Demographic Characteristics and Low Iron Status Markers Are Associated with Hemoglobin Levels and Anemia among Children Living at High Elevation in Cusco, Peru

Maria A. Caravedo Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas;

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Maria Luisa Morales Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru

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Melinda Tanabe Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas;

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Martha Lopez Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru

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A. Clinton White Jr. Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas;

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Miguel M. Cabada Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas;
Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru

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ABSTRACT.

Anemia is a complex condition associated with diet, chronic infections, and blood loss. Children living at high altitudes have higher absolute hemoglobin levels due to hypoxemia. However, they are exposed to repeated infections and dietary limitations. We conducted a cross-sectional study to identify factors affecting the hemoglobin concentration in children living in high-altitude rural communities in the Anta province of Peru. All children 3–16 years of age attending public schools were invited to participate. We enrolled children 3–16 years old in schools and visited their homes to collect demographic, socioeconomic, medical history, and anthropometric data. Children provided blood and stool samples for complete blood counts, iron status markers, and helminth infection testing. Among the 2,000 children enrolled, the mean age was 9.9 (±3.4) years, 1,004 (50.2%) were female, and the median residence altitude was 3,398 (interquartile range 3,35–3,497) meters. The mean hemoglobin level was 15 (±1.15) mg/dL; 320 (16%) had anemia as defined by WHO. Children with anemia were more likely to have lower serum iron levels (odds ratio [OR] 2.8 [95% CI 2.2–3.6], P <0.001) and serum transferrin saturation (OR 2.8 [95% CI 2–3.9], P <0.001). Younger age (OR 0.85 [95% CI 0.82–0.89], P <0.001), stunting (OR 0.68 [95% CI 0.59–0.79], P <0.001), education of the mother (OR 0.94 [95% CI 0.91–0.98], P <0.005), and low eosinophils (OR 0.49 [95% CI 0.26–0.9], P = 0.022) were associated with anemia. Helminth infections were not associated with anemia. Anemia among children at high altitude is multifactorial, but iron deficiency is a contributing factor. Further studies are needed to evaluate iron status and anemia in children living at high altitudes.

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Author Notes

Financial support: This study was supported by the NIH National Institute for Allergy and Infectious Diseases (grant no. 1R01AI104820-01).

Disclosure: The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute for Allergy and Infectious Diseases.

Authors’ addresses: Maria A. Caravedo, Melinda Tanabe, and A. Clinton White Jr., Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, E-mails: macarave@utmb.edu, mbtanabe@utmb.edu, and acwhite@utmb.edu. Maria Luisa Morales and Martha Lopez, Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru, E-mails: malu.morales.fernandez@gmail.com and martlop2000@gmail.com. Miguel M. Cabada, Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, and Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru, E-mail: micabada@utmb.edu.

Address correspondence to Miguel M. Cabada, University of Texas Medical Branch, 301 University Blvd. RT 0435, Galveston, TX 77555. E-mail: micabada@utmb.edu
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