Exploration of the relationship between anemia and iron and zinc deficiencies in children under 5 years of age living in the malaria endemic area of South Kivu/Democratic Republic of Congo

Abstract

The aim of this study was to explore the relationship of iron and zinc deficiencies and anemia in children aged under 5 years living in malaria endemic area of South Kivu/DRC. We conducted a cross-sectional study in the health zone of Miti Murhesa in South Kivu/DRC. A total of 1088 children in good general health were included in this study. Almost 40% of children were anemic. The prevalence of iron deficiency (ID) was found in 34.9% and 49.1% children based on ferritin or free erythrocyte protoporphyrin (FEP), respectively. If anemia is present, we found iron deficiency anemia (IDA) according to the WHOcriteria (ferritin) in 31%, and according to FEP in 66% of children. The overall prevalence of zinc deficiency was 17.6%. If anemia is present, zinc deficiency was found in 24.4% of children. Inflammation/infection, based upon CRP, was present in 39.7% children. The independent factors associated with anemia were recent illness, middle upper arm circumference, weight-for-height, ID according to FEP, zinc deficiency, and submicroscopic Plasmodium infection. A high prevalence of ID was observed in children in South Kivu according to FEP. Ferritin as acute phase protein was less suited in this population due to a high frequency of infection/inflammation. Iron and zinc deficiencies were found to be significantly associated with anemia in this population.

Nutrition-Related Knowledge, Attitudes, Practices, and Anemia Status of Lactating Mothers in Bukavu, Democratic Republic of the Congo—A Cross-Sectional Analysis

“…Other studies in South Kivu found lower rates of anemia in non-pregnant women of reproductive age (16.5%) and children aged 6–23 months (47.8–58.6%) compared to our findings [ 9 , 10 , 11 ]. Rates of iron deficiency were lower than rates of anemia, but frequent infections and genetic Hb disorders were mentioned as potential influencers.…”

“…Rates of iron deficiency were lower than rates of anemia, but frequent infections and genetic Hb disorders were mentioned as potential influencers. Determining iron deficiency by free erythrocyte protoporphyrin resulted in higher levels of iron deficiency [ 9 ]. Factors associated with anemia were malnutrition, illness, Plasmodium infection, and zinc and partly iron deficiency, when not measured by serum ferritin [ 9 , 10 ].…”

“…Determining iron deficiency by free erythrocyte protoporphyrin resulted in higher levels of iron deficiency [ 9 ]. Factors associated with anemia were malnutrition, illness, Plasmodium infection, and zinc and partly iron deficiency, when not measured by serum ferritin [ 9 , 10 ]. Bahizire et al [ 10 ] suggested high iron concentrations in the drinking water due to the volcanic soil in the Kivu region as a possible reason for rare iron deficiency.…”

“…Considering the reported results of other studies in South Kivu and the quite high dietary intake of iron-rich animal-sourced foods and dark green leafy vegetables, the anemia rates observed in this study may only be partly attributed to iron deficiency. Other reasons may include hemoglobinopathies, malaria, or helminth infections [ 9 , 10 , 21 , 29 , 56 , 57 , 58 , 59 , 60 , 61 ], but also malnutrition in terms of other nutrients such as zinc, vitamin A, B12, or folate [ 9 , 21 , 29 , 57 ]. The latter will be discussed in the next section.…”

“…The Democratic Republic of the Congo (DRC) faces high levels of underweight and anemia among women aged 15–49 years (14.4%, 38.4%) and children aged 6–59 months (22.6%, 59.8%), according to the latest Demographic Health Survey (DHS) in 2013–2014 [ 8 ]. In South Kivu, studies reported an anemia prevalence of 16.5–17.6% in pregnant and non-pregnant women of reproductive age (DHS: 22.7%) and 47.8–58.6% in children aged 6–23 months (DHS: 35.7% in children 6–59 months) [ 8 , 9 , 10 , 11 ]. Also, in South Kivu, Moumin et al [ 12 ] found a moderate prevalence of inadequate vitamin A (18%) and iron intake (33%) among women of reproductive age, and moderate to high inadequacy of further nutrients such as folate or zinc.…”