Christopher T Andersen1, Amare Worku Tadesse2,3, Sabri Bromage4, Habtamu Fekadu5, Elena C Hemler6, Simone Passarelli4, Donna Spiegelman7, Christopher R Sudfeld6, Alemayehu Worku8,9, Yemane Berhane10, Wafaie W Fawzi1,4,6. 1. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA. 2. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom. 3. Department of Reproductive Health, Nutrition and Population, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. 4. Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA. 5. Save the Children, Washington, DC, USA. 6. Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA. 7. Department of Biostatistics and Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, New Haven, CT, USA. 8. Department of Epidemiology and Evaluation, Addis Continental Institute of Public Health, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. 9. School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia. 10. Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
Abstract
BACKGROUND: While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. OBJECTIVES: We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia. METHODS: A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models. RESULTS: The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases. CONCLUSIONS: Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.
BACKGROUND: While the causes of anemia at an individual level (such as certain nutritional deficiencies, infections, and genetic disorders) are well defined, there is limited understanding of the relative burden of anemia attributable to each cause within populations. OBJECTIVES: We sought to estimate the proportion of anemia cases attributable to nutrition, infectious diseases, and other risk factors among women, men, and children in 6 regions of Ethiopia. METHODS: A population-based cross-sectional study was conducted. Data were obtained from 2520 women of reproductive age (15-49 y), 1044 adult men (15-49 y), and 1528 children (6-59 mo). Participants provided venous blood samples for assessment of their hemoglobin concentration; ferritin, folate, vitamin B12, and C-reactive protein levels; and the presence of malaria infection. Stool samples were collected to ascertain the helminth infection status. Sociodemographic questionnaires and a 24-h diet recall were administered. Population-weighted prevalences of anemia and risk factors were calculated. Multivariable-adjusted associations of risk factors with anemia and partial population attributable risk percentages were estimated using generalized linear models. RESULTS: The anemia prevalences were 17% (95% CI: 13%-21%) among women, 8% (95% CI: 6%-12%) among men, and 22% (95% CI: 19%-26%) among children. Low serum ferritin contributed to 11% (95% CI: -1% to 23%) of anemia cases among women, 9% (95% CI: 0%-17%) among men, and 21% (95% CI: 4%-34%) among children. The proportions of anemia attributable to low serum folate were estimated at 25% (95% CI: 5%-41%) among women and 29% (95% CI: 11%-43%) among men. Dietary iron intake was adequate for nearly all participants, while inadequacy was common for folate and vitamin B12. Inflammation and malaria were responsible for less than 1 in 10 anemia cases. CONCLUSIONS: Folate deficiency, iron deficiency, and inflammation appear to be important contributors to anemia in Ethiopia. Folic acid food fortification, targeted iron interventions, and strategies to reduce infections may be considered as potential public health interventions to reduce anemia in Ethiopia.
Authors: Jacqueline M Lauer; Shibani Ghosh; Lynne M Ausman; Patrick Webb; Bernard Bashaasha; Edgar Agaba; Florence M Turyashemererwa; Hao Q Tran; Andrew T Gewirtz; Juergen Erhardt; Christopher P Duggan Journal: J Nutr Date: 2020-08-01 Impact factor: 4.798
Authors: Amare Worku Tadesse; Elena C Hemler; Christopher Andersen; Simone Passarelli; Alemayehu Worku; Christopher R Sudfeld; Yemane Berhane; Wafaie W Fawzi Journal: BMC Public Health Date: 2019-10-24 Impact factor: 3.295