Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
PLoS One. 2012;7(5):e36341. doi: 10.1371/journal.pone.0036341. Epub 2012 May 4.
Although iron deficiency is considered to be the main cause of anemia in children worldwide, other contributors to childhood anemia remain little studied in developing countries. We estimated the relative contributions of different factors to anemia in a population-based, cross-sectional survey.
We obtained venous blood samples from 1111 children aged 6 months to 10 years living in the frontier town of Acrelândia, northwest Brazil, to estimate the prevalence of anemia and iron deficiency by measuring hemoglobin, erythrocyte indices, ferritin, soluble transferrin receptor, and C-reactive protein concentrations. Children were simultaneously screened for vitamin A, vitamin B(12), and folate deficiencies; intestinal parasite infections; glucose-6-phosphate dehydrogenase deficiency; and sickle cell trait carriage. Multiple Poisson regression and adjusted prevalence ratios (aPR) were used to describe associations between anemia and the independent variables.
The prevalence of anemia, iron deficiency, and iron-deficiency anemia were 13.6%, 45.4%, and 10.3%, respectively. Children whose families were in the highest income quartile, compared with the lowest, had a lower risk of anemia (aPR, 0.60; 95%CI, 0.37-0.98). Child age (<24 months, 2.90; 2.01-4.20) and maternal parity (>2 pregnancies, 2.01; 1.40-2.87) were positively associated with anemia. Other associated correlates were iron deficiency (2.1; 1.4-3.0), vitamin B(12) (1.4; 1.0-2.2), and folate (2.0; 1.3-3.1) deficiencies, and C-reactive protein concentrations (>5 mg/L, 1.5; 1.1-2.2).
Addressing morbidities and multiple nutritional deficiencies in children and mothers and improving the purchasing power of poorer families are potentially important interventions to reduce the burden of anemia.
尽管缺铁被认为是全世界儿童贫血的主要原因，但在发展中国家，其他导致儿童贫血的因素仍研究甚少。我们在一项基于人群的横断面研究中，评估了不同因素对贫血的相对贡献。
我们从巴西西北部边疆城镇阿克里兰迪亚的 1111 名 6 个月至 10 岁的儿童中抽取静脉血样，通过测量血红蛋白、红细胞指数、铁蛋白、可溶性转铁蛋白受体和 C 反应蛋白浓度，来估算贫血和缺铁的患病率。同时，对儿童进行维生素 A、维生素 B12 和叶酸缺乏症、肠道寄生虫感染、葡萄糖-6-磷酸脱氢酶缺乏症和镰状细胞特征携带情况的筛查。我们采用多泊松回归和调整后的患病率比（aPR）来描述贫血与独立变量之间的关联。
贫血、缺铁和缺铁性贫血的患病率分别为 13.6%、45.4%和 10.3%。与收入最低的家庭相比，收入最高的家庭的孩子贫血风险较低（aPR，0.60；95%CI，0.37-0.98）。儿童年龄（<24 个月，2.90；2.01-4.20）和母亲产次（>2 次，2.01；1.40-2.87）与贫血呈正相关。其他相关的关联因素包括缺铁（2.1；1.4-3.0）、维生素 B12（1.4；1.0-2.2）和叶酸缺乏（2.0；1.3-3.1）以及 C 反应蛋白浓度（>5mg/L，1.5；1.1-2.2）。
针对儿童和母亲的多种发病率和营养缺乏症，并提高贫困家庭的购买力，这些措施可能是减轻贫血负担的重要干预措施。
