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In sub-Saharan Africa, the etiology of anemia in early childhood is complex and multifactorial. Three community-based cross-sectional surveys were used to determine the prevalence and severity of anemia. Regression methods were used to compare mean hemoglobin (Hb) concentrations across covariate levels to identify children at risk of low Hb levels in an area with intense malaria transmission. In a random sample of 2,774 children < 36 months old, the prevalence of anemia (Hb < 11g/dL) was 76.1% and 71%, respectively, in villages without and with insecticide-treated bed nets (ITNs); severe-moderate anemia (Hb < 7 g/dL) was observed in 11% (non-ITN) and 8.3% (ITN). The prevalence of anemia, high-density malaria parasitemia (21.7%), microcytosis (34.9%), underweight (21.9%), and diarrhea (54.8%) increased rapidly from age three months onwards and remained high until 35 months of age. Multivariate analyses showed that family size, history of fever, pale body, general body weakness, diarrhea, soil-eating, concurrent fever, stunting, and malaria parasitemia were associated with mean Hb levels. Prevention of severe anemia should start early in infancy and include a combination of micronutrient supplementation, malaria control, and possibly interventions against diarrheal illness.
Received December 17, 2003. Accepted for publication July 13, 2004.
Acknowledgments: We express our gratitude to the women who participated in the study and the many people that assisted with this project. The authors thank the Director of the Kenya Medical Research Institute for his permission to publish this work. We are grateful to Peter McElroy for providing the reference values used in Figure 1.
Financial support: The ITN project was funded by the United States Agency for International Development. Dianne J. Terlouw was supported by a grant from the Netherlands Foundation for the Advancement of Tropical Research (The Hague, The Netherlands).
Disclaimer: The opinions or assertions contained in this manuscript are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Public Health Service or Department of Health and Human Services. Use of trade names is for identification only and does not imply endorsement by U.S. Public Health Service or Department of Health and Human Services.
Authors’ addresses: Meghna R. Desai, Penelope A. Phillips-Howard, Kathleen A. Wannemuehler, William A. Hawley, and Feiko O. ter Kuile, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-22, Atlanta, GA 30341, E-mail: mdesai{at}cdc.gov. Dianne J. Terlouw, Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Nether-lands. Arthur M. Kwena, Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya. Simon K. Kariuki, Amos Odhacha, and Ya Ping Shi, Center for Vector Biology and Control Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya. Bernard L. Nahlen, Roll Back Malaria, World Health Organization, 1211 Geneva 27, Switzerland.
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