FACTORS ASSOCIATED WITH HEMOGLOBIN CONCENTRATIONS IN PRE-SCHOOL CHILDREN IN WESTERN KENYA: CROSS-SECTIONAL STUDIES

MEGHNA R. DESAI Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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DIANNE J. TERLOUW Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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ARTHUR M. KWENA Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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PENELOPE A. PHILLIPS-HOWARD Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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SIMON K. KARIUKI Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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KATHLEEN A. WANNEMUEHLER Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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AMOS ODHACHA Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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WILLIAM A. HAWLEY Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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YA PING SHI Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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BERNARD L. NAHLEN Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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FEIKO O. TER KUILE Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Center for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya; Department of Infectious Diseases, Tropical Medicine & AIDS, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Biochemistry, Faculty of Health Sciences, Moi University, Eldoret, Kenya; Office of Preventive Health, Kenyan Ministry of Health, Kisumu, Kenya; Roll Back Malaria, World Health Organization, Geneva, Switzerland

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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.

  • 1

    DeMaeyer E, Adiels-Tegman M, 1985. The prevalence of anaemia in the world. World Health Stat Q 38 :302–316.

  • 2

    Bain BJ, 1997. The haematological features of HIV infection. Br J Haematol 99 :1–8.

  • 3

    van Eijk AM, Ayisi JG, ter Kuile FO, Misore A, Otieno JA, Kolczak MS, Kager PA, Steketee RW, Nahlen BL, 2002. Malaria and human immunodeficiency virus infection as risk factors for anemia in infants in Kisumu, western Kenya. Am J Trop Med Hyg 67 :44–53.

    • Search Google Scholar
    • Export Citation
  • 4

    Lengeler C, 2000. Insecticide-treated bednets and curtains for preventing malaria. Cochrane Database Syst Rev: CD000363.

  • 5

    ter Kuile FO, Terlouw DJ, Kariuki SK, Phillips-Howard PA, Mirel LB, Hawley WA, Friedman JF, Shi YP, Kolczak MS, Lal AA, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bed nets on malaria, anemia, and growth in infants in an area of intense perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):68–77.

    • Search Google Scholar
    • Export Citation
  • 6

    ter Kuile FO, Terlouw DJ, Phillips-Howard PA, Hawley WA, Friedman JF, Kolczak MS, Kariuki SK, Shi YP, Kwena AM, Vulule JM, Nahlen BL, 2003. Impact of permethrin-treated bed nets on malaria and all cause morbidity in young children in an area of intense perennial malaria transmission in western Kenya: cross-sectional survey. Am J Trop Med Hyg 68 (Suppl 4):100–107.

    • Search Google Scholar
    • Export Citation
  • 7

    Roll Back Malaria Cabinet Project, 2000. The African Summit on Roll Back Malaria, Abuja, Nigeria. Geneva: World Health Organization.

  • 8

    WHO, 2003. Minutes MERG Anaemia Task Force Meeting: October 27–28, 2003. Geneva: World Health Organization/Roll Back Malaria.

  • 9

    Dolan G, ter Kuile FO, Jacoutot V, White NJ, Luxemburger C, Malankirii L, Chongsuphajaisiddhi T, Nosten F, 1993. Bed nets for the prevention of malaria and anaemia in pregnancy. Trans R Soc Trop Med Hyg 87 :620–626.

    • Search Google Scholar
    • Export Citation
  • 10

    Guyatt HL, Snow RW, 2001. The epidemiology and burden of Plasmodium falciparum–related anemia among pregnant women in sub-Saharan Africa. Am J Trop Med Hyg 64 :36–44.

    • Search Google Scholar
    • Export Citation
  • 11

    Molyneux DH, Nantulya VM, 2004. Linking disease control programmes in rural Africa: a pro-poor strategy to reach Abuja targets and millennium development goals. BMJ 328 :1129–1132.

    • Search Google Scholar
    • Export Citation
  • 12

    Phillips-Howard PA, ter Kuile FO, Nahlen BL, Alaii JA, Gimnig JE, Kolczak MS, Terlouw DJ, Kariuki SK, Shi YP, Kachur SP, Hightower AW, Vulule JM, Hawley WA, 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya II. Study design and methods. Am J Trop Med Hyg 68 (Suppl 4):10–15.

