Gari Taye, Loha Eskindir, Deressa Wakgari, Solomon Tarekegn, Atsbeha Hanibale, Assegid Meselech, Hailu Alemayehu, Lindtjørn Bernt
School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Centre for International Health, University of Bergen, Bergen, Norway.
PLoS One. 2017 Mar 14;12(3):e0170898. doi: 10.1371/journal.pone.0170898. eCollection 2017.
As part of a field trial (PACTR201411000882128) to provide evidence on the combined use of long-lasting insecticidal nets and indoor residual spray for malaria prevention, we measured haemoglobin values among children aged 6 to 59 months. The aim of this study was to estimate the prevalence of anaemia, and to determine the risk factors of anaemia and change in haemoglobin value in Adami Tullu district in south-central Ethiopia.
Repeated cross-sectional surveys among 2984 children in 2014 and 3128 children in 2015; and a cohort study (malaria as exposure and anaemia as outcome variable) were conducted. The study area faced severe drought and food shortages in 2015. Anaemia was diagnosed using HemoCue Hb 301, and children with haemoglobin <11 g/dl were classified as anaemic. Multilevel and Cox regression models were applied to assess predictors of anaemia.
The prevalence of anaemia was 28.2% [95% Confidence Interval (CI), 26.6-29.8] in 2014 and increased to 36.8% (95% CI, 35.1-38.5) in 2015 (P<0.001). The incidence of anaemia was 30; (95% CI, 28-32) cases per 100 children years of observation. The risk of anaemia was high (adjusted Hazard Ratio = 10) among children with malaria. Children from poor families [Adjusted Odds Ratio (AOR); 1.3; 95% CI, 1.1-1.6)], stunted children (AOR 1.5; 95% CI; 1.2-1.8), and children aged less than 36 months (AOR; 2.0; 95% CI, 1.6-2.4) were at risk of anaemia compared to their counterparts. There was no significant difference in risk of anaemia among the trial arms.
Young age, stunting, malaria and poverty were the main predictors of anaemia. An increase in the prevalence of anaemia was observed over a year, despite malaria prevention effort, which could be related to the drought and food shortage. Therefore, conducting trials in settings prone to drought and famine may bring unexpected challenges.
作为一项关于长效驱虫蚊帐和室内滞留喷洒联合用于疟疾预防的实地试验（注册号：PACTR201411000882128）的一部分，我们测量了6至59个月大儿童的血红蛋白值。本研究的目的是估计埃塞俄比亚中南部阿达米图卢地区贫血的患病率，确定贫血的危险因素以及血红蛋白值的变化情况。
于2014年对2984名儿童和2015年对3128名儿童进行了重复横断面调查；并开展了一项队列研究（以疟疾为暴露因素，贫血为结局变量）。研究地区在2015年面临严重干旱和粮食短缺。使用HemoCue Hb 301诊断贫血，血红蛋白<11 g/dl的儿童被归类为贫血。应用多水平和Cox回归模型评估贫血的预测因素。
2014年贫血患病率为28.2% [95%置信区间（CI），26.6 - 29.8]，2015年增至36.8%（95% CI，35.1 - 38.5）（P<0.001）。贫血发病率为每100儿童年观察期30例（95% CI，28 - 32）。患疟疾的儿童贫血风险较高（调整后风险比 = 10）。与其他儿童相比，来自贫困家庭的儿童[调整后比值比（AOR）为1.3；（95% CI，1.1 - 1.6）]、发育迟缓儿童（AOR 1.5；95% CI；1.2 - 1.8）以及年龄小于36个月的儿童（AOR；2.0；95% CI，1.6 - 2.4）有贫血风险。各试验组之间贫血风险无显著差异。
年龄小、发育迟缓、疟疾和贫困是贫血的主要预测因素。尽管开展了疟疾预防工作，但一年中贫血患病率仍有所上升，这可能与干旱和粮食短缺有关。因此，在易发生干旱和饥荒的地区进行试验可能会带来意想不到的挑战。
