title: The impact of malarial infection and diet on the anaemia status of rural pregnant Malawian women.
abstract: OBJECTIVE
  To investigate haematological and biochemical iron indices in relation to malaria, gravida, and dietary iron status in rural pregnant Malawian women.
  
  
  METHODS
  In this self-selected sample, haemoglobin, haematocrit, red cell indices, serum ferritin, serum iron, serum transferrin, and serum transferrin receptor (TfR) were measured. Infection was assessed by a malaria slide, serum C-reactive protein, and white blood cell count. Dietary iron variables were measured by three 24-h interactive recalls.
  
  
  METHODS
  152 rural pregnant women recruited at 24 weeks gestation while attending a rural antenatal clinic in Southern Malawi; 36% were primagravid; 43% were gravida 2-4; 26% were gravida >5.
  
  
  RESULTS
  Of the women, 69% (n=105) were anaemic (haemoglobin <110 g/l); 37% (n=39) had anaemia and malarial parasitaemia on the test day; 17% (n=26) with malaria were also classified with iron deficiency (ID) anaemia (based on serum ferritin < or = 50 microg/l and Hb <110 g/l) while an additional seven with malaria were classified with ID without anaemia. In malarial-free subjects, 32% were classified with IDA (serum ferritin <12 microg/l and Hb <110 g/l) and 17% with ID (serum ferritin <12 microg/l; Hb > or = 110 g/l). Serum TfR concentrations were elevated in anaemic women (P<0.01). In non-malarial parasitaemic subjects, serum TfR correlated negatively with haemoglobin (r=-0.313; P<0.001) but not serum ferritin. Of the women, 49% were at risk for inadequate iron intakes. Most dietary iron was non-haem; plant foods provided 89%; flesh foods (mainly fish) only 9%. Malarial parasitaemia and intakes of available iron impacted significantly on iron status.
  
  
  CONCLUSIONS
  Anaemia prevalence from all causes was high (that is, 69%); three factors were implicated: malaria, and deficiencies of iron and possibly folate, induced partly by an inadequate dietary supply and/or secondary to malarial parasitaemia.
  
  
  BACKGROUND
  International Development Research Centre (IDRC) of Canada. Opportunities for Micronutrient Interventions (OMNI) Project. Natural Sciences and Engineering Research Council of Canada.
authors.affiliation: Division of Applied Human Nutrition, University of Guelph, Ontario, Canada.
authors.forename: J M
authors.initials: JM
authors.lastname: Huddle
authors.forename: R S
authors.initials: RS
authors.lastname: Gibson
authors.forename: T R
authors.initials: TR
authors.lastname: Cullinan
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000097:blood* / Q000209:etiology; D002097:C-Reactive Protein / Q000032:analysis; D004032:Diet; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D008288:Malaria / Q000150:complications*; D008295:Malawi; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011990:Receptors, Transferrin / Q000097:blood; D014168:Transferrin / Q000032:analysis
chemical_list: D011990:Receptors, Transferrin; D014168:Transferrin; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron