine the true prevalence of ID. Also, Sprinkles distribution through an integrated health promotion and income-generating program should be considered in an effort to improve child health in resource poor, and high inflammation settings. |
