Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
J Nutr. 2022 Feb 8;152(2):501-512. doi: 10.1093/jn/nxab366.
While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations.
We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia.
A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models.
The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases.
Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.
虽然个体层面贫血的病因（如某些营养缺乏、感染和遗传疾病）已得到明确界定，但对于人群中每种病因导致贫血的相对负担仍知之甚少。
我们旨在估计 6 个埃塞俄比亚地区女性、男性和儿童中，由营养、传染病和其他危险因素导致的贫血病例比例。
这是一项基于人群的横断面研究。数据来自 2520 名育龄妇女（15-49 岁）、1044 名成年男性（15-49 岁）和 1528 名 6-59 月龄儿童。参与者提供静脉血样，用于评估其血红蛋白浓度、铁蛋白、叶酸、维生素 B12 和 C 反应蛋白水平以及疟疾感染情况。采集粪便样本以确定寄生虫感染状况。还进行了社会人口学问卷调查和 24 小时饮食回顾。计算贫血和危险因素的人群加权患病率。使用广义线性模型估计危险因素与贫血的多变量调整关联以及部分人群归因风险百分比。
女性贫血患病率为 17%（95%CI：13%-21%），男性为 8%（95%CI：6%-12%），儿童为 22%（95%CI：19%-26%）。低血清铁蛋白导致女性 11%（95%CI：-1%至 23%）、男性 9%（95%CI：0%-17%）和儿童 21%（95%CI：4%-34%）的贫血病例。血清叶酸水平低导致的贫血比例估计为女性 25%（95%CI：5%-41%）和男性 29%（95%CI：11%-43%）。几乎所有参与者的膳食铁摄入量都充足，而叶酸和维生素 B12 摄入量不足的情况很常见。炎症和疟疾导致的贫血病例不到 10%。
叶酸缺乏、缺铁和炎症似乎是埃塞俄比亚贫血的重要原因。叶酸食物强化、有针对性的铁干预以及减少感染的策略可被视为潜在的公共卫生干预措施，以减少埃塞俄比亚的贫血。
