Early Childhood Anemia in a Birth Cohort in Coastal Kenya: Links to Infection and Nutrition

Abstract

. Anemia is known to impact a child’s growth and development, but not all anemias are caused by iron deficiency, and the CDC and WHO have emphasized investigating other contributors to anemia. This cross-sectional sub-study of a 2012–2016 maternal-child cohort in coastal Kenya evaluated 244 children and found 185 (76%) to have been anemic on at least one time point since birth. At the time of assessment in 2016, evaluation included a complete blood count, nutritional assessment, and testing for parasitic infections, focusing on the primary outcome of anemia, defined as hemoglobin (Hb) < 11 g/dL. The average age at assessment was 20.5 ± 7 months. Ninety-five percent had a lifetime average Hb in the anemic range. Adjusting for age and gender, prior or current malaria infection (prior: Hb β = −0.99, 95% CI: −1.49 to −0.49, P = 0.01), or having any current infection with hookworm, Trichuris , Strongyloides , Ascaris , and/or malaria (β = −0.84, 95% CI: −1.36 to −0.33, P = 0.01) was associated with decreased current Hb. Nutritional evaluation revealed that children with a declining Hb ate fewer vitamin-A–rich vegetables per week ( P = 0.01) or eggs ( P = 0.01), drank more milk ( P = 0.07), and ate more bread ( P = 0.01), and were more likely to live in a household that experienced food shortage ( P = 0.05). The high prevalence of anemia, polyparasitism, and dietary insufficiency among children in rural coastal Kenya suggests that remedial interventions will need to address both diet and parasitic infections to effectively combat this significant health threat.

Factors associated with early childhood stunted growth in a 2012–2015 birth cohort monitored in the rural Msambweni area of coastal Kenya: a cross-sectional study

“…In choosing to characterize only the non-nutritional causes of stunted growth in this population, child nutritional intake is a confounder that was not examined in this study. We predict that this factor may play a role in the occurrence of stunted growth in this community, given our research group has previously reported a lifetime average blood hemoglobin concentration in the anemic range (< 11 g/dL) in 95% of this pediatric population [10], indicating chronic micronutrient deficiency. Even so, such a high prevalence of anemia in this population is unlikely to explain the observed variation in the occurrence of stunted growth.…”

“…Though inadequate food intake during childhood is one established cause of acute malnutrition and diminished linear growth, chronic malnutrition and stunted growth may also be the result of a variety of other environmental factors. Both childhood exposure to infectious disease and household socioeconomic status (SES) have been demonstrated to correlate with stunted growth [10]. Infant low birth weight, (< 2500 g), which has known links to maternal tobacco use, undernutrition, and anemia, has also been demonstrated to predict stunted growth in childhood, indicating that prenatal exposures may contribute chronic malnutrition [11][12][13].…”

Anemia and Iron-Deficiency Anemia in Children Born to Mothers with HIV in Western Kenya

“…However, although we statistically controlled for differences in socioeconomic status, we acknowledge that unrecognized confounders or contributors to anemia may exist and explain some of the apparent effects of HIV exposure on hemoglobin levels. These include parasitaemia 33 , 34 and lingering effects of, or ongoing exposure to, antiretroviral drugs, 35 , 36 and additional measures of socioeconomic status. Additionally, because the children invited to participate in this study were not randomly sampled from the population of children in Eldoret, it is not possible to say what the true prevalence of anemia is in this population.…”

Impact of helminth–microbiome interactions on childhood health and development—A clinical perspective

“…Helminths can exacerbate malnutrition by a variety of different mechanisms, including causing reduced appetite and food intake, provoking blood loss resulting in anaemia, reducing lactase activity, causing the malabsorption of vitamin A and fat and, in the case of heavy parasitic burdens, directly causing poor digestion and bowel obstruction 109,117,118 . In rats, infection with the roundworm N. brasiliensis directly impaired glucose absorption in intestinal epithelial cells 119 .…”