Stoltzfus R J, Chwaya H M, Tielsch J M, Schulze K J, Albonico M, Savioli L
Center for Human Nutrition, Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD 21205, USA.
Am J Clin Nutr. 1997 Jan;65(1):153-9. doi: 10.1093/ajcn/65.1.153.
Anemia is estimated to affect one-half of school-age children in developing countries. The school years are an opportune time to intervene, and interventions must be based on sound epidemiologic understanding of the problem in this age group. We report on the distribution of iron deficiency and anemia across age, sex, anthropometric indexes, and parasitic infections in a representative sample of 3595 schoolchildren from Pemba Island, Zanzibar. Iron status was assessed by hemoglobin, erythrocyte protoporphyrin (EP), and serum ferritin concentrations from a venous blood sample. Overall, 62.3% of children were anemic (hemoglobin < 110 g/L), and 82.7% of anemia was associated with iron deficiency. The overall prevalence of iron-deficient erythropoiesis (EP > 90 mumol/mol heme) was 48.5%, and the prevalence of exhausted iron stores (serum ferritin < 12 micrograms/L) was 41.3%. In bivariate analyses, iron status was slightly better in girls than in boys, and was better in children aged 7-11 y than in those older or younger. Hemoglobin but not EP or serum ferritin concentrations were lower in stunted children. Infection with malaria, Trichuris trichiura, Ascaris lumbricoides, and hookworms were all associated with worse iron status; the association with hookworms was strongest by far. In multivariate analyses, hookworm infection intensity was the strongest explanatory variable for hemoglobin, EP, and serum ferritin. Sex, malarial parasitemia, A. lumbricoides infection, and stunting were also retained in the multivariate model for hemoglobin. Twenty-five percent of all anemia, 35% of iron deficiency anemia, and 73% of severe anemia were attributable to hookworm infection; < 10% of anemia was attributable to A. lumbricoides, malaria infection, or stunting. We conclude that anthelminthic therapy is an essential component of anemia control in schoolchildren in whom hookworms are endemic, and should be complemented with school-based iron supplementation.
据估计，发展中国家有一半的学龄儿童受到贫血影响。学龄期是进行干预的有利时机，而且干预措施必须基于对该年龄组问题的充分流行病学认识。我们报告了来自桑给巴尔奔巴岛的3595名学童的代表性样本中铁缺乏和贫血在年龄、性别、人体测量指标及寄生虫感染方面的分布情况。通过静脉血样中的血红蛋白、红细胞原卟啉（EP）和血清铁蛋白浓度来评估铁状态。总体而言，62.3%的儿童贫血（血红蛋白<110 g/L），且82.7%的贫血与铁缺乏有关。缺铁性红细胞生成（EP>90 μmol/mol血红素）的总体患病率为48.5%，铁储备耗竭（血清铁蛋白<12 μg/L）的患病率为41.3%。在双变量分析中，女孩的铁状态略好于男孩，7至11岁儿童的铁状态好于年龄较大或较小的儿童。发育迟缓儿童的血红蛋白浓度较低，但EP或血清铁蛋白浓度并非如此。感染疟疾、鞭虫、蛔虫和钩虫均与较差的铁状态相关；其中与钩虫的关联最为强烈。在多变量分析中，钩虫感染强度是血红蛋白、EP和血清铁蛋白的最强解释变量。性别、疟疾寄生虫血症、蛔虫感染和发育迟缓也保留在血红蛋白的多变量模型中。所有贫血的25%、缺铁性贫血的35%和重度贫血的73%可归因于钩虫感染；<10%的贫血可归因于蛔虫、疟疾感染或发育迟缓。我们得出结论，驱虫治疗是钩虫流行地区学童贫血控制的重要组成部分，并且应以学校为基础补充铁剂作为补充。
