The impact of malarial infection and diet on the anaemia status of rural pregnant Malawian women

Objective: To investigate haematological and biochemical iron indices in re lation to malaria, gravida, and dietary iron status in rural pregnant Malaw ian women. Design: In this self-selected sample, haemoglobin, haematocrit, red cell in dices, serum ferritin, serum iron, serum transferrin, and serum transferrin receptor (TfR) were measured. Infection was assessed by a malaria slide, s erum C-reactive protein, and white blood cell count. Dietary iron variables were measured by three 24-h interactive recalls. Setting and subjects: 152 rural pregnant women recruited at 24 weeks gestat ion while attending a rural antenatal clinic in Southern Malawi; 36% were p rimagravid; 43% were gravida 2-4; 26% were gravida > 5. Results: Of the women, 69% (n = 105) were anaemic (haemoglobin < 110 g/l); 37% (n = 39) had anaemia and malarial parasitaemia on the test day; 17% (n = 26) with malaria were also classified with iron deficiency (ID) anaemia ( based on serum ferritin less than or equal to 50 mu g/l and Hb < 110 g/l) w hile an additional seven with malaria were classified with ID without anaem ia. In malarial-free subjects, 32% were classified with IDA (serum ferritin < 12 mu g/l and Hb < 110 g/l) and 17% with ID (serum ferritin < 12 mu g/l; Hb greater than or equal to 110 g/l). Serum TW concentrations were elevate d in anaemic women (P < 0.01). In non-malarial parasitaemic subjects, serum TW correlated negatively with haemoglobin (r = -0.313; P < 0.001) but not serum ferritin. Of the women, 49% were at risk for inadequate iron intakes. Most dietary iron was non-haem; plant foods provided 89%; flesh foods (mai nly fish) only 9%. Malarial parasitaemia and intakes of available iron impa cted significantly on iron status. Conclusion: Anaemia prevalence from all causes was high (that is, 69%); thr ee factors were implicated: malaria, and deficiencies of iron and possibly folate, induced partly by an inadequate dietary supply and/or secondary to malarial parasitaemia. Sponsorship: International Development Research Centre (IDRC) of Canada. Op portunities for Micronutrient Interventions (OMNI) Project. Natural Science s and Engineering Research Council of Canada.