Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections in West Africa
Background:
Childhood anaemia is considered a severe public health problem in most countries of sub-Saharan Africa. We investigated the geographical distribution of prevalence of anaemia and mean haemoglobin concentration (Hb) in children aged 1–4 y (preschool children) in West Africa. The aim was to estimate the geographical risk profile of anaemia accounting for malnutrition, malaria, and helminth infections, the risk of anaemia attributable to these factors, and the number of anaemia cases in preschool children for 2011.
Methods and Findings:
National cross-sectional household-based demographic health surveys were conducted in 7,147 children aged 1–4 y in Burkina Faso, Ghana, and Mali in 2003–2006. Bayesian geostatistical models were developed to predict the geographical distribution of mean Hb and anaemia risk, adjusting for the nutritional status of preschool children, the location of their residence, predicted Plasmodium falciparum parasite rate in the 2- to 10-y age group (Pf PR2–10), and predicted prevalence of Schistosoma haematobium and hookworm infections. In the four countries, prevalence of mild, moderate, and severe anaemia was 21%, 66%, and 13% in Burkina Faso; 28%, 65%, and 7% in Ghana, and 26%, 62%, and 12% in Mali. The mean Hb was lowest in Burkina Faso (89 g/l), in males (93 g/l), and for children 1–2 y (88 g/l). In West Africa, severe malnutrition, Pf PR2–10, and biological synergisms between S. haematobium and hookworm infections were significantly associated with anaemia risk; an estimated 36.8%, 14.9%, 3.7%, 4.2%, and 0.9% of anaemia cases could be averted by treating malnutrition, malaria, S. haematobium infections, hookworm infections, and S. haematobium/hookworm coinfections, respectively. A large spatial cluster of low mean Hb (<80 g/l) and maximal risk of anaemia (>95%) was predicted for an area shared by Burkina Faso and Mali. We estimate that in 2011, approximately 6.7 million children aged 1–4 y are anaemic in the three study countries.
Conclusions:
By mapping the distribution of anaemia risk in preschool children adjusted for malnutrition and parasitic infections, we provide a means to identify the geographical limits of anaemia burden and the contribution that malnutrition and parasites make to anaemia. Spatial targeting of ancillary micronutrient supplementation and control of other anaemia causes, such as malaria and helminth infection, can contribute to efficiently reducing the burden of anaemia in preschool children in Africa.
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections in West Africa. PLoS Med 8(6): e32767. doi:10.1371/journal.pmed.1000438
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1000438
Souhrn
Background:
Childhood anaemia is considered a severe public health problem in most countries of sub-Saharan Africa. We investigated the geographical distribution of prevalence of anaemia and mean haemoglobin concentration (Hb) in children aged 1–4 y (preschool children) in West Africa. The aim was to estimate the geographical risk profile of anaemia accounting for malnutrition, malaria, and helminth infections, the risk of anaemia attributable to these factors, and the number of anaemia cases in preschool children for 2011.
Methods and Findings:
National cross-sectional household-based demographic health surveys were conducted in 7,147 children aged 1–4 y in Burkina Faso, Ghana, and Mali in 2003–2006. Bayesian geostatistical models were developed to predict the geographical distribution of mean Hb and anaemia risk, adjusting for the nutritional status of preschool children, the location of their residence, predicted Plasmodium falciparum parasite rate in the 2- to 10-y age group (Pf PR2–10), and predicted prevalence of Schistosoma haematobium and hookworm infections. In the four countries, prevalence of mild, moderate, and severe anaemia was 21%, 66%, and 13% in Burkina Faso; 28%, 65%, and 7% in Ghana, and 26%, 62%, and 12% in Mali. The mean Hb was lowest in Burkina Faso (89 g/l), in males (93 g/l), and for children 1–2 y (88 g/l). In West Africa, severe malnutrition, Pf PR2–10, and biological synergisms between S. haematobium and hookworm infections were significantly associated with anaemia risk; an estimated 36.8%, 14.9%, 3.7%, 4.2%, and 0.9% of anaemia cases could be averted by treating malnutrition, malaria, S. haematobium infections, hookworm infections, and S. haematobium/hookworm coinfections, respectively. A large spatial cluster of low mean Hb (<80 g/l) and maximal risk of anaemia (>95%) was predicted for an area shared by Burkina Faso and Mali. We estimate that in 2011, approximately 6.7 million children aged 1–4 y are anaemic in the three study countries.
