Genetic Hemoglobin Disorders, Infection, and Deficiencies of Iron and Vitamin A Determine Anemia in Young Cambodian Children

Abstract

In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and a 1 -acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P , 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP .1.0 g/L (P , 0.001), and rural setting (P , 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P , 0.02).Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.

Unhealthy Habits of Rural Children in Fayoum Governorate, Egypt

“…Many Egyptians have developed the concept of drinking tea right after eating. Tea is very healthy, however, some studies have shown that tea interfere with the absorption of iron [30] in our work about two third of the children consume tea immediately after meals 3times and more and the consumption increasing with age this was similar to [20,31].…”

The Homozygous Hemoglobin EE Genotype and Chronic Inflammation Are Associated with High Serum Ferritin and Soluble Transferrin Receptor Concentrations among Women in Rural Cambodia

“…To account for the elevation of ferritin in the presence of inflammation, Thurnham et al (23) have developed correction factors (CFs) based on the stages of inflammation (incubation and early and late convalescence) with the use of data from 32 studies of apparently healthy individuals in the absence of overt disease in over 10 countries. The accuracy of these CFs has not yet been studied in populations with a high prevalence of hemoglobin (Hb) disorders, some of which are known to increase ferritin and sTfR concentrations (e.g., homozygous Hb EE) (12,25). Hb disorders are autosomal recessive and can be inherited in the homozygous or the heterozygous form (also referred to as a ''trait'') (26).…”

Evaluation of two methods to measure hemoglobin concentration among women with genetic hemoglobin disorders in Cambodia: A method-comparison study

“…In Cambodia, genetic Hb disorders affect~50% of the population, the most prevalent of which are Hb E variants and alpha-thalassemia [31][32][33]. Hb E variants, in particular, result in an altered structure of the beta globin chain of Hb resulting in an unstable Hb molecule [34][35][36], hence the commonly used term 'structural variants'.…”