Anemia Etiology in Ethiopia: Assessment of Nutritional, Infectious Disease, and Other Risk Factors in a Population-Based Cross-Sectional Survey of Women, Men, and Children.
Ethiopia
anemia
etiology
folate
infection
iron
population attributable percentage
Journal
The Journal of nutrition
ISSN: 1541-6100
Titre abrégé: J Nutr
Pays: United States
ID NLM: 0404243
Informations de publication
Date de publication:
08 02 2022
08 02 2022
Historique:
received:
07
04
2021
revised:
02
08
2021
accepted:
08
10
2021
pubmed:
15
10
2021
medline:
22
2
2022
entrez:
14
10
2021
Statut:
ppublish
Résumé
While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia. A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models. The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases. Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.
Sections du résumé
BACKGROUND
While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations.
OBJECTIVES
We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia.
METHODS
A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models.
RESULTS
The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases.
CONCLUSIONS
Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.
Identifiants
pubmed: 34647598
pii: S0022-3166(22)00540-5
doi: 10.1093/jn/nxab366
pmc: PMC8990104
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
501-512Subventions
Organisme : NICHD NIH HHS
ID : F31 HD093514
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI007535
Pays : United States
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.
Références
J Nutr. 2020 Aug 1;150(8):2175-2182
pubmed: 32455424
JAMA. 2015 Apr 7;313(13):1325-35
pubmed: 25771069
J Nutr. 2001 Feb;131(2S-2):676S-688S; discussion 688S-690S
pubmed: 11160598
Adv Nutr. 2012 Jan;3(1):54-5
pubmed: 22332101
BMC Public Health. 2019 Oct 24;19(1):1369
pubmed: 31651278
PLoS One. 2018 Nov 14;13(11):e0206212
pubmed: 30427877
Mediterr J Hematol Infect Dis. 2017 Feb 20;9(1):e2017018
pubmed: 28293406
Public Health Nutr. 2014 Mar;17(3):537-50
pubmed: 23464652
Am J Epidemiol. 2004 Apr 1;159(7):702-6
pubmed: 15033648
Blood. 2018 Nov 14;132(20):2134-2142
pubmed: 30429157
Stroke Vasc Neurol. 2018 Jun 6;3(2):51-58
pubmed: 30022794
Nutrients. 2014 Dec 22;6(12):5915-32
pubmed: 25533005
Open Nurs J. 2018 Jul 31;12:155-161
pubmed: 30197721
Nutr J. 2019 Aug 13;18(1):46
pubmed: 31409356
Nutr Rev. 2011 Nov;69 Suppl 1:S37-42
pubmed: 22043881
Ethiop Med J. 2017;55(Suppl 1):75-80
pubmed: 28878432
Ann Epidemiol. 2009 Aug;19(8):553-9
pubmed: 19576535
Cancer Causes Control. 2007 Jun;18(5):571-9
pubmed: 17387622
Infect Dis Poverty. 2018 Nov 05;7(1):103
pubmed: 30392470
Int J Vitam Nutr Res. 2017 Mar;87(1-2):75-84
pubmed: 29052470
Am J Prev Med. 2011 Dec;41(6 Suppl 4):S398-405
pubmed: 22099364
Anemia. 2020 Jan 21;2020:1628357
pubmed: 32047664
Stat Med. 2000 May 15;19(9):1141-64
pubmed: 10797513
Am J Epidemiol. 2004 Aug 15;160(4):331-8
pubmed: 15286018
Neuropsychiatr Dis Treat. 2014 Nov 10;10:2087-95
pubmed: 25419131
Int J Hematol. 2008 Jul;88(1):7-15
pubmed: 18594779
BJOG. 2015 Apr;122(5):681-9
pubmed: 25615842
Adv Nutr. 2020 May 1;11(3):469-483
pubmed: 31701998
Lancet Glob Health. 2018 May;6(5):e548-e554
pubmed: 29571592
Lancet Neurol. 2019 May;18(5):439-458
pubmed: 30871944
Blood. 2014 Jan 30;123(5):615-24
pubmed: 24297872
Trop Med Int Health. 2008 Oct;13(10):1267-71
pubmed: 18721184
Am J Clin Nutr. 2017 Jul;106(Suppl 1):359S-371S
pubmed: 28615259
Am J Clin Nutr. 1997 Apr;65(4 Suppl):1220S-1228S; discussion 1229S-1231S
pubmed: 9094926
Br J Nutr. 2002 Dec;88(6):681-8
pubmed: 12493090
Am J Epidemiol. 1992 Dec 1;136(11):1400-13
pubmed: 1488967