Anaemia, iron deficiency and malaria in a rural community in Brazilian Amazon.
OBJECTIVE
To assess the incidence of anaemia, iron deficiency and malaria in a malaria-endemic community.


METHODS
Three consecutive cross-sectional surveys (A, B and C) of the whole population made at 6-month intervals and malaria surveillance between the surveys.


METHODS
Urupá, a rural community in Western Brazilian Amazon.


METHODS
133 people of all age groups present in at least two cross-sectional surveys.


METHODS
Anaemic patients received ferrous sulphate during 3 months. Patients parasitized by intestinal nematodes were given mebendazole and parasitologically proven Plasmodium falciparum and P. vivax malaria attacks were treated with quinine or chloroquine plus primaquine.


RESULTS
Anaemia (haemoglobin concentrations [Hb] below the cut-off values proposed by the World Health Organization) was diagnosed in respectively 10.0% (13 of 130) subjects in survey A, 9.2% (10 of 109) in B and 29.7% (27 of 91) in C. Depleted iron stores [serum ferritin (SF) < 12 micrograms/l] were detected in 10.0% subjects in survey A, 10.1% in B but in only 8.8% subjects in survey C. Concomitant anaemia and low SF was detected in 5.4% subjects in survey A, 3.7% in B and 6.6% in C. Mean Hb from anaemic patients diagnosed and treated during the study (n = 17) raised 1.2 g/dl after iron therapy and most of them (13 of 17, 76.5%) became non-anaemic. The highest malaria transmission was observed between surveys B and C. People who suffered at least one malaria attack during this period (27 of 63) were at a slightly greater risk of subsequent anaemia (odds ratio = 2.85, 95% confidence interval 0.81-10.28).


CONCLUSIONS
Both malaria and iron deficiency could be considered as important causes of anaemia in this population.


BACKGROUND
Supported by grants from the UNDP/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases (no. 890245), the Ministére des Affaires Etrangeres, France, and from the Fundação de Amparo à Pesquisa do Estado de São Paulo (no. 92/1336-4). M.A.C. was supported by a doctoral fellowship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico.
Cardoso
M A
MA
Departamento de Alimentos e Nutrição Experimental, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, Brazil.
Ferreira
M U
MU
Camargo
L M
LM
Szarfarc
S C
SC
D000293:Adolescent; D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D000747:Anemia, Hypochromic / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D005260:Female; D005296:Ferrous Compounds / Q000008:administration & dosage; D006452:Hemoglobinometry; D006801:Humans; D015994:Incidence; D007223:Infant; D007411:Intestinal Diseases, Parasitic / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D008288:Malaria / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008463:Mebendazole / Q000008:administration & dosage; D010963:Plasmodium falciparum / Q000187:drug effects; D010966:Plasmodium vivax / Q000187:drug effects; D011159:Population Surveillance; D011247:Pregnancy; D011319:Primaquine / Q000008:administration & dosage; D011803:Quinine / Q000008:administration & dosage; D012424:Rural Population / Q000706:statistics & numerical data*
D005296:Ferrous Compounds; C020748:ferrous sulfate; D008463:Mebendazole; D002738:Chloroquine; D011803:Quinine; D011319:Primaquine