Stanford University School of Medicine, Stanford, California.
Technical University of Mombasa, Mombasa, Kenya.
Am J Trop Med Hyg. 2019 Jul;101(1):242-252. doi: 10.4269/ajtmh.17-0688.
Anemia is known to impact a child's growth and development, but not all anemias are caused by iron deficiency, and the CDC and WHO have emphasized investigating other contributors to anemia. This cross-sectional sub-study of a 2012-2016 maternal-child cohort in coastal Kenya evaluated 244 children and found 185 (76%) to have been anemic on at least one time point since birth. At the time of assessment in 2016, evaluation included a complete blood count, nutritional assessment, and testing for parasitic infections, focusing on the primary outcome of anemia, defined as hemoglobin (Hb) < 11 g/dL. The average age at assessment was 20.5 ± 7 months. Ninety-five percent had a lifetime average Hb in the anemic range. Adjusting for age and gender, prior or current malaria infection (prior: Hb β = -0.99, 95% CI: -1.49 to -0.49, = 0.01), or having any current infection with hookworm, , , , and/or malaria (β = -0.84, 95% CI: -1.36 to -0.33, = 0.01) was associated with decreased current Hb. Nutritional evaluation revealed that children with a declining Hb ate fewer vitamin-A-rich vegetables per week ( = 0.01) or eggs ( = 0.01), drank more milk ( = 0.07), and ate more bread ( = 0.01), and were more likely to live in a household that experienced food shortage ( = 0.05). The high prevalence of anemia, polyparasitism, and dietary insufficiency among children in rural coastal Kenya suggests that remedial interventions will need to address both diet and parasitic infections to effectively combat this significant health threat.
贫血已知会影响儿童的生长和发育，但并非所有贫血都是由缺铁引起的，疾病预防控制中心和世界卫生组织强调要调查贫血的其他原因。本研究是 2012 年至 2016 年肯尼亚沿海母婴队列的一项横断面子研究，评估了 244 名儿童，发现自出生以来至少有 185 名（76%）在一个以上时间点存在贫血。在 2016 年进行评估时，评估包括全血细胞计数、营养评估和寄生虫感染检测，重点是贫血的主要结局，定义为血红蛋白（Hb）<11g/dL。评估时的平均年龄为 20.5±7 个月。95%的儿童终生平均 Hb 值处于贫血范围内。调整年龄和性别后，先前或当前疟疾感染（先前：Hbβ=-0.99，95%CI：-1.49 至-0.49， = 0.01）或当前存在任何钩虫、 、 、 、和/或疟疾感染（β=-0.84，95%CI：-1.36 至-0.33， = 0.01）与当前 Hb 降低相关。营养评估显示，Hb 下降的儿童每周摄入的富含维生素 A 的蔬菜较少（ = 0.01）或鸡蛋（ = 0.01），摄入更多的牛奶（ = 0.07），更多的面包（ = 0.01），并且更有可能生活在经历粮食短缺的家庭中（ = 0.05）。农村沿海肯尼亚儿童贫血、多寄生虫感染和饮食不足的高患病率表明，补救干预措施需要同时解决饮食和寄生虫感染问题，以有效应对这一重大健康威胁。