    • Search Google Scholar
    • Export Citation
  • 13

    Phillips-Howard PA, Nahlen BL, Alaii JA, ter Kuile FO, Gimnig JE, Terlouw DJ, Kachur SP, Hightower AW, Lal AA, Schoute E, Oloo AJ, Hawley WA, 2003. The efficacy of permethrin-treated bed nets on child mortality and morbidity in western Kenya I. Development of infrastructure and description of study site. Am J Trop Med Hyg 68 (Suppl 4):3–9.

    • Search Google Scholar
    • Export Citation
  • 14

    Phillips-Howard PA, Nahlen BL, Kolczak MS, Hightower AW, ter Kuile FO, Alaii JA, Gimnig JE, Arudo J, Vulule JM, Odhacha A, Kachur SP, Schoute E, Rosen DH, Sexton JD, Oloo AJ, Hawley WA, 2003. Efficacy of permethrin-treated bed nets in the prevention of mortality in young children in an area of high perennial malaria transmission in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):23–29.

    • Search Google Scholar
    • Export Citation
  • 15

    Bloland PB, Ruebush TK, McCormick JB, Ayisi J, Boriga DA, Oloo AJ, Beach R, Hawley W, Lal A, Nahlen B, Udhayaku-mar V, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission I. Description of study site, general methodology, and study population. Am J Trop Med Hyg 60 :635–640.

    • Search Google Scholar
    • Export Citation
  • 16

    McElroy PD, Lal AA, Hawley WA, Bloland PB, Kuile FO, Oloo AJ, Harlow SD, Lin X, Nahlen BL, 1999. Analysis of repeated hemoglobin measures in full-term, normal birth weight Kenyan children between birth and four years of age. III. The Asemobo Bay Cohort Project. Am J Trop Med Hyg 61 :932–940.

    • Search Google Scholar
    • Export Citation
  • 17

    Beier JC, Oster CN, Onyango FK, Bales JD, Sherwood JA, Perkins PV, Chumo DK, Koech DV, Whitmire RE, Roberts CR, Diggs CL, Hoffman SL, 1994. Plasmodium falciparum incidence relative to entomologic inoculation rates at a site proposed for testing malaria vaccines in western Kenya. Am J Trop Med Hyg 50 :529–536.

    • Search Google Scholar
    • Export Citation
  • 18

    Ministry of Health, 1998. National Guidelines for Diagnosis, Treatment and Prevention of Malaria for Health Workers. Nairobi, Kenya: Ministry of Health.

  • 19

    Shapiro RL, Muga OR, Adcock PM, Phillips-Howard PA, Hawley WA, Kumar L, Waiyaki P, Nahlen BL, Slutsker L, 1999. Transmission of epidemic Vibrio cholerae O1 in rural western Kenya associated with drinking water from Lake Victoria: an environmental reservoir for cholera? Am J Trop Med Hyg 60 :271–276.

    • Search Google Scholar
    • Export Citation
  • 20

    Malakooti M, Alaii JA, Shanks D, Phillips-Howard PA, 1997. Epidemic dysentery in western Kenya. Trans R Soc Trop Med Hyg 91 :541–543.

  • 21

    Kwena AM, Terlouw DJ, de Vlas SJ, Phillips-Howard PA, Hawley WA, Friedman JF, Vulule JM, Nahlen BL, Sauerwein RW, ter Kuile FO, 2003. Prevalence and severity of malnutrition in pre-school children in a rural area in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):94–99.

    • Search Google Scholar
    • Export Citation
  • 22

    McElroy PD, ter Kuile FO, Hightower AW, Hawley WA, Phil-lips-Howard PA, Oloo AJ, Lal AA, Nahlen BL, 2001. All-cause mortality among young children in western Kenya. VI: The Asembo Bay Cohort Project. Am J Trop Med Hyg 64 :18–27.

    • Search Google Scholar
    • Export Citation
  • 23

    Meltzer MI, Terlouw DJ, Kolczak MS, Odhacha A, ter Kuile FO, Vulule JM, Alaii JA, Nahlen BL, Hawley WA, Phillips-Howard PA, 2003. The household-level economics of using permethrin-treated bed nets to prevent malaria in children less than five years of age. Am J Trop Med Hyg 68 (Suppl 4):149–160.

