Graduate School, Khon Kaen University, Khon Kaen, Thailand.
Centre for Research and Development of Medical Diagnostic Laboratories (CMDL), Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.
PLoS One. 2023 Jun 23;18(6):e0287527. doi: 10.1371/journal.pone.0287527. eCollection 2023.
Anemia is a globally well-known major public health problem. In Southeast Asia where there is ethnic diversity, both iron deficiency (ID) and inherited hemoglobin disorders (IHDs) are prevalent and are considered to be the major factors contributing to anemia. However, little is known about the anemia burden among the ethnic minorities. In this study, we determine the burden of anemia, in relation to ID and IHDs, among the Karen ethnic minorities living in the rural area of lower northern Thailand.
A cross-sectional community-based study was conducted at Ban Rai district, Uthai Thani province. Study participants included 337 Karen people aged over 18 years. Socio-economic and health-related information were obtained through interviews and recorded by local health staff. Anemia, IHDs and ID were diagnosed according to standard laboratory methods. Multivariate logistic regression analysis was applied to identify risk factors of moderate-to-severe anemia.
The prevalence of overall anemia was 27.9% (95% CI = 23.2-33.0). Mild and moderate anemia were detected in 18.7% (95% CI = 14.7-23.3) and 8.9% (95% CI = 6.1-12.5) respectively. Severe anemia was found in one case (0.3%). Various forms of IHDs were identified in 166 participants, constituting 49.3% (95% CI = 43.8-54.7). The most common form of IHDs was α+-thalassemia (32.9%), followed by β-thalassemia (12.2%), α0-thalassemia (4.2%), hemoglobin E (3.9%), and hemoglobin Constant Spring (0.9%). Among 308 participants who were investigated for ID, the prevalence was discovered to be 6.8% (95% CI = 4.3-10.2). Analysis of risk factors of moderate-to-severe anemia revealed that individuals with ID, β-thalassemia and age > 65 years were at high risk with adjusted odds ratio of 17 (95% CI = 3.8-75.2), 6.2 (95% CI = 1.4-27.8) and 8.1 (95% CI = 1.6-40.4) respectively.
Anemia among the Karen is of public health significance; and IHDs are the major contributing factors. Because of the high risk of developing moderate-to-severe anemia, special attention should be paid to individuals affected with ID, β-thalassemia and the elderly. Public awareness of the health burden of severe thalassemia syndromes should also be campaigned.
贫血是一个全球知名的重大公共卫生问题。在拥有种族多样性的东南亚，缺铁（ID）和遗传性血红蛋白病（IHDs）都很普遍，被认为是导致贫血的主要因素。然而，关于少数民族的贫血负担，人们知之甚少。在这项研究中，我们确定了生活在泰国北部低地的 Karen 族少数民族的贫血负担，以及与 ID 和 IHDs 的关系。
这是一项在乌泰他尼府 Ban Rai 区进行的基于社区的横断面研究。研究对象包括 337 名年龄在 18 岁以上的 Karen 人。通过访谈获取社会经济和健康相关信息，并由当地卫生人员记录。根据标准实验室方法诊断贫血、IHDs 和 ID。采用多变量逻辑回归分析确定中重度贫血的危险因素。
总体贫血患病率为 27.9%（95%CI=23.2-33.0）。轻度和中度贫血的检出率分别为 18.7%（95%CI=14.7-23.3）和 8.9%（95%CI=6.1-12.5）。仅发现一例严重贫血（0.3%）。在 166 名参与者中发现了各种形式的 IHDs，占 49.3%（95%CI=43.8-54.7）。最常见的 IHDs 形式是 α+-地中海贫血（32.9%），其次是 β-地中海贫血（12.2%）、α0-地中海贫血（4.2%）、血红蛋白 E（3.9%）和血红蛋白 Constant Spring（0.9%）。在 308 名接受 ID 检查的参与者中，发现 ID 的患病率为 6.8%（95%CI=4.3-10.2）。中重度贫血的危险因素分析显示，ID、β-地中海贫血和年龄>65 岁的个体发生中重度贫血的风险较高，调整后的优势比分别为 17（95%CI=3.8-75.2）、6.2（95%CI=1.4-27.8）和 8.1（95%CI=1.6-40.4）。
Karen 族的贫血具有公共卫生意义；IHDs 是主要的致病因素。由于发生中重度贫血的风险较高，应特别关注 ID、β-地中海贫血和老年人。还应开展宣传活动，提高公众对严重地中海贫血综合征健康负担的认识。
