A cohort study of haemoglobin and zinc protoporphyrin levels in term Zambian infants: effects of iron stores at birth, complementary food and placental malaria.
OBJECTIVE
To examine zinc-protoporphyrin (ZPP) and haemoglobin levels, and to determine predictors of iron deficiency anaemia (IDA) in Zambian infants.


METHODS
Ninety-one women and their normal birth weight (NBW) infants were followed bi-monthly during the first 6 months of life, and iron status, food intake, malaria parasitaemia and growth were monitored. At 4 months, the infants were divided into two groups, and the data were analysed according to whether or not they were exclusively breastfed.


RESULTS
Almost two-third of infants were born with low iron stores as defined by ZPP levels, and this proportion increased with age. Over 50% had developed IDA by 6 months. Exclusive breastfeeding at 4 months could be a protective factor for IDA (odds ratio (OR): 0.2; 95% confidence interval (CI): 0.0-1.1). Exclusively breastfed infants had higher haemoglobin values at 4 and 6 months (mean difference 0.6; 95% CI: 0.1-1.2 g/dl and mean difference 0.9; 95% CI: 0.2-1.7 g/dl, respectively), compared with infants with early complementary feeding. In univariate analysis, past or chronic placental malaria appeared to be a predictor of IDA at 4 and 6 months, but the significance was lost in multivariate analysis.


CONCLUSIONS
Zambian NBW infants are born with low iron stores and have a high risk to develop IDA in the first 6 months of life. Continuation of exclusive breastfeeding after 4 months is associated with a reduction of anaemia. The effect of placental malaria infection on increased risk of infant IDA could not be proven.
van Rheenen
P F
PF
Paediatric Gastroenterology, Department of Paediatrics, University Medical Centre, Groningen, The Netherlands. p.f.vanrheenen@gmail.com
de Moor
L T T
LT
Eschbach
S
S
Brabin
B J
BJ
D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D000818:Animals; D001942:Breast Feeding / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D008297:Male; D009751:Nutritional Requirements; D016017:Odds Ratio; D010920:Placenta / Q000469:parasitology; D010922:Placenta Diseases / Q000097:blood / Q000453:epidemiology / Q000469:parasitology; D011237:Predictive Value of Tests; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000097:blood / Q000453:epidemiology*; D011524:Protoporphyrins / Q000032:analysis / Q000097:blood*; D012307:Risk Factors; D014886:Weaning; D015024:Zambia / Q000453:epidemiology
D006454:Hemoglobins; D011524:Protoporphyrins; C017803:zinc protoporphyrin