Conclusions:
By mapping the distribution of anaemia risk in preschool children adjusted for malnutrition and parasitic infections, we provide a means to identify the geographical limits of anaemia burden and the contribution that malnutrition and parasites make to anaemia. Spatial targeting of ancillary micronutrient supplementation and control of other anaemia causes, such as malaria and helminth infection, can contribute to efficiently reducing the burden of anaemia in preschool children in Africa.
: Please see later in the article for the Editors' Summary
Zdroje
1. World Health Organization 2008 Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. Geneva World Health Organization. Available: http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf. Accessed 25 April 2011
2. Grantham-McGregorS
AniC
2001 A review of studies on the effect of iron deficiency on cognitive development in children. J Nutr 131 649S 666S; discussion 666S-668S
3. LawlessJW
LathamMC
StephensonLS
KinotiSN
PertetAM
1994 Iron supplementation improves appetite and growth in anemic Kenyan primary school children. J Nutr 124 645 654
4. OppenheimerSJ
2001 Iron and its relation to immunity and infectious disease. J Nutr 131 616S 633S; discussion 633S-635S
5. MorrisCR
SingerST
WaltersMC
2006 Clinical hemoglobinopathies: iron, lungs and new blood. Curr Opin Hematol 13 407 418
6. WambuaS
MwangiTW
KortokM
UyogaSM
MachariaAW
2006 The effect of α+-thalassaemia on the incidence of malaria and other diseases in children living on the coast of Kenya. PLoS Med 3 e158 doi:10.1371/journal.pmed.0030158
7. KraemerK
ZimmermannMB
2007 Nutritional anemia. Basel Sight and Life Press
8. SembaRD
BloemMW
2002 The anemia of vitamin A deficiency: epidemiology and pathogenesis. Eur J Clin Nutr 56 271 281
9. FishmanSM
ChristianP
WestKP
2000 The role of vitamins in the prevention and control of anaemia. Public Health Nutr 3 125 150
10. AllenLH
PeersonJM
2009 Impact of multiple micronutrient versus iron-folic acid supplements on maternal anemia and micronutrient status in pregnancy. Food Nutr Bull 30 S527 S532
11. CrawleyJ
2004 Reducing the burden of anemia in infants and young children in malaria-endemic countries of Africa: from evidence to action. Am J Trop Med Hyg 71 25 34
12. AdiasTC
UkoE
ErhaborO
2006 Anaemia in human immunodeficiency virus infection: a review. Niger J Med 15 203 206
13. WilliamsTN
UyogaS
MachariaA
NdilaC
McAuleyCF
2009 Bacteraemia in Kenyan children with sickle-cell anaemia: a retrospective cohort and case-control study. Lancet 374 1364 1370
14. MeansRT
2000 The anaemia of infection. Best Pract Res Clin Haematol 13 151 162
15. BatesI
McKewS
SarkinfadaF
2007 Anaemia: a useful indicator of neglected disease burden and control. PLoS Med 4 e231 doi:10.1371/journal.pmed.0040231
16. StoltzfusRJ
ChwayaHM
MontresorA
AlbonicoM
SavioliL
2000 Malaria, hookworms and recent fever are related to anemia and iron status indicators in 0- to 5-y old Zanzibari children and these relationships change with age. J Nutr 130 1724 1733
17. BrookerS
PeshuN
WarnPA
MosoboM
GuyattHL
1999 The epidemiology of hookworm infection and its contribution to anaemia among pre-school children on the Kenyan coast. Trans R Soc Trop Med Hyg 93 240 246
18. FriedmanJF
KanzariaHK
McGarveyST
2005 Human schistosomiasis and anemia: the relationship and potential mechanisms. Trends Parasitol 21 386 392
19. HotezPJ
BrookerS
BethonyJM
BottazziME
LoukasA
2004 Hookworm infection. N Engl J Med 351 799 807
20. GhoshK
2007 Pathogenesis of anemia in malaria: a concise review. Parasitol Res 101 1463 1469
21. EzeamamaAE
McGarveyST
AcostaLP
ZierlerS
ManaloDL
2008 The synergistic effect of concomitant schistosomiasis, hookworm, and trichuris infections on children's anemia burden. PLoS Negl Trop Dis 2 e245 doi:10.1371/journal.pntd.0000245
