Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: The importance of hookworms
Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: The importance of hookworms
复制标题
DOI：
10.1093/ajcn/65.1.153
复制
发表时间：
1997-01-01
影响因子：
7.1
通讯作者：
Savioli, L
中科院分区：
文献类型：
--
作者：
Stoltzfus, RJ;Chwaya, HM;Savioli, L
据估计，发展中国家一半的学龄儿童患有贫血症。学年是进行干预的好时机，干预措施必须基于对这一年龄组问题的正确流行病学理解。我们报告了来自桑给巴尔奔巴岛的3595名学生的代表性样本中缺铁和贫血在年龄、性别、人体测量指数和寄生虫感染方面的分布。铁状态评估血红蛋白、红细胞原卟啉（EP）和血清铁蛋白浓度从静脉血样本。总体而言，62.3%的儿童贫血（血红蛋白< 110 g/L）， 82.7%的贫血与缺铁有关。红细胞缺铁性（EP < 90 mu mol/mol血红素）的总体患病率为48.5%，铁储备耗竭（血清铁蛋白< 12 mu g/L）的总体患病率为41.3%。在双变量分析中，女孩的铁含量略高于男孩，7-11岁儿童的铁含量高于年龄更大或更小的儿童。发育不良儿童的血红蛋白浓度较低，而EP或血清铁蛋白浓度较低。感染疟疾、毛滴虫、类蛔虫和钩虫均与较差的铁状态相关；到目前为止，与钩虫的联系最为密切。在多变量分析中，钩虫感染强度是血红蛋白、EP和血清铁蛋白的最强解释变量。性别、疟原虫、类蚓蛔虫感染和发育迟缓也保留在血红蛋白的多变量模型中。25%的贫血、35%的缺铁性贫血和73%的严重贫血可归因于钩虫感染；< 10%的贫血可归因于类蚓蛔虫、疟疾感染或发育迟缓。我们得出的结论是，驱虫治疗是控制钩虫地方病学童贫血的重要组成部分，并应辅以以学校为基础的补铁。
Anemia is estimated to affect one-half of school-age children in developing countries. The school years are an opportune time to intervene, and interventions must be based on sound epidemiologic understanding of the problem in this age group. We report on the distribution of iron deficiency and anemia across age, sex, anthropometric indexes, and parasitic infections in a representative sample of 3595 schoolchildren from Pemba Island, Zanzibar. Iron status was assessed by hemoglobin erythrocyte protoporphyrin (EP), and serum ferritin concentrations from a venous blood sample. Overall, 62.3% of children were anemic (hemoglobin < 110 g/L), and 82.7% of anemia was associated with iron deficiency. The overall prevalence of iron-deficient erythropoiesis (EP > 90 mu mol/mol heme) was 48.5%, and the prevalence of exhausted iron stores (serum ferritin < 12 mu g/L) was 41.3%. In bivariate analyses, iron status was slightly better in girls than in boys, and was better in children aged 7-11 y than in those older or younger. Hemoglobin but not EP or serum ferritin concentrations were lower in stunted children. Infection with malaria, Trichuris trichiura, Ascaris lumbricoides, and hookworms were all associated with worse iron status; the association with hookworms was strongest by far. In multivariate analyses, hookworm infection intensity was the strongest explanatory variable for hemoglobin, EP, and serum ferritin. Sex, malarial parasitemia, A. lumbricoides infection, and stunting were also retained in the multivariate model for hemoglobin. Twenty-five percent of all anemia, 35% of iron deficiency anemia, and 73% of severe anemia were attributable to hookworm infection; < 10% of anemia was attributable to A. lumbricoides, malaria infection, or stunting. We conclude that anthelminthic therapy is an essential component of anemia control in schoolchildren in whom hookworms are endemic, and should be complemented with school-based iron supplementation.