Determinants of Anemia among Preschool Children in Rural, Western Kenya

Eric M. Foote Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Kevin M. Sullivan Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Laird J. Ruth Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Jared Oremo Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Ibrahim Sadumah Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Thomas N. Williams Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Parminder S. Suchdev Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; Safe Water and AIDS Project, Kisumu, Kenya; and Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya; Nuffield Department of Clinical Medicine, Oxford, United Kingdom

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Although anemia in preschool children is most often attributed to iron deficiency, other nutritional, infectious, and genetic contributors are rarely concurrently measured. In a population-based, cross-sectional survey of 858 children 6–35 months of age in western Kenya, we measured hemoglobin, malaria, inflammation, sickle cell, α-thalassemia, iron deficiency, vitamin A deficiency, anthropometry, and socio-demographic characteristics. Anemia (Hb < 11 g/dL) and severe anemia (Hb < 7 g/dL) prevalence ratios (PRs) for each exposure were determined using multivariable modeling. Anemia (71.8%) and severe anemia (8.4%) were common. Characteristics most strongly associated with anemia were malaria (PR: 1.7; 95% confidence interval [CI] = 1.5–1.9), iron deficiency (1.3; 1.2–1.4), and homozygous α-thalassemia (1.3; 1.1–1.4). Characteristics associated with severe anemia were malaria (10.2; 3.5–29.3), inflammation (6.7; 2.3–19.4), and stunting (1.6; 1.0–2.4). Overall 16.8% of anemia cases were associated with malaria, 8.3% with iron deficiency, and 6.1% with inflammation. Interventions should address malaria, iron deficiency, and non-malarial infections to decrease the burden of anemia in this population.

Author Notes

* Address correspondence to Parminder S. Suchdev, Nutrition Branch, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341. E-mail: psuchdev@cdc.gov

Financial support: This work is supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR000454 and TL1TR000456, Emory University School of Medicine, the Centers for Disease Control and Prevention, and a senior fellowship from the Wellcome Trust, UK (091758).

Authors' addresses: Eric M. Foote, University of Washington School of Medicine, Seattle, WA, E-mail: efoote@uw.edu. Kevin M. Sullivan, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mail: cdckms@sph.emory.edu. Laird J. Ruth and Parminder S. Suchdev, Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: lruth@cdc.gov and psuchdev@cdc.gov. Jared Oremo and Ibrahim Sadumah, Safe Water and AIDS Project, Kisumu, Kenya, E-mails: jerryoresh@yahoo.com and sirahimah@yahoo.com. Thomas N. Williams, Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya, E-mail: twilliams@kilifi.kemri-wellcome.org.

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