In Botswana, there is limited data available on the health and nutritional status of the San People (also known as the Basarwa or Bushmen), an Indigenous minority group primarily living in the Ghanzi District. Our aim in this study was to assess anemia prevalence among and anthropometric indices of women and young children in Ghanzi District through a cross-sectional survey. We recruited 367 mother–child pairs (women 15–49 years and children 6–59 months) in nine randomly selected areas. A capillary blood sample was collected, and weight and height were measured. Hemoglobin (Hb) concentration was measured with use of a hemoglobinometer (HemoCue, AB), as per global recommendations. Overall, adjusted anemia prevalence was 12% in non-pregnant women (Hb < 120 g/L), 26% in pregnant women (Hb < 110 g/L), and 42% in children (Hb < 110 g/L), but it varied widely depending on whether or not the controversial factor of ethnicity was adjusted for (range of 6–26%, 22–30%, and 35–68% prevalence, respectively). Thirty-nine percent (n = 133/344) of non-pregnant women and 52% (n = 12/23) of pregnant women were underweight (BMI < 18.5 kg/m2). In children aged 6–23 months, 41% were underweight (weight-for-age z-score < −2 SD), 13% were wasted (weight-for-height z-score < −2 SD), and 65% were stunted (height-for-age z-score < −2 SD); in children aged 24–59 months, 57% were underweight, 13% were wasted, and 66% were stunted. Fifty-six percent (n = 205/367) of women self-reported smoking in any form (rolled cigarettes or snuffing). The high prevalence of smoking among women, underweight status among pregnant women, and anemia, stunting, and wasting among children is of the highest concern for public health and should be addressed in future health and nutrition programming.
Genetic hemoglobinopathies are the most common single-gene disorder worldwide. Some automated hematology analyzers have the capability of flagging individuals who may have hematological disorders based on complete blood count (CBC) biomarkers. We aimed to evaluate the accuracy of a hematology analyzer in identifying genetic hemoglobinopathies in Cambodian women and to determine which hematological biomarkers are the best predictors. A CBC was completed using a Sysmex XN-1000 analyzer and hemoglobinopathies were determined with capillary hemoglobin electrophoresis for 808 nonpregnant Cambodian women. Sysmex XN-1000 Interpretive Program (IP) messages, which flag potential hematological disorders, were produced from CBC results. Then, 2 × 2 tables were used to determine sensitivity and specificity of the IP message “Hemoglobin defect” to detect a genetic hemoglobinopathy. Receiver operating characteristic (ROC) analyses assessed the diagnostic ability of six CBC biomarkers to predict a genetic hemoglobinopathy. In total, 74% of women had a hemoglobinopathy (predominantly Hb E and α-thalassemia). “Hb defect” IP message sensitivity and specificity for genetic hemoglobinopathy detection were 10.4% and 98.6%, respectively. Variable selection strategies yielded a two-variable model including mean corpuscular volume (MCV) and red blood cell (RBC) count (AIC = 99.83, AUCROC = 0.98 (95% CI: 0.97, 0.99)) for the prediction of a homozygous EE disorder. Sensitivity and specificity values do not justify the use of Sysmex XN-1000 IP flag messages for identification of genetic hemoglobinopathies in Cambodian women. Development of an algorithm based on MCV and RBC biomarkers may optimize the screening ability of automated hematology analyzers.
Objectives Globally, Indigenous women and young children disproportionately face increased nutritional risks, which may have serious adverse health consequences. In Botswana, data is limited on the health and nutritional status of the San People, an Indigenous minority group primarily living in the Ghanzi District. This cross-sectional study aimed to assess the prevalence of anemia and undernutrition among San women and young children in Ghanzi District. Methods We recruited 367 mother-child pairs (women 15–49 years and children 6–59 months) from San households from nine randomly selected areas. A capillary blood sample was collected, and weight and height were measured in both mothers and children. Hemoglobin (Hb) concentration was measured using a hemoglobinometer (HemoCue, AB). As per global recommendations, Hb concentrations were adjusted for altitude, smoking (in women), and ethnicity. Results Fifty-six % (n = 205/367) of women self-reported smoking in any form (rolled cigarettes or snuffing). Overall, adjusted anemia prevalence was 12% in non-pregnant women (Hb < 120 g/L), 26% in pregnant women (Hb < 110 g/L), and 42% in children (Hb < 110 g/L); but ranged widely based on the controversial factor of whether or not adjustments for ethnicity were applied (range of 6–26%, 22–30% and 35–68% prevalence, respectively). Thirty-nine % (n = 133/344) of non-pregnant women and 52% (n = 12/23) of pregnant women were underweight (BMI < 18.5 kg/m2). In children 6–23 months, 41% were underweight (weight-for-age z-score < -2SD), 13% were wasted (weight-for-height z-score < -2SD), and 65% were stunted (height-for-age z-score < -2SD); in children 24–59 months 57% were underweight, 13% were wasted and 66% were stunted. Conclusions The high prevalence of smoking among women, underweight status among pregnant women, and anemia, stunting, and wasting among children were of the highest public health concern and should be addressed in future health and nutrition programming. These findings will inform and guide targeted nutrition and health policies for the San People and potentially motivate more research with other Indigenous groups. Funding Sources International Development Research Centre (Doctoral Research Award), Botswana International University of Science and Technology (Ph.D. Fellowship), and University of British Columbia (Public Scholar Initiative).
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