Anemia and intestinal parasite infection in school children in rural Vietnam.
OBJECTIVE
This study hypothesized that besides iron deficiency, intestinal parasites infection is also a determinant of anemia in schoolchildren in rural Vietnam.


METHODS
400 primary schoolchildren from 20 primary schools in Tam Nong district, a poor rural area in Vietnam, were randomly selected from enrollment lists. Venous blood (5ml) was collected in a cross sectional study and analyzed for hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (TfR), serum C-reactive protein (CRP) and total immunoglobulin E (IgE). Stools samples were examined for hookworm, Trichuris, and Ascaris infection. Logistic regression was used to assess the effect of intestinal parasites on anemia.


RESULTS
The prevalence of anemia (Hb < 115g/l) was 25%. Iron deficiency (TfR > 8.5mg/L) occurred in 2% of the children. The prevalence of intestinal parasites was 92% with the highest prevalence for Trichuris (76%) and Ascaris (71%). More than 30% and 80% of the children showed an elevated CRP (> or = 8 mg/L) and IgE (> 90 IU/ml) concentration. Anemia status was borderline significantly associated with SF and not associated with TfR and CRP. The prevalence odds ratio for Trichuris infection was 1.96 (95% CI 1.07-3.59) and 2.00 (95% CI 1.08-3.65) with iron deficiency reflected by TfR and SF, respectively.


CONCLUSIONS
Anemia is highly prevalent among schoolchildren in Vietnam but may not be associated with iron deficiency. Trichuris infection is associated with a doubled risk of anemia, not mediated through iron deficiency. Chronic infection may play a role in anemia, but needs further investigation.
Le
Huong Thi
HT
Nutrition Department, Hanoi Medical University, Vietnam. huong.lethi@wur.nl
Brouwer
Inge D
ID
Verhoef
Hans
H
Nguyen
Khan Cong
KC
Kok
Frans J
FJ
D000740:Anemia / Q000453:epidemiology / Q000209:etiology; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000209:etiology*; D002097:C-Reactive Protein / Q000032:analysis; D002648:Child; D003430:Cross-Sectional Studies; D005243:Feces / Q000469:parasitology*; D005260:Female; D005293:Ferritins / Q000032:analysis; D006306:Health Surveys; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007411:Intestinal Diseases, Parasitic / Q000150:complications* / Q000453:epidemiology; D007501:Iron / Q000097:blood*; D000090463:Iron Deficiencies; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D011990:Receptors, Transferrin / Q000032:analysis; D012423:Rural Health; D014744:Vietnam / Q000453:epidemiology
D006454:Hemoglobins; D011990:Receptors, Transferrin; D007073:Immunoglobulin E; D002097:C-Reactive Protein; D005293:Ferritins; D007501:Iron