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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.
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: email@example.com. Kevin M. Sullivan, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, E-mail: firstname.lastname@example.org. Laird J. Ruth and Parminder S. Suchdev, Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: email@example.com and firstname.lastname@example.org. Jared Oremo and Ibrahim Sadumah, Safe Water and AIDS Project, Kisumu, Kenya, E-mails: email@example.com and firstname.lastname@example.org. Thomas N. Williams, Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute, Kilifi, Kenya, E-mail: email@example.com.