    • Search Google Scholar
    • Export Citation
  • 24

    Knight WB, Hiatt RA, Cline BL, Ritchie LS, 1976. A modification of the formol-ether concentration technique for increased sensitivity in detecting Schistosoma mansoni eggs. Am J Trop Med Hyg 25 :818–823.

    • Search Google Scholar
    • Export Citation
  • 25

    Katz N, Chaves A, Pellegrino J, 1972. A simple device for quantitative stool thick-smear technique in schistosomiasis mansoni. Rev Inst Med Trop Sao Paulo 14 :397–400.

    • Search Google Scholar
    • Export Citation
  • 26

    Hawley WA, Phillips-Howard PA, ter Kuile FO, Terlouw DJ, Vulule JM, Ombok M, Nahlen BL, Gimnig JE, Kariuki SK, Kolczak MS, Hightower AW, 2003. Community-wide effects of permethrin-treated bed nets on child mortality and malaria morbidity in western Kenya. Am J Trop Med Hyg 68 (Suppl 4):121–127.

    • Search Google Scholar
    • Export Citation
  • 27

    Dallman PR, Siimes MA, 1979. Percentile curves for hemoglobin and red cell volume in infancy and childhood. J Pediatr 94 :26–31.

  • 28

    Bloland PB, Boriga DA, Ruebush TK, McCormick JB, Roberts JM, Oloo AJ, Hawley W, Lal A, Nahlen B, Campbell CC, 1999. Longitudinal cohort study of the epidemiology of malaria infections in an area of intense malaria transmission II. Descriptive epidemiology of malaria infection and disease among children. Am J Trop Med Hyg 60 :641–648.

    • Search Google Scholar
    • Export Citation
  • 29

    Dibley MJ, Goldsby JB, Staehling NW, Trowbridge FL, 1987. Development of normalized curves for the international growth reference: historical and technical considerations. Am J Clin Nutr 46 :736–748.

    • Search Google Scholar
    • Export Citation
  • 30

    WHO Working Group, 1986. Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Organ 64 :929–941.

    • Search Google Scholar
    • Export Citation
  • 31

    Verhoef H, West CE, Veenemans J, Beguin Y, Kok FJ, 2002. Stunting may determine the severity of malaria-associated anemia in African children. Pediatrics 110 :e48.

    • Search Google Scholar
    • Export Citation
  • 32

    Nacher M, Singhasivanon P, Gay F, Phumratanaprapin W, Silachamroon U, Looareesuwan S, 2001. Association of helminth infection with decreased reticulocyte counts and hemoglobin concentration in Thai falciparum malaria. Am J Trop Med Hyg 65 :335–337.

    • Search Google Scholar
    • Export Citation
  • 33

    United Nations, 2000. Fourth Report on the World Nutrition Situation. Geneva: UN Administrative Committee on Coordination/ Sub-Committee on Nutrition Publication.

  • 34

    UNICEF, KEMRI, Ministry of Health, Kenya, 1999. Summary Results of the Study on Anaemia and States of Iron, Vitamin A and Zinc in Kenya. Nairobi, Kenya: Ministry of Health.

  • 35

    Kitua AY, Smith TA, Alonso PL, Urassa H, Masanja H, Kimario J, Tanner M, 1997. The role of low level Plasmodium falciparum parasitaemia in anaemia among infants living in an area of intense and perennial transmission. Trop Med Int Health 2 :325–333.

    • Search Google Scholar
    • Export Citation
  • 36

    le Cessie S, Verhoeff FH, Mengistie G, Kazembe P, Broadhead R, Brabin BJ, 2002. Changes in haemoglobin levels in infants in Malawi: effect of low birth weight and fetal anaemia. Arch Dis Child Fetal Neonatal Ed 86 :F182–F187.

    • Search Google Scholar
    • Export Citation
  • 37

    McElroy PD, ter Kuile FO, Lal AA, Bloland PB, Hawley WA, Oloo AJ, Monto AS, Meshnick SR, Nahlen BL, 2000. Effect of Plasmodium falciparum parasitemia density on hemoglobin concentrations among full-term, normal birth weight children in western Kenya, IV. The Asembo Bay Cohort Project. Am J Trop Med Hyg 62 :504–512.

    • Search Google Scholar
    • Export Citation
  • 38

    Desai MR, Mei JV, Kariuki SK, Wannemuehler KA, Phillips-Howard PA, Nahlen BL, Kager PA, Vulule JM, ter Kuile FO, 2003. Randomized, controlled trial of daily iron supplementation and intermittent sulfadoxine-pyrimethamine for the treatment of mild childhood anemia in western Kenya. J Infect Dis 187 :658–666.

