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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
Esto Bahizire
Esto Bahizire
Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, Democratic Republic of the Congo;
Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium;
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Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium;
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Paluku Bahwere
Paluku Bahwere
Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium;
Valid International, Oxford, United Kingdom;
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Valid International, Oxford, United Kingdom;
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Philippe Donnen
Philippe Donnen
Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium;
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P. Lundimu Tugirimana
P. Lundimu Tugirimana
Department of Clinical Biology, National University of Rwanda, Kigali, Rwanda;
Faculty of Medicine, Université de Goma, Goma, Democratic Republic of the Congo;
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Faculty of Medicine, Université de Goma, Goma, Democratic Republic of the Congo;
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Serge Balol'ebwami
Serge Balol'ebwami
Department of Pediatrics, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo;
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Michèle Dramaix
Michèle Dramaix
Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium;
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Chouchou Nfundiko
Chouchou Nfundiko
National Program of Nutrition, Division Provinciale de la Santé du Sud-Kivu, Bukavu, Democratic Republic of the Congo;
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Raphaël Chirimwami
Raphaël Chirimwami
Department of Pathology, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo;
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Kanigula Mubagwa
Kanigula Mubagwa
Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium
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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.
Author Notes
Financial support: This study was partially supported by the grant from the VLIR-UOS Project ZRDC2010MP068 and the David and Alice Van Buuren foundation.
Authors' addresses: Esto Bahizire, Centre de Recherche en Sciences Naturelles de Lwiro, Bukavu, Democratic Republic of the Congo, and Center of Research in Epidemiology, Biostatistics and clinical Research, Université Libre de Bruxelles, Brussels, Belgium, E-mail: esto.bahizire@gmail.com. Paluku Bahwere, Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium, and Valid International, Oxford, United Kingdom, E-mail: paluku@validinternational.org. Philippe Donnen and Michèle Dramaix, Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Brussels, Belgium, E-mails: pdonnen@ulb.ac.be and michele.dramaix@ulb.ac.be. P. Lundimu Tugirimana, Department of Clinical Biology, National University of Rwanda, Kigali, Rwanda, and Faculty of Medicine, Université de Goma, Goma, Democratic Republic of the Congo, E-mail: pierrotlundimu@gmail.com. Serge Balol'ebwami, Department of Pediatrics, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo, E-mail: sergebalole@gmail.com. Chouchou Nfundiko, National Program of Nutrition, Division Provinciale de la Santé du Sud-Kivu, Bakavu, Democratic Republic of the Congo, E-mail: cnfundiko@yahoo.fr. Raphaël Chirimwami, Department of Pathology, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo, E-mail: chirimwamibr@hotmail.com. Kanigula Mubagwa, Department of Cardiovascular Diseases, Katholieke Universiteit Leuven, Leuven, Belgium, E-mail: kanigula.mubagwa@med.kuleuven.ac.be.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
WHO, 2011. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Vitamin and Mineral Nutrition Information System. Geneva, Switzerland: World Health Organization (WHO/NMH/NHD/MNM/11.1). Available at: http://apps.who.int/iris/bitstream/10665/85839/3/WHO_NMH_NHD_MNM_11.1_eng.pdf?ua=1. Accessed June 16, 2016.
-
2.
Alvarez-Uria G, Naik PK, Midde M, Yalla PS, Pakam R, 2014. Prevalence and severity of anaemia stratified by age and gender in rural India. Anemia 2014: 176182.
-
3.
WHO, 2005. World Health Report 2005. Geneva, Switzerland: World Health Organization.
-
4.
Walker SP, Wachs TD, Meeks Gardner J, Lozoff B, Wasserman GA, Pollitt E, Carter JA, 2007. Child development: risk factors for adverse outcomes in developing countries. Lancet 369: 145–157.
-
5.
Lozoff BJE, Hagen J, Mollen E, Wolf AW, 2000. Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics 105: e51.
-
6.
Sherriff A, Emond A, Bell CJ, Golding J; ALSPAC Study Team, 2001. Should infants be screened for anaemia? A prospective study investigating the relation between haemoglobin at 8, 12, and 18 months and development at 18 months. Arch Dis Child 84: 480–485.
-
7.
McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B, 2009. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 12: 444–454.
-
8.
Balarajan Y, Ramakrishnan U, Özaltin E, Shankar AH, Subramanian SV, 2011. Anaemia in low-income and middle-income countries. Lancet 378: 2123–2135.
-
9.
Diouf S, Folquet M, Mbofung K, Ndiaye O, Brou K, Dupont C, Vuillerod M, Azais-Braesco V, Tetanye E, 2015. Prevalence and determinants of anemia in young children in French-speaking Africa. Role of iron deficiency [in French]. Arch Pediatr 22: 1188–1197.
-
10.
International MoPaM, 2008. Democratic Republic of Congo Demographic and Health Survey 2007. Calverton, MD: Ministère du Plan et Macro International.
-
11.
Stoltzfus JR, Chwaya MH, Tielsch MJ, Schulze JK, Albonico M, Savioli L, 1997. Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: the importance of hookworms. Am J Clin Nutr 65: 153–159.
-
12.
Ezzati MLA, Rodgers AA, Murray CJL, 2004. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors, Vol. 1. Geneva, Switzerland: World Health Organization.
-
13.
