Prevalence of Anemia, Iron-Deficiency Anemia, and Associated Factors among Children Aged 1–5 Years in the Rural, Malaria-Endemic Setting of Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study

Abstract

Iron deficiency (ID), the leading cause of anemia and the most common nutritional deficiency globally, is not well reported among children in malaria-endemic settings, and little is known about its contribution to anemia in these settings. We aimed to assess the prevalence of anemia, the role of ID using multiple parameters, and the factors associated with anemia in a malaria-endemic rural area. We conducted a community-based cross-sectional study of 432 children aged 1–5 years from the Popokabaka Health Zone, Democratic Republic of Congo. Sociodemographic characteristics, medical history, anthropometric parameters, and biochemical parameters were considered. Hemoglobin and malaria prevalence were assessed using rapid finger-prick capillary blood testing in the field. Venous blood samples were analyzed for serum ferritin, serum iron, total iron-binding capacity, and C-reactive protein (CRP) in a laboratory. Anemia was found in 294 out of 432 (68%) patients. Malaria was found in 375 out of 432 (87%), and ID in 1.8% according to diagnosis by adjusted ferritin only and in 12.9% according to transferrin saturation. ID indicators were not significantly correlated with low hemoglobin levels. Malaria, fever, and CRP > 5 mg/L were major factors associated with anemia in Popokabaka. Anemia control should focus on treating inflammatory conditions and infectious diseases among children in such settings.

Distribution and Determinants of Serum Zinc, Copper, and Selenium Levels among Children under Five Years from Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study

“…Chronic malnutrition is common because half of all children are stunted [ 24 , 25 ]. Malaria and anemia are also highly prevalent [ 26 ].…”

“…Children were selected using a three-stage cluster sampling technique. More details on sampling are described in our former article [ 26 ].…”

Anemia, iron deficiency and malaria amidst impoverishment: a nexus for the anemia management challenge

“…We have read the article "Prevalence of Anemia, Iron-Deficiency Anemia, and Associated Factors among Children Aged 1-5 Years in the Rural, Malaria-Endemic Setting of Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study" of Mbunga et al with great interest (Mbunga et al, 2021). The context and the findings -the high prevalence of childhood anemia (68.1%) and malaria (86.8%) and the low level of iron deficiency (ID) (1.8-12.9%, according to the different methods) in an impoverished rural setting of the Democratic Republic of Congo posit a challenge for controlling the high burden of anemia.…”

“…Though unmeasured in the Mbunga et al study, the overwhelming prevalence of malaria suggests that there might have been a good level of circulating hepcidin in the study children which complements the high prevalence of anemia. The presence of food insecurity, low dietary diversity, low animal food intake and poverty (Mbunga et al, 2021) entail that the iron from the dietary sources was suboptimum, thus further augmenting the proposition of acquired dyserthopoiesis. Additionally, the other possible cause of the anemia could be the malarial parasite-induced premature phagocytosis and destruction of the red blood cells by the reticuloendothelial system (Perkins et al, 2011).…”

“…The mechanisms of hepcidin suppression could be by erythropoietic drive, hypoxia, or iron deficiency (Spottiswoode et al, 2014). Since the prevalence of malaria was exceedingly high in the setting (Mbunga et al, 2021), we assume that there might be a proportion of the cases with severe malarial infection leading to possible hepcidin suppression. Hence, the ID might be higher than that reported in the study as a possible consequence of hepcidin suppression.…”