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Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study.

Abstract

To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, malaria and inflammation, a nationally representative cross-sectional survey was conducted. A three-stage sampling procedure was used to randomly select children <5 years of age and adult women from households in two strata (urban and rural). Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A, folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence rates of anemia (76.3%; 95% CI: 71.8, 80.4), malaria (52.6%; 95% CI: 46.0, 59.0), and acute and chronic inflammation (72.6%; 95% CI: 67.5, 77.1) were high. However, the prevalence of vitamin A deficiency (17.4%; 95% CI: 13.9, 21.6) was moderate, and the prevalence of iron deficiency (5.2%; 95% CI: 3.3, 8.1) and iron-deficiency anemia (3.8%; 95% CI: 2.5, 5.8) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8% (95% CI: 40.1, 49.5), 35.1% (95% CI: 30.1, 40.4), and 23.6% (95% CI: 20.4, 27.3) were affected by anemia, malaria, or inflammation, respectively. The prevalence rates of iron deficiency (8.3%; 95% CI: 6.2, 11.1), iron-deficiency anemia (6.1%; 95% CI: 4.4, 8.6), vitamin A deficiency (2.1%; 95% CI: 1.1, 3.1) and vitamin B12 deficiency (0.5%; 95% CI: 0.2, 1.4) were low, while folate deficiency was high (79.2%; 95% CI: 74.1, 83.5). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone. Since malaria and inflammation only contributed to 25% of anemia, other causes of anemia, such as hemoglobinopathies, should also be explored.

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  • Authors+Show Affiliations

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    GroundWork, Crans-près-Céligny, Switzerland.

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    GroundWork, Crans-près-Céligny, Switzerland.

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    GroundWork, Crans-près-Céligny, Switzerland.

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    UNICEF, Freetown, Sierra Leone.

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    WHO, Freetown, Sierra Leone.

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    Ministry of Health and Sanitation, Freetown, Sierra Leone.

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    Ministry of Health and Sanitation, Freetown, Sierra Leone.

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    Helen Keller International, Freetown, Sierra Leone.

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    WHO West Africa, Ouagadougou, Burkina Faso.

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    GroundWork, Crans-près-Céligny, Switzerland.

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    USDA/ARS Western Human Nutrition Research Center, Davis, United States of America.

    ,

    WHO Headquarters, Geneva, Switzerland.

    Helen Keller International, Freetown, Sierra Leone.

    Source

    PloS one 11:5 2016 pg e0155031

    MeSH

    Adult
    Anemia
    Anemia, Iron-Deficiency
    Child, Preschool
    Cross-Sectional Studies
    Disease Outbreaks
    Female
    Folic Acid Deficiency
    Hemorrhagic Fever, Ebola
    Humans
    Infant
    Infant, Newborn
    Inflammation
    Male
    Micronutrients
    Pregnancy
    Prevalence
    Rural Population
    Sierra Leone
    Urban Population
    Vitamin A Deficiency
    Vitamin B 12 Deficiency

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    27163254

    Citation

    Wirth, James P., et al. "Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study." PloS One, vol. 11, no. 5, 2016, pp. e0155031.
    Wirth JP, Rohner F, Woodruff BA, et al. Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study. PLoS ONE. 2016;11(5):e0155031.
    Wirth, J. P., Rohner, F., Woodruff, B. A., Chiwile, F., Yankson, H., Koroma, A. S., ... Hodges, M. H. (2016). Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study. PloS One, 11(5), pp. e0155031. doi:10.1371/journal.pone.0155031.
    Wirth JP, et al. Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study. PLoS ONE. 2016;11(5):e0155031. PubMed PMID: 27163254.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study. AU - Wirth,James P, AU - Rohner,Fabian, AU - Woodruff,Bradley A, AU - Chiwile,Faraja, AU - Yankson,Hannah, AU - Koroma,Aminata S, AU - Russel,Feimata, AU - Sesay,Fatmata, AU - Dominguez,Elisa, AU - Petry,Nicolai, AU - Shahab-Ferdows,Setareh, AU - de Onis,Mercedes, AU - Hodges,Mary H, Y1 - 2016/05/10/ PY - 2015/11/17/received PY - 2016/03/25/accepted PY - 2016/5/11/entrez PY - 2016/5/11/pubmed PY - 2017/7/6/medline SP - e0155031 EP - e0155031 JF - PloS one JO - PLoS ONE VL - 11 IS - 5 N2 - To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, malaria and inflammation, a nationally representative cross-sectional survey was conducted. A three-stage sampling procedure was used to randomly select children <5 years of age and adult women from households in two strata (urban and rural). Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A, folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence rates of anemia (76.3%; 95% CI: 71.8, 80.4), malaria (52.6%; 95% CI: 46.0, 59.0), and acute and chronic inflammation (72.6%; 95% CI: 67.5, 77.1) were high. However, the prevalence of vitamin A deficiency (17.4%; 95% CI: 13.9, 21.6) was moderate, and the prevalence of iron deficiency (5.2%; 95% CI: 3.3, 8.1) and iron-deficiency anemia (3.8%; 95% CI: 2.5, 5.8) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8% (95% CI: 40.1, 49.5), 35.1% (95% CI: 30.1, 40.4), and 23.6% (95% CI: 20.4, 27.3) were affected by anemia, malaria, or inflammation, respectively. The prevalence rates of iron deficiency (8.3%; 95% CI: 6.2, 11.1), iron-deficiency anemia (6.1%; 95% CI: 4.4, 8.6), vitamin A deficiency (2.1%; 95% CI: 1.1, 3.1) and vitamin B12 deficiency (0.5%; 95% CI: 0.2, 1.4) were low, while folate deficiency was high (79.2%; 95% CI: 74.1, 83.5). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone. Since malaria and inflammation only contributed to 25% of anemia, other causes of anemia, such as hemoglobinopathies, should also be explored. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27163254/Anemia_Micronutrient_Deficiencies_and_Malaria_in_Children_and_Women_in_Sierra_Leone_Prior_to_the_Ebola_Outbreak___Findings_of_a_Cross_Sectional_Study_ L2 - http://dx.plos.org/10.1371/journal.pone.0155031 DB - PRIME DP - Unbound Medicine ER -