High Prevalence of Anemia but Low Level of Iron Deficiency in Preschool Children during a Low Transmission Period of Malaria in Rural Kivu, Democratic Republic of the Congo

Abstract

Anemia is a worldwide public health concern especially in preschool children in developing countries and iron deficiency (ID) is generally assumed to cause at least 50% of the cases. However, data on this contribution are scarce. To close this gap, we determined in 2013 the contribution of ID in the etiology of anemia and measured others factors associated to noniron deficiency anemia (NIDA) in 900 preschool children randomly selected during a two-stage cluster nutritional survey in the Miti-Murhesa health zone, in eastern Democratic Republic of the Congo. In these children, we collected sociodemographic, clinical, and biological parameters and determined the nutritional status according to the World Health Organization 2006 standards. Anemia was defined as altitude-adjusted hemoglobin < 110 g/L and ID was defined as serum ferritin < 12 μg/L or < 30 μg/L in the absence or presence of inflammation, respectively. Median (interquartile range) age was 29.4 (12-45) months. The prevalence of anemia was 46.6% (391/838) among whom only 16.5% (62/377) had ID. Among children without signs of inflammation, only 4.4% (11/251) met the ferritin-based (unadjusted) definition of ID. Logistic regression analysis identified ID, history of fever during the last 2 weeks and mid-upper arm circumference < 125 mm as the only independent factors associated to anemia. In conclusion, anemia is a severe public health problem in the Miti-Murhesa health zone, but NIDA is mostly predominant and needs to be further studied. Control of infections and prevention of acute undernutrition (wasting) are some of appropriate interventions to reduce the burden anemia in this region.

Malaria Is More Prevalent Than Iron Deficiency among Anemic Pregnant Women at the First Antenatal Visit in Rural South Kivu

“…Similar results have been reported among WCBA and preschool children from the region. 26,46 It is important to identify other etiologies of anemia in the South Kivu province and in the entire country or even the whole region to design more effective interventions. Etiology might be context specific.…”

Malaria and Iron Load at the First Antenatal Visit in the Rural South Kivu, Democratic Republic of the Congo: Is Iron Supplementation Safe or Could It Be Harmful?

“…5,6 A similar low ID prevalence was also found in preschool children in the same area. 4,5 As mentioned previously, elsewhere IS has been associated with a higher risk of malaria during pregnancy 9 and a higher risk of morbidity and mortality due to infectious diseases, including malaria, among preschool children. 10 According to published data from others settings, ID may protect against PAM.…”

“…3 This policy is being implemented in most sub-Saharan African countries, including the Democratic Republic of Congo (DRC). However, recent data from South Kivu, in the eastern part of DRC, show a lower-than-expected prevalence of ID 4,5 and further raise questions on the possible negative outcome of IS on malaria. In South Kivu, prevalence of ID was 5.4% among nonpregnant women 5 and 7.6% among pregnant women.…”

Early Childhood Anemia in a Birth Cohort in Coastal Kenya: Links to Infection and Nutrition

“…Other causes include dietary insufficiencies of folate and vitamin B 12 , acute blood loss from parasitic infection, chronic hemolysis, thalassemia and other hemoglobinopathies, and anemia of chronic inflammation. 6–9 The role of parasitism in anemia has been addressed in recent articles, 10–13 with anemia specifically linked to certain parasite infections, including malaria, 12,14,15 hookworm, 11,16 and Schistosoma infection. 7 Anemia of chronic inflammation with hepcidin-associated iron sequestration is another established cause of chronic anemia in parasite-endemic areas, 15,17 but low dietary iron intake and impaired nutritional status in the same at-risk locations can yield mixed patterns of iron-deficiency + inflammation-related anemia.…”