title: Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children.
abstract: In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.
authors.affiliation: World Vision Cambodia, Phnom Penh, Cambodia.
authors.forename: Joby
authors.initials: J
authors.lastname: George
authors.forename: Miriam
authors.initials: M
authors.lastname: Yiannakis
authors.forename: Barbara
authors.initials: B
authors.lastname: Main
authors.forename: Robyn
authors.initials: R
authors.lastname: Devenish
authors.forename: Courtney
authors.initials: C
authors.lastname: Anderson
authors.forename: Ung Sam
authors.initials: US
authors.lastname: An
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Williams
authors.forename: Rosalind S
authors.initials: RS
authors.lastname: Gibson
mesh_terms: D000367:Age Factors; D000740:Anemia / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000453:epidemiology; D002160:Cambodia / Q000453:epidemiology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006446:Hemoglobin E / Q000032:analysis / Q000235:genetics; D006453:Hemoglobinopathies / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D006454:Hemoglobins / Q000032:analysis; D006455:Hemoglobins, Abnormal / Q000032:analysis / Q000235:genetics; D006801:Humans; D007223:Infant; D007411:Intestinal Diseases, Parasitic / Q000097:blood / Q000453:epidemiology / Q000469:parasitology / Q000503:physiopathology*; D000090463:Iron Deficiencies; D008297:Male; D015995:Prevalence; D012423:Rural Health; D012959:Socioeconomic Factors; D014504:Urban Health; D014802:Vitamin A Deficiency / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*
chemical_list: D006454:Hemoglobins; D006455:Hemoglobins, Abnormal; D006446:Hemoglobin E