Anemia Among Children Exposed to Polyparasitism in Coastal Kenya.
Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool- and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9-11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia.
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Alicia
A
Chang Cojulun
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Amaya L
AL
Bustinduy
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Laura J
LJ
Sutherland
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Peter L
PL
Mungai
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Francis
F
Mutuku
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Eric
E
Muchiri
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Uriel
U
Kitron
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya chk@cwru.edu.
Charles H
CH
King
D000740:Anemia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005368:Filariasis / Q000150:complications / Q000453:epidemiology; D006454:Hemoglobins / Q000032:analysis*; D006725:Hookworm Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000150:complications / Q000453:epidemiology; D008297:Male; D009752:Nutritional Status; D016017:Odds Ratio; D010272:Parasitic Diseases / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012553:Schistosomiasis haematobia / Q000150:complications / Q000453:epidemiology; D012959:Socioeconomic Factors; D014958:Wuchereria bancrofti
D006454:Hemoglobins