22. BrookerS
ClementsAC
HotezPJ
HaySI
TatemAJ
2006 The co-distribution of Plasmodium falciparum and hookworm among African schoolchildren. Malar J 5 99
23. World Health Organization 2001 Iron deficiency anaemia: assessment, prevention, and control: a guide for programme managers. Geneva World Health Organization. Available: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf. Accessed 25 April 2011
24. SazawalS
BlackRE
RamsanM
ChwayaHM
StoltzfusRJ
2006 Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet 367 133 143
25. StoltzfusRJ
DreyfussML
1998 Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. Washington (District of Columbia) ILSI Press
26. MendisK
RietveldA
WarsameM
BosmanA
GreenwoodB
2009 From malaria control to eradication: The WHO perspective. Trop Med Int Health 14 802 809
27. World Health Organization 2007 Malaria elimination: a field manual for low and moderate endemic countries. Geneva World Health Organization. Available: http://whqlibdoc.who.int/publications/2007/9789241596084_eng.pdf. Accessed 25 April 2011
28. BriandV
CottrellG
MassougbodjiA
CotM
2007 Intermittent preventive treatment for the prevention of malaria during pregnancy in high transmission areas. Malar J 6 160
29. BrookerS
ClarkeS
SnowRW
BundyDA
2008 Malaria in African schoolchildren: options for control. Trans R Soc Trop Med Hyg 102 304 305
30. BrookerS
WhawellS
KabatereineNB
FenwickA
AndersonRM
2004 Evaluating the epidemiological impact of national control programmes for helminths. Trends Parasitol 20 537 545
31. FenwickA
WebsterJP
Bosque-OlivaE
BlairL
FlemingFM
2009 The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002-2008. Parasitology 136 1719 1730
32. StoltzfusRJ
DreyfussML
ChwayaHM
AlbonicoM
1997 Hookworm control as a strategy to prevent iron deficiency. Nutr Rev 55 223 232
33. GulaniA
NagpalJ
OsmondC
SachdevHP
2007 Effect of administration of intestinal anthelmintic drugs on haemoglobin: systematic review of randomised controlled trials. BMJ 334 1095
34. World Health Organization 2006 Iron supplementation of young children in regions where malaria transmission is intense and infectious disease highly prevalent. Geneva World Health Organization. Available: http://www.who.int/entity/child_adolescent_health/documents/pdfs/who_statement_iron.pdf. Accessed 25 April 2011
35. World Health Organization, United Nations Children's Fund 2004 How to add deworming to vitamin A distribution. Geneva World Health Organization. Available: http://whqlibdoc.who.int/hq/2004/WHO_CDS_CPE_PVC_2004.11.pdf. Accessed 25 April 2011
36. HaySI
GuerraCA
GethingPW
PatilAP
TatemAJ
2009 A world malaria map: Plasmodium falciparum endemicity in 2007. PLoS Med 6 e1000048 doi:10.1371/journal.pmed.1000048
37. MagalhaesRJ
ClementsAC
PatilAP
GethingPW
BrookerS
2011 The applications of model-based geostatistics in helminth epidemiology and control. Adv Parasitol 74 267 296
38. RoweAK
PowellKE
FlandersWD
2004 Why population attributable fractions can sum to more than one. Am J Prev Med 26 243 249
39. SharmanA
2000 Anemia testing in population-based surveys: general information and guidelines for country monitors and program managers. Calverton (Maryland) ORC Macro
40. NandyS
IrvingM
GordonD
SubramanianSV
SmithGD
2005 Poverty, child undernutrition and morbidity: new evidence from India. Bull World Health Organ 83 210 216
41. ClementsAC
FirthS
DembeleR
GarbaA
ToureA
2010 Use of Bayesian geostatistical prediction to estimate local variations in Schistosoma haematobium infection in West Africa. Bull World Health Organ 87 921 929
42. ClementsAC
GarbaA
SackoM
ToureS
DembeleR
2008 Mapping the probability of schistosomiasis and associated uncertainty, West Africa. Emerg Infect Dis 14 1629 1632
