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Nutrients 2016, 8(6), 348; doi:10.3390/nu8060348

The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders

1
Institute of Research for Development (IRD), UMR Nutripass UM-IRD-SupAgro, Montpellier 3400, France
2
Department of Fisheries, Post-harvest Technologies and Quality control, Fisheries Administration, MAFF, 186 Preah Norodom Boulevard, Phnom Penh 12000, Cambodia
3
UNICEF, Maternal, Newborn and Child Health and Nutrition section, no11 street 75, Phnom Penh 12202, Cambodia
4
National Nutrition Program, Maternal and Child Health Center, No 31A, Rue de France (St. 47), Phnom Penh 12202, Cambodia
5
National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh 12202, Cambodia
6
ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA
7
Nutrition, Exercise and Sports (NEXS), Copenhagen University, Rolighedsvej 25, 1958 Frederiksberg, Copenhagen DK-1958, Denmark
*
Author to whom correspondence should be addressed.
Received: 13 January 2016 / Revised: 31 May 2016 / Accepted: 2 June 2016 / Published: 7 June 2016
(This article belongs to the Special Issue Nutrients and National Strategies to Impact Health)
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Abstract

Background: Anemia is highly prevalent in Cambodian women and children, but data on causes of anemia are scarce. We performed a national micronutrient survey in children and women that was linked to the Cambodian Demographic Health Survey 2014 (CDHS-2014) to assess the prevalence of micronutrient deficiency, hemoglobin disorders and intestinal parasite infection. Methods: One-sixth of households from the CDHS-2014 were selected for a follow-up visit for the micronutrient survey. Households were visited from two weeks to two months after the CDHS-2014 visit. Data on micronutrient status were available for 1512 subjects (792 children and 720 women). Results: Anemia was found in 43% of the women and 53% of the children. Hemoglobin disorders affected >50% of the population, with Hemoglobin-E the most prevalent disorder. Deficiencies of iron (ferritin < 15 g/L), vitamin A (retinol-binding-protein (RBP) < 0.70 mol/L) or vitamin B12 (<150 pmol/L) were not prevalent in the women (<5% for all), whereas 17.8% of the women had low concentrations of folic acid (<10 nmol/L). In the children, the prevalence of iron, vitamin A, vitamin B12 or folic acid deficiency was <10%. Zinc deficiency, hookworm infection and hemoglobinopathy were significantly associated with anemia in children, whereas in the women none of the factors was significantly associated with anemia. Iron deficiency anemia (IDA) was more prevalent in children <2 years, but in older children and women, the prevalence of IDA was <5%. The most prevalent, preventable causes of anemia were hookworm infection and zinc and folic acid deficiency. Over 40% of the anemia was not caused by nutritional factors. Conclusion: The very high prevalence of anemia in Cambodian women and children cannot be explained solely by micronutrient deficiencies and hemoglobin disorders. Micronutrient interventions to improve anemia prevalence are likely to have limited impact in the Cambodian setting. The focus of current interventions to reduce the high prevalence of anemia in children and women should be broadened to include zinc and folic acid as well as effective anti-hookworm measures. View Full-Text
Keywords: anemia; iron; vitamin A; folic acid; vitamin B12; zinc; hemoglobin disorders; children; women of reproductive age; Cambodia anemia; iron; vitamin A; folic acid; vitamin B12; zinc; hemoglobin disorders; children; women of reproductive age; Cambodia
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MDPI and ACS Style

Wieringa, F.T.; Dahl, M.; Chamnan, C.; Poirot, E.; Kuong, K.; Sophonneary, P.; Sinuon, M.; Greuffeille, V.; Hong, R.; Berger, J.; Dijkhuizen, M.A.; Laillou, A. The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders. Nutrients 2016, 8, 348.

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