A study of 152 rural Malawian women aged 23.2+/-5.5 y (x+/-SD) at 24 wk gestation included measurements of biochemical indexes of zinc (plasma and hair), protein (serum albumin), and infection (serum C-reactive protein, white blood cell count, and malaria), and dietary intakes (via three interactive 24-h dietary recalls). Data on health, demographic and socioeconomic status, family characteristics, reproductive history, and anthropometry were also collected. The study revealed a high prevalence of suboptimal zinc status: 36% of the women had low plasma and 46% had low hair zinc values. Median daily intake of zinc (9.0 mg) was low and poorly available: 61% was provided by cereals and 20% by flesh foods. Median intake of animal protein was only 5.6 g/d, and phytate intakes were high (1.4 g/d). Women consuming diets with phytate-zinc ratios > 17 (the median) had lower hair zinc concentrations (1.6 compared with 1.8 micromol/g, P < 0.03), were older (24 compared with 20 y, P < 0.02), and had a higher number of pregnancies (3 compared with 2, P < 0.02) than those consuming diets with a phytate-zinc ratio < 17. Frequent reproductive cycling was related to zinc status; hair zinc was higher for a prima- than for a multigravida (2.0 compared with 1.6 micromol/g, P < 0.01). Malaria prevalence was also associated with hair zinc (P < 0.05) but not with plasma zinc, after the number of pregnancies was controlled for. We conclude that low intakes of poorly available dietary zinc, frequent reproductive cycling, and malaria prevalence are three major factors in the etiology of suboptimal zinc status in these rural, pregnant Malawian women.

Pregnant women consuming plant-based diets are at risk of Zn deficiency; Zn requirements for fetal growth and maternal tissue accretion are high. Therefore we have studied, at 24 and 33 weeks gestation, the Zn status of eighty-seven pregnant rural Malawian women (mean age 22.7 years) who consume maize-based diets, using anthropometry, dietary intake data, plasma and hair Zn concentrations, and infection status via serum C-reactive protein, leucocyte count, and malaria blood smear. Of the women, 12 % were stunted (height-for-age Z score < -2 SD ) and 20 % lost weight over the 9-week period; weight gain averaged 0.13 kg/week. Mean plasma Zn concentration declined significantly from 24 to 33 weeks (7.9 (SD 2.2) v. 6.6 (SD 2.0) pmol/l; P < 0.0003). Both plasma and hair Zn values were very low; nearly 50 % of the women had both plasma and hair Zn values below acceptable cut-off values. No significant differences in biochemical Zn indices existed between those who tested positive and negative for infection. Cereals (mainly maize) provided more than two-thirds of mean energy intake compared with less than 5 % from flesh foods. As a result about 60 % of the subjects had dietary phytate : Zn molar ratios greater than 15, and more than 35 % had inadequate Zn intakes based on probability estimates and WHO basal requirements. Biochemical evidence of Zn deficiency was attributed in part to low intakes of poorly available Zn. The anthropometric, biochemical, and dietary data together indicate that Zn deficiency may be a factor limiting pregnancy outcome in rural Malawian women.

Objective: To investigate haematological and biochemical iron indices in relation to malaria, gravida, and dietary iron status in rural pregnant Malawian women. Design: In this self-selected sample, haemoglobin, haematocrit, red cell indices, serum ferritin, serum iron, serum transferrin, and serum transferrin receptor (TfR) were measured. Infection was assessed by a malaria slide, serum C-reactive protein, and white blood cell count. Dietary iron variables were measured by three 24-h interactive recalls. Setting and subjects: 152 rural pregnant women recruited at 24 weeks gestation while attending a rural antenatal clinic in Southern Malawi; 36% were primagravid; 43% were gravida 2 ± 4; 26% were gravida b 5. Results: Of the women, 69% (n 105) were anaemic (haemoglobin`110 gal); 37% (n 39) had anaemia and malarial parasitaemia on the test day; 17% (n 26) with malaria were also classi®ed with iron de®ciency (ID) anaemia (based on serum ferritin 50 mgal and Hb`110 gal) while an additional seven with malaria were classi®ed with ID without anaemia. In malarial-free subjects, 32% were classi®ed with IDA (serum ferritiǹ 12 mgal and Hb`110 gal) and 17% with ID (serum ferritin`12 mgal; Hb ! 110 gal). Serum TfR concentrations were elevated in anaemic women (P`0.01). In non-malarial parasitaemic subjects, serum TfR correlated negatively with haemoglobin (r 7 0.313; P`0.001) but not serum ferritin. Of the women, 49% were at risk for inadequate iron intakes. Most dietary iron was non-haem; plant foods provided 89%;¯esh foods (mainly ®sh) only 9%. Malarial parasitaemia and intakes of available iron impacted signi®cantly on iron status. Conclusion: Anaemia prevalence from all causes was high (that is, 69%); three factors were implicated: malaria, and de®ciencies of iron and possibly folate, induced partly by an inadequate dietary supply andaor secondary to malarial parasitaemia.