43. DigglePJ
MoyeedRA
TawnJA
1998 Model-based geostatistics. Appl Stat 47 299 350
44. BrookerS
HaySI
BundyDA
2002 Tools from ecology: useful for evaluating infection risk models? Trends Parasitol 18 70 74
45. HaySI
NoorAM
NelsonA
TatemAJ
2005 The accuracy of human population maps for public health application. Trop Med Int Health 10 1073 1086
46. RothmanKJ
GreenlandS
LashTL
2008 Modern epidemiology, 3rd edition. Philadelphia Lippincott, Williams, & Wilkins
47. RasoG
VounatsouP
SingerBH
N'GoranEK
TannerM
2006 An integrated approach for risk profiling and spatial prediction of Schistosoma mansoni-hookworm coinfection. Proc Natl Acad Sci U S A 103 6934 6939
48. HutcheonJA
ChioleroA
HanleyJA
2010 Random measurement error and regression dilution bias. BMJ 340 c2289
49. BruzziP
GreenSB
ByarDP
BrintonLA
SchairerC
1985 Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol 122 904 914
50. HellerRF
BuchanI
EdwardsR
LyratzopoulosG
McElduffP
2003 Communicating risks at the population level: application of population impact numbers. BMJ 327 1162 1165
51. RockhillB
NewmanB
WeinbergC
1998 Use and misuse of population attributable fractions. Am J Public Health 88 15 19
52. WeatherallDJ
CleggJB
2001 Inherited haemoglobin disorders: an increasing global health problem. Bull World Health Organ 79 704 712
53. PielFB
PatilAP
HowesRE
NyangiriOA
GethingPW
2010 Global distribution of the sickle cell gene and geographical confirmation of the malaria hypothesis. Nat Commun 1 104
54. BenichouJ
2001 A review of adjusted estimators of attributable risk. Stat Methods Med Res 10 195 216
55. BenichouJ
1991 Methods of adjustment for estimating the attributable risk in case-control studies: a review. Stat Med 10 1753 1773
56. RuckingerS
von KriesR
ToschkeAM
2009 An illustration of and programs estimating attributable fractions in large scale surveys considering multiple risk factors. BMC Med Res Methodol 9 7
57. MasonCA
TuS
2008 Partitioning the population attributable fraction for a sequential chain of effects. Epidemiol Perspect Innov 5 5
58. LeonardoLR
RiveraP
SanielO
VillacorteE
CrisostomoB
2008 Prevalence survey of schistosomiasis in Mindanao and the Visayas, The Philippines. Parasitol Int 57 246 251
59. KazembeLN
MuulaAS
SimoongaC
2009 Joint spatial modelling of common morbidities of childhood fever and diarrhoea in Malawi. Health Place 15 165 172
60. KazembeLN
NamangaleJJ
2007 A Bayesian multinomial model to analyse spatial patterns of childhood co-morbidity in Malawi. Eur J Epidemiol 22 545 556
61. MargaiFM
2007 Geographical targeting of risk zones for childhood stunting and related health outcomes in Burkina Faso. World Health Popul 9 64 82
62. GethingPW
KiruiVC
AleganaVA
OkiroEA
NoorAM
2010 Estimating the number of paediatric fevers associated with malaria infection presenting to Africa's public health sector in 2007. PLoS Med 7 e1000301 doi:10.1371/journal.pmed.1000301
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2011 Číslo 6
- Statinová intolerance
- Očkování proti virové hemoragické horečce Ebola experimentální vakcínou rVSVDG-ZEBOV-GP
- Co dělat při intoleranci statinů?
- Pleiotropní účinky statinů na kardiovaskulární systém
- DESATORO PRE PRAX: Aktuálne odporúčanie ESPEN pre nutričný manažment u pacientov s COVID-19
Najčítanejšie v tomto čísle
- Mapping the Risk of Anaemia in Preschool-Age Children: The Contribution of Malnutrition, Malaria, and Helminth Infections in West Africa
- More and Better Information to Tackle HIV Epidemics: Towards Improved HIV Incidence Assays
- Migration and "Low-Skilled" Workers in Destination Countries
- Energy Density, Portion Size, and Eating Occasions: Contributions to Increased Energy Intake in the United States, 1977–2006