Etiology of anemia among infants, school-aged children, and young non-pregnant women in different settings of South-Central Cote d'Ivoire

Abstract

Anemia affects one-quarter of the world's population, but its etiology remains poorly understood. We determined the prevalence of anemia and studied underlying risk factors in infants (6-23 months), young school-aged children (6-8 years), and young non-pregnant women (15-25 years) in south-central Côte d'Ivoire. Blood, stool, and urine samples were subjected to standardized, quality-controlled methods. We found high prevalence of anemia, malaria, inflammation, and deficiencies of iron, riboflavin, and vitamin A but low prevalence and intensities of soil-transmitted helminth and schistosome infections. Multivariate regression analysis revealed significant associations between anemia and Plasmodium falciparum for infants, inflammation for school-aged children, and cellular iron deficiency for both school-aged children and non-pregnant women. Women with riboflavin deficiency had significantly lower odds of anemia. Our findings call for interventions to protect infants from malaria, improved intake of dietary iron, better access to health care, and health education.

Figure 1.

Study sites. The study was embedded in the recently established Taabo HDSS located in south-central Côte d'Ivoire. Taabo HDSS covers the area around Lake Taabo. This survey was conducted in three settings: Taabo Cité, the only small town; Ahondo, 1 of 13 main villages in close proximity to Lake Taabo; and Katchénou, considered as 1 of over 100 small hamlets at the time of the survey and situated 55 km south of Taabo Cité. Modified from the work by Glinz and others.

Figure 2.

Study participation and compliance. Diagram detailing the study participation of infants (6–23 months), school-aged children (6–8 years), and non-pregnant women (15–25 years) from Taabo Cité, Ahondo, and Katchénou in April of 2010. Individuals who provided at least one urine and/or one stool sample were considered for additional analyses. Blood samples from individuals with a complete parasitologic dataset were analyzed for nutrition parameters and inflammatory markers. Pregnant women were not considered for the final analyses. AGP = α1-acid glycoprotein; CRP = C-reactive protein; Hb = hemoglobin; RBP = retinol binding protein; sTfR = soluble transferrin receptor.

Figure 3.

(A) Prevalence of P. falciparum, soil-transmitted helminth, and schistosome infection (n = 375), acute inflammation (n = 251), chronic inflammation (n = 251), storage iron depletion (n = 251), cellular iron deficiency (n = 251), VAD (based on SR values; n = 221), VAD (based on RBP values; n = 251), and riboflavin deficiency (n = 251), stratified by age group. (B) Prevalence of P. falciparum, soil-transmitted helminth, and schistosome infection (n = 375), acute inflammation (n = 251), chronic inflammation (n = 251), storage iron depletion (n = 251), cellular iron deficiency (n = 251), VAD (based on SR values; n = 221), VAD (based on RBP values; n = 251), and riboflavin deficiency (n = 251), stratified by locality. The prevalence of micronutrient deficiency is calculated for participants with complete parasitologic datasets but without acute inflammation (CRP ≤ 10 mg/L) in the Taabo HDSS in April of 2010. AGP = α1-acid glycoprotein; CRP = C-reactive protein; EGRAC = erythrocyte glutathione reductase activity coefficient; sTfR = soluble transferrin receptor.