Chang Cojulun Alicia, Bustinduy Amaya L, Sutherland Laura J, Mungai Peter L, Mutuku Francis, Muchiri Eric, Kitron Uriel, King Charles H
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya.
Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya
Am J Trop Med Hyg. 2015 Nov;93(5):1099-105. doi: 10.4269/ajtmh.15-0353. Epub 2015 Aug 31.
Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool- and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9-11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia.
对于生活在资源有限且寄生虫负担严重地区的儿童来说，贫血是一个相当严重的问题。我们对254名肯尼亚学龄前和学龄儿童进行了一项横断面研究，这些儿童生活在多种慢性寄生虫感染的流行地区，以探究他们贫血的机制。完整的静脉血细胞计数显示当地儿童贫血的患病率很高（79%）。在评估低血红蛋白与社会经济因素、营养状况、血红蛋白病和/或寄生虫感染之间的潜在联系时，我们确定年龄<9岁（比值比[OR]：12.0，95%置信区间[CI]：4.4，33）和无症状疟疾感染的存在（OR：6.8，95%CI：2.1，22）是贫血最强烈的独立相关因素。在进行铁代谢研究的155名贫血儿童中，共有130名（84%）有缺铁性贫血（IDA）的证据，16%为非IDA；在另外接受检测的52名贫血儿童中，有50名符合可溶性转铁蛋白受体（sTfR）联合炎症性贫血（AI）伴IDA的标准。最年幼年龄组的儿童缺铁的几率最高（OR：10.0，95%CI：3.9，26）。虽然9至11岁的大龄儿童贫血较少，但他们可检测到的疟疾、血吸虫感染、钩虫更多，且非IDA的比例更高。在这种情况下，贫血似乎是多因素的，因此在儿童贫血的综合管理中，需要同时解决慢性炎症和缺铁问题。
