Anemia, micronutrient deficiencies, and malaria in children and women in Sierra Leone prior to the Ebola outbreak

Authors: WIRTH, JAMES - United Nations Children Fund; ROHNER, FABIAN - United Nations Children Fund; WOODRUFF, BRADLEY - United Nations Children Fund; CHIWILE, FARAJA - United Nations Children Fund; YANKSON, HANNAH - World Health Organization (WHO) - Switzerland; KOROMA, AMINATA - United Nations Children Fund; FEIMATA, RUSSEL - United Nations Children Fund; SESAY, FATMATA - Helen Keller International (HKI), United States; DOMINGUEZ, ELISA - World Health Organization (WHO) - Switzerland; PETRY, NICOLAI - United Nations Children Fund; Shahab-Ferdows, Setti; DE ONIS, MERCEDES - World Health Organization (WHO) - Switzerland; HODGES, MARY - Helen Keller International (HKI), United States

Submitted to: PLOS ONE
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/29/2016
Publication Date: 5/10/2016
Citation: Wirth, J.P., Rohner, F., Woodruff, B.A., Chiwile, F., Yankson, H., Koroma, A.S., Feimata, R., Sesay, F., Dominguez, E., Petry, N., Shahab-Ferdows, S., De Onis, M., Hodges, M. 2016. Anemia, micronutrient deficiencies, and malaria in children and women in Sierra Leone prior to the Ebola outbreak. PLoS One. DOI: 10.1371/journal.pone.0155031.

Interpretive Summary: There are not a lot of data available on vitamin and mineral status of the population in Sierra Leone. We now have evidence on anemia in the population. In 2013 a national survey was conducted in the country to assess the reason for the anemia and if vitamin and mineral concentrations were low. The survey also assessed the existence of malaria and inflammation. The survey was done in randomly selected households; women and children of less than 5 years of age were chosen. The survey personnel collected information on the diet and weight and height of the participants. A total of 945 non-pregnant women and 839 children were surveyed. Among children 76.3% had anemia, 52.6% had malaria, and 76.3% had inflammation due to either chronic or acute illness. However, the prevalence low vitamin A was 16.8%, low iron was 5.2% and anemia due to low iron was 3.8% were quite low. Malaria infection and anemia were related to each other but malaria explained only 25% of the anemia in the children. In non-pregnant women, 44.8% had anemia, 35.1% malaria, and 23.6% inflammation. Low iron 8.3%, low iron anemia 6.1%, and low vitamin A 2.1% and vitamin B12 0.5% were not very common. However, low folate was high 79.2%. For the women, like the children, anemia was related to malaria but only explained only 25% of cases of anemia.

Technical Abstract: To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, malaria and inflammation, a nationally representative cross-sectional survey was conducted. A three-stage sampling procedure was used to randomly select children <5 years of age and adult women from households in two strata (urban and rural). Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A,folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence rates of anemia (76.3%; 95% CI: 71.8, 80.4), malaria (52.6%; 95% CI: 46.0, 59.0), and acute and chronic inflammation (72.6%; 95% CI: 67.5,77.1) were high. However, the prevalence of vitamin A deficiency (17.4%; 95% CI: 13.9, 21.6) was moderate, and the prevalence of iron deficiency (5.2%; 95% CI: 3.3, 8.1) and iron-deficiency anemia (3.8%; 95% CI: 2.5, 5.8) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8% (95% CI: 40.1, 49.5), 35.1% (95% CI: 30.1, 40.4), and 23.6%(95% CI: 20.4,27.3) were affected by anemia, malaria, or inflammation, respectively. The prevalence rates of iron deficiency (8.3%; 95% CI: 6.2, 11.1), iron-deficiency anemia (6.1%; 95% CI: 4.4,8.6), vitamin A deficiency (2.1%; 95% CI: 1.1, 3.1) and vitamin B12 deficiency (0.5%; 95% CI: 0.2, 1.4) were low, while folate deficiency was high (79.2%; 95% CI: 74.1, 83.5). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone. Since malaria and inflammation only contributed to 25% of anemia, other causes of anemia, such as hemoglobinopathies, should also be explored.