Adu-Afarwuah Seth, Kumordzie Sika M, Wessells K Ryan, Arnold Charles D, Tan Xiuping, Fuseini Ahmed, Vosti Stephen A, Haskell Marjorie J, Becher Emily R, Davis Jennie N, Adams Katherine P, Engle-Stone Reina
Department of Nutrition and Food Science, University of Ghana, Legon, Accra, Ghana.
Institute for Global Nutrition, University of California, Davis, California, United States of America.
PLoS One. 2025 Jun 17;20(6):e0317647. doi: 10.1371/journal.pone.0317647. eCollection 2025.
Previous data had shown a high prevalence of anemia and various micronutrient deficiencies (MNDs) in the Tolon and Kumbungu districts. We aimed to reassess these outcomes among lactating women (LW), women of reproductive age (WRA), and preschool children (PSC) to inform the design of a MN-fortified bouillon cubes trial, including the choice of micronutrients and selection of study sites; among WRA and PSC, we aimed to identify factors associated with anemia, MND, and inflammation, and to examine anemia co-occurring with MND and inflammation.
In this cross-sectional study (Nov 2020-Jan 2021), we randomly selected 7 urban and 7 rural clusters per district from those accessible at the time, recruited participants through a random walk-based search, and collected and analyzed breastmilk (LW) and venous blood (WRA and PSC). Ferritin (WRA and PSC), and retinol, retinol-binding protein, and zinc (PSC only) were adjusted for inflammation. Binary outcomes were defined using accepted cut-offs. Data analyses involved descriptive statistics, generalized linear mixed models (identify factors), and Rao-Scott chi-squared test (examine co-occurrence).
Approximately 240 each of LW (average age, 30 y), WRA (30 y), and PSC (41 months) participated. Among LW, 41% had low breastmilk B-12; 8% had low breastmilk retinol. Among WRA, anemia was 31%; prevalences of MNDs were: iron, 45%; zinc, 79%; vitamin A, 1%; B-12, 12%; and folate, 12%; with 15% elevated α1-acid glycoprotein (AGP) or C-reactive protein (CRP). Among PSC, anemia was 36%; prevalences of MNDs were: iron, 57%; zinc, 67%; vitamin A, 19%; and B-12, 19%; with 39% elevated AGP or CRP. Improved source of drinking water was associated with lower odds of anemia, iron deficiency, and vitamin A deficiency in WRA; rural or Kumbungu residence was linked to higher odds of vitamin B-12 or vitamin A deficiency in PSC. Anemia co-occurred with iron deficiency and inflammation in WRA and PSC.
Anemia and MNDs were common in this setting, suggesting the need for targeted interventions.
先前的数据显示，托隆和昆本古地区贫血和各种微量营养素缺乏症（MNDs）的患病率很高。我们旨在重新评估哺乳期妇女（LW）、育龄妇女（WRA）和学龄前儿童（PSC）中的这些情况，为一项强化微量营养素的肉汤块试验的设计提供信息，包括微量营养素的选择和研究地点的选择；在育龄妇女和学龄前儿童中，我们旨在确定与贫血、微量营养素缺乏症和炎症相关的因素，并研究贫血与微量营养素缺乏症和炎症同时出现的情况。
在这项横断面研究（2020年11月至2021年1月）中，我们从当时可进入的地区中，每个地区随机选择7个城市和7个农村集群，通过基于随机行走的搜索招募参与者，并收集和分析母乳（哺乳期妇女）和静脉血（育龄妇女和学龄前儿童）。对铁蛋白（育龄妇女和学龄前儿童）、视黄醇、视黄醇结合蛋白和锌（仅学龄前儿童）进行炎症校正。二元结局使用公认的临界值定义。数据分析包括描述性统计、广义线性混合模型（确定因素）和Rao-Scott卡方检验（检查同时出现的情况）。
哺乳期妇女（平均年龄30岁）、育龄妇女（30岁）和学龄前儿童（41个月）各约240人参与。在哺乳期妇女中，41%的母乳维生素B-12含量低；8%的母乳视黄醇含量低。在育龄妇女中，贫血患病率为31%；微量营养素缺乏症的患病率分别为：铁缺乏45%；锌缺乏79%；维生素A缺乏1%；维生素B-12缺乏12%；叶酸缺乏12%；15%的α1-酸性糖蛋白（AGP）或C反应蛋白（CRP）升高。在学龄前儿童中，贫血患病率为36%；微量营养素缺乏症的患病率分别为：铁缺乏57%；锌缺乏67%；维生素A缺乏19%；维生素B-12缺乏19%；39%的AGP或CRP升高。改善饮用水源与育龄妇女贫血、缺铁和维生素A缺乏的较低几率相关；农村或昆本古地区居住与学龄前儿童维生素B-12或维生素A缺乏的较高几率相关。育龄妇女和学龄前儿童中贫血与缺铁和炎症同时出现。
在这种情况下，贫血和微量营养素缺乏症很常见，表明需要有针对性的干预措施。
