Estimating the burden of iron deficiency among African children

Abstract

Background: Iron deficiency (ID) is a major public health burden in African children and accurate prevalence estimates are important for effective nutritional interventions. However, ID may be incorrectly estimated in Africa because most measures of iron status are altered by inflammation and infections such as malaria. Through the current study, we have assessed different approaches to the prediction of iron status and estimated the burden of ID in African children. Methods:We assayed iron and inflammatory biomarkers in 4853 children aged 0-8 years from Kenya, Uganda, Burkina Faso, South Africa, and The Gambia. We described iron status and its relationship with age, sex, inflammation, and malaria parasitemia. We defined ID using the WHO guideline (ferritin < 12 μg/L or < 30 μg/L in the presence of inflammation in children < 5 years old or < 15 μg/L in children ≥ 5 years old). We compared this with a recently proposed gold standard, which uses regression-correction for ferritin levels based on the relationship between ferritin levels, inflammatory markers, and malaria. We further investigated the utility of other iron biomarkers in predicting ID using the inflammation and malaria regression-corrected estimate as a gold standard. Results: The prevalence of ID was highest at 1 year of age and in male infants. Inflammation and malaria parasitemia were associated with all iron biomarkers, although transferrin saturation was least affected. Overall prevalence of WHOdefined ID was 34% compared to 52% using the inflammation and malaria regression-corrected estimate. This unidentified burden of ID increased with age and was highest in countries with high prevalence of inflammation and malaria, where up to a quarter of iron-deficient children were misclassified as iron replete. Transferrin saturation < 11% most closely predicted the prevalence of ID according to the regression-correction gold standard. Conclusions: The prevalence of ID is underestimated in African children when defined using the WHO guidelines, especially in malaria-endemic populations, and the use of transferrin saturation may provide a more accurate approach. Further research is needed to identify the most accurate measures for determining the prevalence of ID in sub-Saharan Africa.

Prevalence of Anemia, Iron-Deficiency Anemia, and Associated Factors among Children Aged 1–5 Years in the Rural, Malaria-Endemic Setting of Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study

“…Gebreegziabher et al [ 17 ] reported the same situation in rural southern Ethiopia among women of reproductive age. By contrast, Muriuki et al investigated iron prevalence across five countries in Africa [ 18 ] and found a much higher pooled prevalence of ID, 34.3%. The difference might be due to the high prevalence of malaria and inflammation in our population.…”

“…Motadi et al [ 19 ] also found a much higher prevalence according to TSAT (12%) than adjusted ferritin (2.3%). Moreover, Muriuki et al [ 18 ] reported that TSAT is the most sensitive and specific marker compared to the gold standard, which is regression with adjusted ferritin in African children. Dignass et al [ 20 ] also suggested the use of TSAT rather than ferritin in the context of chronic inflammatory diseases.…”

A review of micronutrient deficiencies and analysis of maize contribution to nutrient requirements of women and children in Eastern and Southern Africa

“…Anemia is defined as hemoglobin levels below 11 g/dL in children 6-50 months, and below 11.5 g/dL in children aged over 5 years (WHO 2018(WHO , 2011. It was estimated that about half of all anemia is attributable to iron deficiency depending on the geographic and disease environment (Darnton-Hill and Mkparu 2015), but recent studies show that the prevalence of iron deficiency is underestimated in African children, and is much lower than that of anemia (Lemoine and Tounian 2020;Muriuki et al 2020). In fact, ferritin is a good indicator of the body's iron stores, but it is not a specific reflection, with both inflammation and infection causing an increase: the use of transferrin saturation may provide a more accurate approach (Muriuki et al 2020).…”

“…It was estimated that about half of all anemia is attributable to iron deficiency depending on the geographic and disease environment (Darnton-Hill and Mkparu 2015), but recent studies show that the prevalence of iron deficiency is underestimated in African children, and is much lower than that of anemia (Lemoine and Tounian 2020;Muriuki et al 2020). In fact, ferritin is a good indicator of the body's iron stores, but it is not a specific reflection, with both inflammation and infection causing an increase: the use of transferrin saturation may provide a more accurate approach (Muriuki et al 2020). Accurate epidemiological data on the prevalence of iron deficiency are difficult to obtain due to the many compounding factors, especially infections and general inflammation (Lemoine and Tounian 2020).…”

“…Therefore, interventions to improve iron intake should be targeted to strictly iron-deficient subjects (Mwangi et al 2017). This emphasizes the necessity of precise measurement of iron deficiency in children (Muriuki et al 2020).…”