Topical Area: Global Nutrition
To examine the etiology of anemia among women and children in Habiganj District, Sylhet considering nutritional and non-nutritional factors.
We analyzed data from 366 non-pregnant women and 204 children (6-37 months) collected at the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial’s 2015 baseline survey in 96 settlements. Blood samples were analyzed for anemia (hemoglobin), iron status (serum ferritin, serum transferrin receptor), vitamin A status (retinol binding protein (RBP)), inflammation (c-reactive protein and α-1-acid glycoprotein), vitamin B-12 status (methylmalonic acid (MMA)), and hemoglobinopathies (α-, β-thalassemia, Hemoglobin E and S). Logistic regression was conducted to identify factors associated with anemia, adjusting iron and vitamin A for inflammation using internal regression correction.
Almost half of women and children were anemic (45% and 46%) though only 2% of women and 17% of children were iron-deficient (total body iron < 0 mg/kg). Almost 20% of women and 60% of children had deficient or insufficient vitamin A levels (RBP < 1.05 µmol/L). Vitamin B-12 deficiency (MMA: < 210 nM) was high among women (27%) and children (70%). About 10% of women and children had any thalassemia or hemoglobinopathy; 5% had either β-thalassemia or HbE. Despite little iron deficiency among women, total body iron (mg/kg) was strongly associated with anemia, as was RBP (µmol/L) (OR (95% CI): iron: 0.8 (0.7, 0.8); vitamin A: 0.5 (0.3, 0.8)). In children, total body iron and age were also protective for anemia. In both women and children, having β-thalassemia or Hemoglobin E was associated with increased odds of anemia. Vitamin B-12 status was not associated with anemia.
Although iron deficiency was uncommon, there remained a strong association between total body iron and anemia. Vitamin A was also strongly associated with anemia and may be a key intervention strategy as Vitamin A levels were low. However, further research is still needed as a large proportion of anemia remains unexplained.
Funding Sources :
The FAARM trial was supported by the Germany Ministry of Education and Research (BMBF). The first author received support from the Alexander von Humboldt Foundation and a Thrasher Research Fund Early Career Award.
Heidelberg Institute of Global Health, University of Heidelberg
Technical Director – National Information Platform for Nutrition, Bangladesh
Helen Keller International
Head, Unit of Epidemiology and Biostatistics
Heidelberg Institute of Global Health