Anemia, Micronutrient Deficiencies, and Malaria in Children and Women in Sierra Leone Prior to the Ebola Outbreak - Findings of a Cross-Sectional Study

Abstract

To identify the factors associated with anemia and to document the severity of micronutrient deficiencies, malaria and inflammation, a nationally representative cross-sectional survey was conducted. A three-stage sampling procedure was used to randomly select children <5 years of age and adult women from households in two strata (urban and rural). Household and individual data were collected, and blood samples from children and women were used to measure the prevalence of malaria, inflammation, and deficiencies of iron, vitamin A, folate, and vitamin B12. 839 children and 945 non-pregnant women were included in the survey. In children, the prevalence rates of anemia (76.3%; 95% CI: 71.8, 80.4), malaria (52.6%; 95% CI: 46.0, 59.0), and acute and chronic inflammation (72.6%; 95% CI: 67.5, 77.1) were high. However, the prevalence of vitamin A deficiency (17.4%; 95% CI: 13.9, 21.6) was moderate, and the prevalence of iron deficiency (5.2%; 95% CI: 3.3, 8.1) and iron-deficiency anemia (3.8%; 95% CI: 2.5, 5.8) were low. Malaria and inflammation were associated with anemia, yet they explained only 25% of the population-attributable risk. In women, 44.8% (95% CI: 40.1, 49.5), 35.1% (95% CI: 30.1, 40.4), and 23.6% (95% CI: 20.4, 27.3) were affected by anemia, malaria, or inflammation, respectively. The prevalence rates of iron deficiency (8.3%; 95% CI: 6.2, 11.1), iron-deficiency anemia (6.1%; 95% CI: 4.4, 8.6), vitamin A deficiency (2.1%; 95% CI: 1.1, 3.1) and vitamin B12 deficiency (0.5%; 95% CI: 0.2, 1.4) were low, while folate deficiency was high (79.2%; 95% CI: 74.1, 83.5). Iron deficiency, malaria, and inflammation were significantly associated with anemia, but explained only 25% of cases of anemia. Anemia in children and women is a severe public health problem in Sierra Leone. Since malaria and inflammation only contributed to 25% of anemia, other causes of anemia, such as hemoglobinopathies, should also be explored.

Global folate status in women of reproductive age: a systematic review with emphasis on methodological issues

“…In most cases, appropriate procedures were followed to ensure specimen integrity (Supplementary Table S1, online only). In a few cases, storage or handling of samples under suboptimal conditions may have led to folate losses (Côte d'Ivoire 2007, Sierra Leone 2013, the United Kingdom 2000–2001, and 2008–2012, and Uzbekistan 2008); in other cases, incomplete information was provided (Afghanistan 2013, Australia 2011–2012, Cambodia 2014, Ecuador 2012, Jordan 2010, Lebanon 2003, Mongolia 2004, and Sweden 2010–2011). No information was reported in one survey (Newfoundland, Canada).…”

“…The four surveys conducted in countries with low‐income economies (Table ) were representative of the national population of adolescent girls in Afghanistan and WRA in Cambodia, Sierra Leone, and Ethiopia . Folate status was based solely on serum or plasma folate concentration; therefore, the prevalence of folate insufficiency was not reported for any low‐income country.…”

“…Because the prevalence factor was >0.85 but <1.15, it was concluded that the prevalence was likely a correct estimate of deficiency. The 2013 Sierra Leone Micronutrient Survey reported a prevalence of folate deficiency in WRA of ∼80% at <10 nmol/L and used the same assay and cutoff as the Cambodian survey; thus, the prevalence was also likely a correct estimate of deficiency. The 2005 Ethiopian national assessment (9 of 11 regions) of folate status in WRA reported that nearly 50% of WRA had serum folate values ≤9 nmol/L .…”

Should vitamin B12 status be considered in assessing risk of neural tube defects?

“…By contrast, vitamin B 12 deficiency does not appear to be a problem in other areas. For example, in a population study of 871 women of reproductive age in Sierra Leone, vitamin B 12 status was high (mean (SD) of 556 (263) pmol/L), and the prevalence of deficiency (<150 pmol/L) was extremely low (<0.5%) . In the Democratic Republic of the Congo, folate and vitamin B 12 deficiencies were reported to be <5%, and in Ghana they were also negligible…”

NONE TOO S.M.A.LL: the global challenge of severe malarial anaemia and its transfusion support

“…Anaemia and malaria disproportionately afflict women and children and, together, render a population even more vulnerable to other emerging public health threats. In a survey of children in Sierra Leone before the Ebola epidemic struck, nearly 80% of children were anaemic, with more than half of these cases exhibiting concomitant malaria . New problems are therefore even more difficult to address when old ones have not yet been solved, while the potential for range expansion of vector‐borne diseases is also looming with climate change .…”