BACKGROUND: Childhood anaemia, defined as haemoglobin (Hb) < 110 g/L, is widespread in Zambia, affecting 55% of children under 5 years and 70% of children under 12 months. More broadly, it is a global concern that has been linked to a range of negative health outcomes, some irreversible. While the causes of anaemia are well understood, the specific etiology varies regionally, complicating efforts to create interventions. Unfortunately, there has been only limited research on the causes of anaemia in Zambia.
OBJECTIVES: To determine the prevalence of anaemia, iron deficiency, and iron deficiency anaemia (IDA) in children 6-11 months in Mbala District, Northern Province, Zambia. Exploratory objectives examined factors associated with mild and moderate anaemia and haemoglobin concentrations to inform future interventions and research.
METHODS: Analysis was performed on a convenience sample of 631 child-caregiver pairs that were recruited in Mbala District. Data on demographics, morbidity, sanitation and hygiene, and infant and young child feeding (IYCF) practices, anthropometry and the presence of malaria parasites was collected. Blood samples were obtained to measure haemoglobin, serum ferritin, serum transferrin receptor (STfR), and indicators of inflammation.
RESULTS: 57% of the children were anaemic, 74% exhibited inflammation and the rate of iron deficiency varied between 13% when determined using inflammation adjusted serum ferritin cut-offs and 93% when using STfR > 8.3 mg/L, resulting in rates of IDA ranging from 8-22%. Using logistic regression it was found that increased age and achieving minimum dietary diversity were associated with reduced risk of being mildly or moderately anaemic, while increased malaria parasite loads, STfR concentrations, C-reactive protein concentrations, fever in the previous 2 weeks, and having been counselled on IYCF were associated with increased risk (p < 0.05).
CONCLUSION: Anaemia is widespread, representing a major health burden. While there is potentially widespread iron deficiency, inflammation makes it difficult to state what the true prevalence is, suggesting the need for further research. Interventions targeting dietary diversity, malaria and other infections, and iron status may be effective for lowering anaemia in the area. Future studies measuring further covariates and establishing causal pathways are required.