Genetic Hemoglobin Disorders, Infection, and Deficiencies of Iron and Vitamin A Determine Anemia in Young Cambodian Children

Abstract

In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α1-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6–11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12–23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.

Determinants of Anemia among Preschool Children in Rural, Western Kenya

“…However, neither condition was associated with a majority of cases of anemia, which may challenge the estimation that 50% of cases of anemia in malaria-endemic areas is caused by iron deficiency 4. George and others27 recently examined the association of genetic disorders and other factors with anemia in Cambodia; however, the association of these disorders with severe anemia, a risk factor for mortality, was not examined. Furthermore, no estimate was made of the relative contribution of each of these factors to anemia in the population.…”

The influence of vitamin A status on iron-deficiency anaemia in anaemic adolescent schoolgirls in Myanmar

“…For example, a recent study from Cambodia showed SCI (i.e. elevated AGP) was a significant risk factor for anaemia among young children (16) . Similarly, another study from Papua New Guinea highlighted that SCI (i.e.…”

“…In South-East Asia, tropical diseases such as malaria, dengue and haemorrhagic fever, worm infestations and genetic Hb disorders are common and all contribute to anaemia (16,17) . In Myanmar, reports show that malaria and dengue fever are the leading causes of morbidity and mortality and worm infestations are also common in the country (18,19) .…”

Erythroid‐extrinsic regulation of normal erythropoiesis by retinoic acid receptors

“…Epidemiological studies (Calis et al, 2008;George et al, 2012), and early nutrition-based animal models (Hodges et al, 1978) found a strong association of vitamin A deficiency with anaemia in humans. Indeed, anaemia associated with nutritional deficiencies including vitamin A deficiency is a serious health problem, especially in developing countries.…”