title: The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders.
abstract: BACKGROUND
  Anemia is highly prevalent in Cambodian women and children, but data on causes of anemia are scarce. We performed a national micronutrient survey in children and women that was linked to the Cambodian Demographic Health Survey 2014 (CDHS-2014) to assess the prevalence of micronutrient deficiency, hemoglobin disorders and intestinal parasite infection.
  
  
  METHODS
  One-sixth of households from the CDHS-2014 were selected for a follow-up visit for the micronutrient survey. Households were visited from two weeks to two months after the CDHS-2014 visit. Data on micronutrient status were available for 1512 subjects (792 children and 720 women).
  
  
  RESULTS
  Anemia was found in 43% of the women and 53% of the children. Hemoglobin disorders affected >50% of the population, with Hemoglobin-E the most prevalent disorder. Deficiencies of iron (ferritin < 15 g/L), vitamin A (retinol-binding-protein (RBP) < 0.70 mol/L) or vitamin B12 (<150 pmol/L) were not prevalent in the women (<5% for all), whereas 17.8% of the women had low concentrations of folic acid (<10 nmol/L). In the children, the prevalence of iron, vitamin A, vitamin B12 or folic acid deficiency was <10%. Zinc deficiency, hookworm infection and hemoglobinopathy were significantly associated with anemia in children, whereas in the women none of the factors was significantly associated with anemia. Iron deficiency anemia (IDA) was more prevalent in children <2 years, but in older children and women, the prevalence of IDA was <5%. The most prevalent, preventable causes of anemia were hookworm infection and zinc and folic acid deficiency. Over 40% of the anemia was not caused by nutritional factors.
  
  
  CONCLUSIONS
  The very high prevalence of anemia in Cambodian women and children cannot be explained solely by micronutrient deficiencies and hemoglobin disorders. Micronutrient interventions to improve anemia prevalence are likely to have limited impact in the Cambodian setting. The focus of current interventions to reduce the high prevalence of anemia in children and women should be broadened to include zinc and folic acid as well as effective anti-hookworm measures.
authors.affiliation: Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France. franck.wieringa@ird.fr.
authors.forename: Frank Tammo
authors.initials: FT
authors.lastname: Wieringa
authors.affiliation: Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia. dahl.miriam@gmail.com.
authors.forename: Miriam
authors.initials: M
authors.lastname: Dahl
authors.affiliation: Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia. chhounchamnan@gmail.com.
authors.forename: Chhoun
authors.initials: C
authors.lastname: Chamnan
authors.affiliation: UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia. epoirot@unicef.org.
authors.forename: Etienne
authors.initials: E
authors.lastname: Poirot
authors.affiliation: Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia. kuong.kh@gmail.com.
authors.forename: Khov
authors.initials: K
authors.lastname: Kuong
authors.affiliation: National Nutrition Program, Maternal and Child Health Center, No 31A, Rue de France (St. 47), Phnom Penh 12202, Cambodia. sophonprak@gmail.com.
authors.forename: Prak
authors.initials: P
authors.lastname: Sophonneary
authors.affiliation: National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh 12202, Cambodia. sinuonm@cnm.gov.kh.
authors.forename: Muth
authors.initials: M
authors.lastname: Sinuon
authors.affiliation: Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France. valerie.greffeuille@ird.fr.
authors.forename: Valerie
authors.initials: V
authors.lastname: Greuffeille
authors.affiliation: ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA. rathavuth.hong@icfi.com.
authors.forename: Rathavuth
authors.initials: R
authors.lastname: Hong
authors.affiliation: Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France. jacques.berger@ird.fr.
authors.forename: Jacques
authors.initials: J
authors.lastname: Berger
authors.affiliation: Nutrition, Exercise and Sports (NEXS), Copenhagen University, Rolighedsvej 25, 1958 Frederiksberg, Copenhagen DK-1958, Denmark. madijkhuizen@gmail.com.
authors.forename: Marjoleine Amma
authors.initials: MA
authors.lastname: Dijkhuizen
authors.affiliation: UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia. alaillou@unicef.org.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Laillou
mesh_terms: D000328:Adult; D000740:Anemia / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D002160:Cambodia / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D005494:Folic Acid Deficiency / Q000150:complications; D006454:Hemoglobins / Q000378:metabolism*; D006725:Hookworm Infections / Q000150:complications; D006801:Humans; D007223:Infant; D007501:Iron / Q000378:metabolism; D000090463:Iron Deficiencies; D018977:Micronutrients / Q000172:deficiency* / Q000378:metabolism; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D014802:Vitamin A Deficiency / Q000150:complications; D014806:Vitamin B 12 Deficiency / Q000150:complications; D015032:Zinc / Q000172:deficiency
chemical_list: D006454:Hemoglobins; D018977:Micronutrients; D007501:Iron; D015032:Zinc
keywords: Cambodia; anemia; children; folic acid; hemoglobin disorders; iron; vitamin A; vitamin B12; women of reproductive age; zinc