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Risk factors for anemia in young children in rural Malawi
S C Reed1, J J Wirima, R W Steketee
1Division of Parasitic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Anemia affects 25% of young infants in Malawi, with placental malaria infection being a major risk factor. Early anemia in infants may increase the risk of death, highlighting the need to combat malaria.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Anemia is a significant health concern in African children.
- Early life anemia poses risks for infant mortality.
Purpose of the Study:
- To determine the prevalence and risk factors of anemia in infants in southern Malawi.
- To investigate the association between anemia and infant mortality.
Main Methods:
- A cohort of 252 pregnant women and their infants were studied in Mangochi District, Malawi.
- Infant hematocrit levels and Plasmodium falciparum infection were assessed at approximately two months of age.
- Infant mortality was tracked during the first year of life.
Main Results:
- 25% of infants were anemic (hematocrit < 25%) at two months of age.
- Placental malaria infection was the strongest risk factor for infant anemia (RR=2.0, P=0.003).
- Infants with Plasmodium falciparum parasitemia had lower hematocrit values (median 28% vs. 31%, P=0.02).
Conclusions:
- Anemia is common in young Malawian infants and acquired early in life.
- Plasmodium falciparum infection is a key factor in infant anemia.
- Anemia may be a risk factor for infant mortality, necessitating interventions targeting malaria.
Abstract:
Anemia is an increasingly recognized health problem in African children. To determine the prevalence of and risk factors for anemia in young children, we enrolled 252 pregnant women and studied their newborn infants in Mangochi District in southern Malawi. At the first follow-up visit after birth at approximately two months of age, the mean hematocrit value of the 252 infants was 29.5%, and 64 infants (25%) were anemic (hematocrit value < 25%). Placental malaria infection was the strongest risk factor for an infant having anemia at the first follow-up (relative risk = 2.0, P = 0.003). Infants who had Plasmodium falciparum parasitemia at the first follow-up had lower hematocrit values than infants without parasitemia (median 28% versus 31%; P = 0.02). Neither the mother's hematocrit at enrollment, her hematocrit at delivery, sex of the infant, nor fever illness in the infant was associated with having a hematocrit less than 25% at the first follow-up. Although infants with hematocrit values less than 25% were more likely than infants with higher hematocrit values to die during the first year of life, this difference was not statically significant (relative risk = 1.7, P = 0.15). In rural Malawi, anemia commonly affects young infants, is acquired early in life, and is probably a risk factor for death in infancy. Strategies to reduce anemia in infants must address P. falciparum infection, both during pregnancy and in the first few months of life.