title: Multicausal etiology of anemia among women of reproductive age in Vietnam.
abstract: OBJECTIVE
  Anemia is a significant public health concern, especially among women and young children. An improved understanding of the complex etiology of anemia is crucial for developing appropriate prevention strategies. This paper examines the determinants of anemia in a large sample of Vietnamese women of reproductive age (WRA).
  
  
  METHODS
  We included baseline data from 4986 WRA participating in a randomized controlled trial (PRECONCEPT). Hemoglobin (Hb) concentrations were measured with Hemocue. Plasma ferritin (Fe), retinol binding protein (RBP) and markers of inflammation were assessed using the ELISA technique. We used multivariate logistic regression to describe associations with anemia and structural equation modeling (SEM) to characterize direct and indirect pathways influencing Hb concentrations.
  
  
  RESULTS
  Prevalence of anemia, iron deficiency (Fe <12 μg/l), insufficient iron stores (Fe<30 μg/l) and iron deficiency anemia was 19.7, 3.5, 14.4 and 1.9%, respectively. Ferritin concentration (0.29 per log-mg/dl), being an ethnic minority (-0.24 compared with Kinh), number of children (-0.17) and socioeconomic status (0.09) were directly associated with Hb concentration (P<0.05). Similarly, RBP was directly (0.27 per mg/dl) associated with Hb and also indirectly (0.09 mg/dl) with ferritin. Hookworm infection was indirectly associated with Hb (-0.11) through RBP and ferritin.
  
  
  CONCLUSIONS
  These findings illustrate the complex etiology of anemia and provide a useful framework for designing, targeting and evaluating appropriate strategies for the prevention and control of anemia. Contrary to expectations, iron deficiency accounted for a very small proportion of anemia in Northern Vietnam.
authors.affiliation: 1] Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam [2] Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Hanoi, Vietnam.
authors.forename: P H
authors.initials: PH
authors.lastname: Nguyen
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: I
authors.initials: I
authors.lastname: Gonzalez-Casanova
authors.affiliation: Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
authors.forename: H
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
authors.forename: H
authors.initials: H
authors.lastname: Pham
authors.affiliation: Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
authors.forename: T V
authors.initials: TV
authors.lastname: Truong
authors.affiliation: Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
authors.forename: S
authors.initials: S
authors.lastname: Nguyen
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Martorell
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: U
authors.initials: U
authors.lastname: Ramakrishnan
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D018798:Anemia, Iron-Deficiency / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000032:analysis; D006725:Hookworm Infections / Q000097:blood; D006801:Humans; D007249:Inflammation / Q000097:blood; D000090463:Iron Deficiencies; D019266:Iron, Dietary / Q000008:administration & dosage; D009752:Nutritional Status; D010298:Parity; D012177:Retinol-Binding Proteins; D012307:Risk Factors; D012959:Socioeconomic Factors; D014744:Vietnam / Q000453:epidemiology
chemical_list: D006454:Hemoglobins; D019266:Iron, Dietary; D012177:Retinol-Binding Proteins; D005293:Ferritins