    • Search Google Scholar
    • Export Citation
  • 39

    Desai MR, Dhar R, Rosen DH, Kariuki SK, Shi YP, Kager PA, ter Kuile FO, 2004. Daily iron supplementation is more efficacious than twice weekly iron supplementation for the treatment of childhood anemia in western Kenya. J Nutr 134 :1167–1174.

    • Search Google Scholar
    • Export Citation
  • 40

    Riley EM, Wagner GE, Akanmori BD, Koram KA, 2001. Do maternally acquired antibodies protect infants from malaria infection? Parasite Immunol 23 :51–59.

    • Search Google Scholar
    • Export Citation
  • 41

    King CL, Malhotra I, Wamachi A, Kioko J, Mungai P, Wahab SA, Koech D, Zimmerman P, Ouma J, Kazura JW, 2002. Acquired immune responses to Plasmodium falciparum merozoite surface protein-1 in the human fetus. J Immunol 168 :356–364.

    • Search Google Scholar
    • Export Citation
  • 42

    Milman N, Bergholt T, Byg KE, Eriksen L, Graudal N, 1999. Iron status and iron balance during pregnancy. A critical reappraisal of iron supplementation. Acta Obstet Gynecol Scand 78 :749–757.

    • Search Google Scholar
    • Export Citation
  • 43

    Allen LH, 2000. Anemia and iron deficiency: effects on pregnancy outcome. Am J Clin Nutr 71 :1280S–1284S.

  • 44

    Blot I, Diallo D, Tchernia G, 1999. Iron deficiency in pregnancy: effects on the newborn. Curr Opin Hematol 6 :65–70.

  • 45

    de Pee S, Bloem MW, Sari M, Kiess L, Yip R, Kosen S, 2002. The high prevalence of low hemoglobin concentration among Indonesian infants aged 3-5 months is related to maternal anemia. J Nutr 132 :2215–2221.

    • Search Google Scholar
    • Export Citation
  • 46

    Kilbride J, Baker TG, Parapia LA, Khoury SA, Shuqaidef SW, Jerwood D, 1999. Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan. Int J Epidemiol 28 :461–468.

    • Search Google Scholar
    • Export Citation
  • 47

    Dallman PR, Siimes MA, Stekel A, 1980. Iron deficiency in infancy and childhood. Am J Clin Nutr 33 :86–118.

  • 48

    Menendez C, Kahigwa E, Hirt R, Vounatsou P, Aponte JJ, Font F, Acosta CJ, Schellenberg DM, Galindo CM, Kimario J, Urassa H, Brabin B, Smith TA, Kitua AY, Tanner M, Alonso PL, 1997. Randomised placebo-controlled trial of iron supplementation and malaria chemoprophylaxis for prevention of severe anaemia and malaria in Tanzanian infants. Lancet 350 :844–850.

    • Search Google Scholar
    • Export Citation
  • 49

    Shankar AH, 2000. Nutritional modulation of malaria morbidity and mortality. J Infect Dis 182 (Suppl 1):S37–S53.

  • 50

    Hassan K, Sullivan KM, Yip R, Woodruff BA, 1997. Factors associated with anemia in refugee children. J Nutr 127 :2194–2198.

  • 51

    Maxwell CA, Msuya E, Sudi M, Njunwa KJ, Carneiro IA, Curtis CF, 2002. Effect of community-wide use of insecticide-treated nets for 3–4 years on malarial morbidity in Tanzania. Trop Med Int Health 7 :1003–1008.

    • Search Google Scholar
    • Export Citation
  • 52

    Holtz TH, Marum LH, Mkandala C, Chizani N, Roberts JM, Macheso A, Parise ME, Kachur SP, 2002. Insecticide-treated bednet use, anaemia, and malaria parasitaemia in Blantyre District, Malawi. Trop Med Int Health 7 :220–230.

    • Search Google Scholar
    • Export Citation
  • 53

    Brooks JT, Shapiro RL, Kumar L, Wells JG, Phillips-Howard PA, Shi YP, Vulule JM, Hoekstra RM, Mintz E, Slutsker L, 2003. Epidemiology of sporadic bloody diarrhea in rural Western Kenya. Am J Trop Med Hyg 68 :671–677.

