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Etiology of Anemia Among Women and Children in Rural Bangladesh: An Assessment of Nutritional and Non-nutritional Factors (P10-115-19).

Objectives
To examine the etiology of anemia among women and children in Habiganj District, Sylhet considering nutritional and non-nutritional factors.


Methods
We analyzed data from 366 non-pregnant women and 204 children (6-37 months) collected at the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) cluster-randomized trial's 2015 baseline survey in 96 settlements. Blood samples were analyzed for anemia (hemoglobin), iron status (serum ferritin, serum transferrin receptor), vitamin A status (retinol binding protein (RBP)), inflammation (c-reactive protein and α-1-acid glycoprotein), vitamin B-12 status (methylmalonic acid (MMA)), and hemoglobinopathies (α-, β-thalassemia, Hemoglobin E and S). Logistic regression was conducted to identify factors associated with anemia, adjusting iron and vitamin A for inflammation using internal regression correction.


Results
Almost half of women and children were anemic (45% and 46%) though only 2% of women and 17% of children were iron-deficient (total body iron <0 mg/kg). Almost 20% of women and 60% of children had deficient or insufficient vitamin A levels (RBP <1.05 µmol/L). Vitamin B-12 deficiency (MMA: <210 nM) was high among women (27%) and children (70%). About 10% of women and children had any thalassemia or hemoglobinopathy; 5% had either β-thalassemia or HbE. Despite little iron deficiency among women, total body iron (mg/kg) was strongly associated with anemia, as was RBP (µmol/L) (OR (95% CI): iron: 0.8 (0.7, 0.8); vitamin A: 0.5 (0.3, 0.8)). In children, total body iron and age were also protective for anemia. In both women and children, having β-thalassemia or Hemoglobin E was associated with increased odds of anemia. Vitamin B-12 status was not associated with anemia.


Conclusions
Although iron deficiency was uncommon, there remained a strong association between total body iron and anemia. Vitamin A was also strongly associated with anemia and may be a key intervention strategy as Vitamin A levels were low. However, further research is still needed as a large proportion of anemia remains unexplained.


Funding Sources
The FAARM trial was supported by the Germany Ministry of Education and Research (BMBF). The first author received support from the Alexander von Humboldt Foundation and a Thrasher Research Fund Early Career Award.