Fondu P, Hariga-Muller C, Mozes N, Neve J, Van Steirteghem A, Mandelbaum IM, 1978. Protein-energy malnutrition and anemia in Kivu. Am J Clin Nutr 31: 46–56.
-
14.
Mitangala PN et al.., 2013. Malaria infection and nutritional status: results from a cohort survey of children from 6-59 months old in the Kivu province, Democratic Republic of the Congo. Rev Epidemiol Sante Publique 61: 111–120.
-
15.
Action Against Hunger, 2012. Enquête Nutritionnelle Anthropométrique: zone de santé de Miti-Murhesa [in French]. Available at: http://www.actionagainsthunger.org/sites/default/files/publications/Enquete_Nutritionnelle_Anthropometrique_Zone_de_Sante_de_Miti-Murhesa_Province_du_Sud-Kivu_DRC_08.2011.pdf. Accessed June 16, 2016.
-
16.
Gorstein J, Sullivan KM, Parvanta I, Begin F, 2007. Indicators and Methods for Cross-Sectional Surveys of Vitamin and Mineral Status of Populations. Atlanta, GA: Centers for Disease Control and Prevention
-
17.
SMART, 2012. Sampling Methods and Sample Size Calculation for the SMART Methodology. Available at: http://smartmethodology.org/survey-planning-tools/smart-methodology/. Accessed February 23, 2013.
-
18.
Cogill B, 2003. Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project, FHI 360.
-
19.
Erhardt JG, Estes JE, Pfeiffer CM, Biesalski HK, Craft NE, 2004. Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J Nutr 134: 3127–3132.
-
20.
de Onis M, Onyango WA, van den Broeck J, Chumlea WM, Martorell R, 2004. Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference. Food Nutr Bull 25(1 Suppl): S27–S36.
-
21.
WHO, 2013. Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children. Geneva, Switzerland: World Health Organization.
-
22.
Annan AR, Webb P, Brown R, 2014. Management of Moderate Acute Malnutrition (MAM): Current Knowledge and Practice: CMAM Forum Technical Brief. Available at: http://foodaidquality.org/sites/default/files/publications/MAM-management-CMAM-Forum-Technical-Brief-Sept-2014.pdf. Accessed August 3, 2016.
-
23.
WHO/CDC, 2004. Technical Consultation on the Assessment of Iron Status at the Population Level. Geneva, Switzerland: World Health Organization.
-
24.
Thurnham DI, McCabe GP, Northrop-Clewes CA, Nestel P, 2003. Effects of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: meta-analysis. Lancet 362: 2052–2058.
-
25.
Donnen P, Brasseur D, Dramaix M, Assimbo V, Hennart P, 1997. Effects of cow's milk supplementation on milk output of protein deficient lactating mothers and on their infants' energy and protein status. Trop Med Int Health 2: 38–46.
-
26.
Levitt DG, Levitt MD, 2016. Human serum albumin homeostasis: a new look at the roles of synthesis, catabolism, renal and gastrointestinal excretion, and the clinical value of serum albumin measurements. Int J Gen Med 9: 229–255.
-
27.
Ministry of Planning and Monitoring of the Implementation of the Revolution of Modernity (MPMIRM), Ministry of Public Health (MPH) and ICF International, 2014. Demographic and Health Survey in the Democratic Republic of Congo 2013–2014. Rockville, MD: MPMIRM, MPH and ICF International.
-
28.
Harvey-Leeson S et al.., 2016. Anemia and micronutrient status of women of childbearing age and children 6–59 months in the Democratic Republic of the Congo. Nutrients 8: 98.
-
29.
Gahutu JB et al.., 2011. Prevalence and risk factors of malaria among children in southern highland Rwanda. Malar J 10: 134.
-
30.
Ndeba PM, 2012. Efficacy of artesunate plus amodiaquine for treatment of uncomplicated clinical Falciparum malaria in severely malnourished children aged 6–59 months, Democratic Republic of Congo. J Clin Exp Pathol. S3: 5.
-
31.
Bahizire E, Mitangala P, Donnen P, Balegamire S, Mulinganya G, Bahizi P, D'Alessandro U, Senterre C, Meuris S, Dramaix M, 2016. Malaria at the first antenatal visit: prevalence and associated factors in rural area in south Kivu, eastern part of the Democratic Republic of Congo. Med Afr Noire 63: 437–449.
-
32.
Frosch AE, Ondigo BN, Ayodo GA, Vulule JM, John CC, Cusick SE, 2014. Decline in childhood iron deficiency after interruption of malaria transmission in highland Kenya. Am J Clin Nutr 100: 968–973.
-
33.
Danquah I, Gahutu JB, Zeile I, Musemakweri A, Mockenhaupt FP, 2014. Anaemia, iron deficiency and a common polymorphism of iron-regulation, TMPRSS6 rs855791, in Rwandan children. Trop Med Int Health 19: 117–122.
-
34.
Chang Cojulun A, Bustinduy AL, Sutherland LJ, Mungai PL, Mutuku F, Muchiri E, Kitron U, King CH, 2015. Anemia among children exposed to polyparasitism in coastal Kenya. Am J Trop Med Hyg 93: 1099–1105.
-
35.
Asobayire SFAP, Davidsson L, Cook DJ, Hurrell FR, 2001. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: a study in Côte d'Ivoire. Am J Clin Nutr 74: 776–782.
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