Desai Meghna R, Terlouw Dianne J, Kwena Arthur M, Phillips-Howard Penelope A, Kariuki Simon K, Wannemuehler Kathleen A, Odhacha Amos, Hawley William A, Shi Ya Ping, Nahlen Bernard L, Ter Kuile Feiko O
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
Am J Trop Med Hyg. 2005 Jan;72(1):47-59.
In sub-Saharan Africa, the etiology of anemia in early childhood is complex and multifactorial. Three community-based cross-sectional surveys were used to determine the prevalence and severity of anemia. Regression methods were used to compare mean hemoglobin (Hb) concentrations across covariate levels to identify children at risk of low Hb levels in an area with intense malaria transmission. In a random sample of 2,774 children < 36 months old, the prevalence of anemia (Hb < 11g/dL) was 76.1% and 71%, respectively, in villages without and with insecticide-treated bed nets (ITNs); severe-moderate anemia (Hb < 7 g/dL) was observed in 11% (non-ITN) and 8.3% (ITN). The prevalence of anemia, high-density malaria parasitemia (21.7%), microcytosis (34.9%), underweight (21.9%), and diarrhea (54.8%) increased rapidly from age three months onwards and remained high until 35 months of age. Multivariate analyses showed that family size, history of fever, pale body, general body weakness, diarrhea, soil-eating, concurrent fever, stunting, and malaria parasitemia were associated with mean Hb levels. Prevention of severe anemia should start early in infancy and include a combination of micronutrient supplementation, malaria control, and possibly interventions against diarrheal illness.
在撒哈拉以南非洲地区，幼儿贫血的病因复杂且具有多因素性。三项基于社区的横断面调查被用于确定贫血的患病率和严重程度。采用回归方法比较不同协变量水平下的平均血红蛋白（Hb）浓度，以识别在疟疾传播强烈地区存在低Hb水平风险的儿童。在2774名年龄小于36个月的儿童随机样本中，在没有和有经杀虫剂处理蚊帐（ITN）的村庄中，贫血（Hb<11g/dL）的患病率分别为76.1%和71%；重度-中度贫血（Hb<7g/dL）在无ITN组中为11%，在有ITN组中为8.3%。贫血、高密度疟疾寄生虫血症（21.7%）、小红细胞症（34.9%）、体重不足（21.9%）和腹泻（54.8%）的患病率从三个月龄起迅速上升，并一直保持在高位直至35个月龄。多变量分析表明，家庭规模、发热史、面色苍白、全身乏力、腹泻、食土癖、同时发热、发育迟缓以及疟疾寄生虫血症与平均Hb水平相关。预防重度贫血应在婴儿期尽早开始，包括补充微量营养素、控制疟疾以及可能针对腹泻疾病的干预措施。
