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Anemia Among Children Exposed to Polyparasitism in Coastal Kenya

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  • Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio; Great Ormond Street NHS Trust, London, United Kingdom; Department of Environmental Sciences, Emory University, Atlanta, Georgia; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya

Anemia represents a substantial problem for children living in areas with limited resources and significant parasite burden. We performed a cross-sectional study of 254 Kenyan preschool- and early school-age children in a setting endemic for multiple chronic parasitic infections to explore mechanisms of their anemia. Complete venous blood cell counts revealed a high prevalence of local childhood anemia (79%). Evaluating the potential links between low hemoglobin and socioeconomic factors, nutritional status, hemoglobinopathy, and/or parasite infection, we identified age < 9 years (odds ratio [OR]: 12.0, 95% confidence interval [CI]: 4.4, 33) and the presence of asymptomatic malaria infection (OR: 6.8, 95% CI: 2.1, 22) as the strongest independent correlates of having anemia. A total of 130/155 (84%) of anemic children with iron studies had evidence of iron-deficiency anemia (IDA), 16% had non-IDA; 50/52 of additionally tested anemic children met soluble transferrin-receptor (sTfR) criteria for combined anemia of inflammation (AI) with IDA. Children in the youngest age group had the greatest odds of iron deficiency (OR: 10.0, 95% CI: 3.9, 26). Although older children aged 9–11 years had less anemia, they had more detectable malaria, Schistosoma infection, hookworm, and proportionately more non-IDA. Anemia in this setting appears multifactorial such that chronic inflammation and iron deficiency need to be addressed together as part of integrated management of childhood anemia.

Author Notes

* Address correspondence to Charles H. King, Center for Global Health and Diseases, Biomedical Research Building, Room 422, Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106. E-mail: chk@cwru.edu

Financial support: This work was supported by National Institutes of Health Research Grant R01TW008067 funded by the Ecology of Infectious Diseases Program of the Fogarty International Center. Funding support was also provided through a National Institutes of Health T32 Ruth L. Kirschstein National Service Research Award Training Grant.

Authors' addresses: Alicia Chang Cojulun, Unidad De Oncologia Pediatrica (UNOP), Guatemala City, Guatemala, E-mail: aliciachc18@gmail.com. Amaya L. Bustinduy, Paediatric Infectious Diseases Research Group, Institute of Immunity and Infection, St. George's University of London, London, United Kingdom, E-mail: amaya.bustinduy@doctors.org.uk. Laura J. Sutherland, College of Veterinary Medicine, the Ohio State University, Columbus, OH, E-mail: sutherland.93@osu.edu. Peter L. Mungai, Msambweni District Hospital, Msambweni, Kenya, E-mail: plmungai@yahoo.com. Francis Mutuku, Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya, E-mail: fmutuku@tum.ac.ke. Eric Muchiri, Meru University of Science and Technology, Meru, Kenya, E-mail: ericmmuchiri@gmail.com. Uriel Kitron, Department of Environmental Sciences, Emory University, Atlanta, GA, E-mail: ukitron@emory.edu. Charles H. King, Center for Global Health and Diseases, CWRU School of Medicine, Cleveland, OH, E-mail: chk@cwru.edu.

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