Relative Contributions of Malaria, Inflammation, and Deficiencies of Iron and Vitamin A to the Burden of Anemia during Low and High Malaria Seasons in Rural Zambian Children.

Abstract

OBJECTIVE:

To estimate the burden of anemia attributable to malaria, inflammation, and deficiency of iron or vitamin A during low and high malaria seasons among Zambian children.

STUDY DESIGN:

From a cohort of children (n = 820), 4-8 years of age participating in a randomized controlled trial of pro-vitamin A, we estimated attributable fractions for anemia (hemoglobin of <110 or 115 g/L, by age) owing to current malaria or inflammation (C-reactive protein of >5 mg/L, or α-1 acid glycoprotein of >1 g/L, or both), and current or prior iron deficiency (ID; defined as low ferritin [<12 or 15 μg/L for age <5 or >5 years] or functional ID [soluble transferrin receptor of >8.3 mg/L] or both) and vitamin A deficiency (retinol of <0.7 μmol/L), during low and high malaria seasons, using multivariate logistic regression. Serum ferritin, soluble transferrin receptor, and retinol were adjusted for inflammation.

RESULTS:

The burden of anemia independently associated with current malaria, inflammation, ID, and vitamin A deficiency in the low malaria season were 12% (P < .001), 6% (P = .005), 14% (P = .001), and 2% (P = .07), respectively, and 32% (P < .001), 15% (P < .001), 10% (P = .06), and 2% (P = .06), respectively, in the high malaria season. In both seasons, functional ID was independently associated with more anemia (approximately 11%) than low ferritin (approximately 4%). Anemia and ID in the low malaria season, accounted for 20% (P < .001) and 4% (P = .095) of the anemia in the subsequent high malaria season.

CONCLUSIONS:

Anemia in this population is strongly linked to malaria, inflammation, and functional ID, and to a lesser extent, low iron stores. Integrated control strategies are needed.

• Authors: Maxwell A Barffour, Kerry J Schulze, Ng'andwe Kalungwana, William J Moss, Keith P West Jr, Justin Chileshe, Ward Siamusantu, Amanda C Palmer
• Journal: The Journal of pediatrics (J Pediatr) Vol. 213 Pg. 74-81.e1 (10 2019) ISSN: 1097-6833 [Electronic] United States
• PMID: 31402145 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Anemia (diagnosis, epidemiology)
• Child
• Child, Preschool
• Cohort Studies
• Cost of Illness
• Female
• Humans
• Inflammation (complications)
• Iron Deficiencies
• Malaria (complications, epidemiology)
• Male
• Prevalence
• Rural Health
• Vitamin A Deficiency (complications)
• Zambia