Background: Anemia is common in HIV infection and independently associated with disease progression and mortality. The pathophysiology of HIV-related anemia is not well understood especially in infancy.

World Bank Studies are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.

Books in this series are published to communicate the results of Bank research, analysis, and operational experience with the least possible delay. The extent of language editing varies from book to book. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.

One method of preventing postnatal iron deficiency is to ensure that the infant is born with a full endowment of iron. We calculated total body iron at birth (TBI) as the sum of hemoglobin iron (HbI) and body storage iron (BSI) in 2021 Zimbabwean newborns, and related TBI to subsequent anemia from 3 to 12 mo of age and to maternal and fetal characteristics. We estimated the mean +/- SD TBI to be 210 +/- 41 mg. There was an inverse dose-response association between TBI quartile and risk of anemia at all postnatal ages. The odds of anemia were >3 times higher in the lowest vs. highest TBI quartile (P < 0.001) at 6, 9 and 12 mo. Preterm birth and parity were not independently associated with TBI after controlling for birthweight. The predicted change in TBI per kilogram increase in birthweight was 68 mg (P < 0.001). After adjusting for birthweight, TBI increased by 25 mg with each 10-y decrement in maternal age (P = 0.033). Maternal hemoglobin was a strong linear predictor of TBI (P < 0.001). Maternal and infant HIV infection, especially among girls, was associated with apparently greater estimated TBI. We speculate that this is actually an artifact, explained by an inflammatory response, and that there was a sex difference in the response. We conclude that we can make satisfactory estimates of TBI and that the assumptions required for this approach are sufficiently robust to lead to an acceptable estimate of the prenatally acquired iron endowment. Babies born with low birthweight or to mothers with low hemoglobin are born with less TBI, which confers a substantially greater risk of anemia from 3 to 12 mo of age.

Some rights reserved 1 2 3 4 18 17 16 15 World Bank Studies are published to communicate the results of the Bank's work to the development community with the least possible delay. The manuscript of this paper therefore has not been prepared in accordance with the procedures appropriate to formally edited texts. This work is a product of the staff of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved.