Etiology of Anemia Among Infants, School-Aged Children, and Young Non-Pregnant Women in Different Settings of South-Central Côte d'Ivoire

Aurélie A. Righetti Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Ahou-Yah G. Koua Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Lukas G. Adiossan Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Dominik Glinz Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Richard F. Hurrell Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Eliézer K. N'Goran Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Sébastien Niamké Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Rita Wegmüller Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Jürg Utzinger Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire; Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire; Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire

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Anemia affects one-quarter of the world's population, but its etiology remains poorly understood. We determined the prevalence of anemia and studied underlying risk factors in infants (6–23 months), young school-aged children (6–8 years), and young non-pregnant women (15–25 years) in south-central Côte d'Ivoire. Blood, stool, and urine samples were subjected to standardized, quality-controlled methods. We found high prevalence of anemia, malaria, inflammation, and deficiencies of iron, riboflavin, and vitamin A but low prevalence and intensities of soil-transmitted helminth and schistosome infections. Multivariate regression analysis revealed significant associations between anemia and Plasmodium falciparum for infants, inflammation for school-aged children, and cellular iron deficiency for both school-aged children and non-pregnant women. Women with riboflavin deficiency had significantly lower odds of anemia. Our findings call for interventions to protect infants from malaria, improved intake of dietary iron, better access to health care, and health education.

Author Notes

* Address correspondence to Jüerg Utzinger, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, PO Box, CH-4002 Basel, Switzerland. E-mail: juerg.utzinger@unibas.ch

Financial support: This work was supported by the Swiss National Science Foundation (project no. IZ70Z0_123900). Start-up funding for the establishment and running of the Taabo HDSS has been granted by Fairmed. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors' addresses: Aurélie A. Righetti and Jürg Utzinger, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland, E-mails: aurelie.righetti@unibas.ch and juerg.utzinger@unibas.ch. Ahou-Yah G. Koua and Sébastien Niamké, Laboratoire de Biotechnologies, Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire, E-mails: kouayahgisele@yahoo.fr and niamkes@yahoo.fr. Lukas G. Adiossan, Hôpital Général de Taabo, Taabo Cité, Côte d'Ivoire, E-mail: adiossanlukas@yahoo.fr. Dominik Glinz, Richard F. Hurrell, and Rita Wegmüller, Laboratory of Human Nutrition, Institute of Food, Nutrition, and Health, ETH Zurich, Zurich, Switzerland, E-mails: dominik.glinz@hest.ethz.ch, richard.hurrell@hest.ethz.ch, and rita.wegmueller@hest.ethz.ch. Eliézer K. N'Goran, Laboratoire de Zoologie Biologie Animale, Unité de Formation et de Recherche Biosciences, Université de Cocody, Abidjan, Côte d'Ivoire, E-mail: eliezerngoran@yahoo.fr.

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