    • Search Google Scholar
    • Export Citation
  • 54

    Shapiro RL, Kumar L, Phillips-Howard P, Wells JG, Adcock P, Brooks J, Ackers ML, Ochieng JB, Mintz E, Wahlquist S, Waiyaki P, Slutsker L, 2001. Antimicrobial-resistant bacterial diarrhea in rural western Kenya. J Infect Dis 183 :1701–1704.

    • Search Google Scholar
    • Export Citation
  • 55

    Mintz ED, Reiff FM, Tauxe RV, 1995. Safe water treatment and storage in the home. A practical new strategy to prevent water-borne disease. JAMA 273 :948–953.

    • Search Google Scholar
    • Export Citation
  • 56

    Golden MH, 1995. Specific deficiencies versus growth failure: type I and type II nutrients. SCN News December:10–14.

  • 57

    Handzel T, Karanja DM, Addiss DG, Hightower A, Rosen DH, Colley DG, Andove J, Slutsker L, Secor WE, 2003. Geographic distribution of schistosomiasis and soil-transmitted helminths in western Kenya: implications for antihelminthic mass treatment. Am J Trop Med Hyg 69 :318–323.

    • Search Google Scholar
    • Export Citation
  • 58

    Brooker S, Peshu N, Warn PA, Mosobo M, Guyatt HL, Marsh K, Snow RW, 1999. The epidemiology of hookworm infection and its contribution to anaemia among pre-school children on the Kenyan coast. Trans R Soc Trop Med Hyg 93 :240–246.

    • Search Google Scholar
    • Export Citation
  • 59

    Stoltzfus RJ, Chway HM, Montresor A, Tielsch JM, Jape JK, Albonico M, Savioli L, 2004. Low dose daily iron supplementation improves iron status and appetite but not anemia, whereas quarterly anthelminthic treatment improves growth, appetite and anemia in Zanzibari preschool children. J Nutr 134 :348–356.

    • Search Google Scholar
    • Export Citation
  • 60

    Geissler PW, Mwaniki DL, Thiong’o F, Michaelsen KF, Friis H, 1998. Geophagy, iron status and anaemia among primary school children in Western Kenya. Trop Med Int Health 3 :529–534.

    • Search Google Scholar
    • Export Citation
  • 61

    Geissler P, 2000. The significance of earth-eating: social and cultural aspects of geophagy among Luo children. Africa 70 :653–682.

  • 62

    Prince RJ, Luoba AI, Adhiambo P, Ng’uono J, Geissler PW, 1999. Geophagy is common among Luo women in western Kenya. Trans R Soc Trop Med Hyg 93 :515–516.

    • Search Google Scholar
    • Export Citation
  • 63

    Singhi S, Ravishanker R, Singhi P, Nath R, 2003. Low plasma zinc and iron in pica. Indian J Pediatr 70 :139–143.

  • 64

    Kahigwa E, Schellenberg D, Sanz S, Aponte JJ, Wigayi J, Mshinda H, Alonso P, Menendez C, 2002. Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case-control study. Trop Med Int Health 7 :823–830.

    • Search Google Scholar
    • Export Citation
  • 65

    Lartey A, Manu A, Brown KH, Peerson JM, Dewey KG, 1999. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Am J Clin Nutr 70 :391–404.

    • Search Google Scholar
    • Export Citation
  • 66

    Kuate Defo B, 1997. Effects of infant feeding practices and birth spacing on infant and child survival: a reassessment from retrospective and prospective data. J Biosoc Sci 29 :303–326.

    • Search Google Scholar
    • Export Citation
  • 67

    Aidoo M, Terlouw DJ, Kolczak MS, McElroy PD, ter Kuile FO, Kariuki S, Nahlen BL, Lal AA, Udhayakumar V, 2002. Protective effects of the sickle cell gene against malaria morbidity and mortality. Lancet 359 :1311–1312.

    • Search Google Scholar
    • Export Citation
  • 68

    Makutsa P, Nzaku K, Ogutu P, Barasa P, Ombeki S, Mwaki A, Quick RE, 2001. Challenges in implementing a point-of-use water quality intervention in rural Kenya. Am J Public Health 91 :1571–1573.

    • Search Google Scholar
    • Export Citation
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