Malaria, hookworms and recent fever are related to anemia and iron status indicators in 0-to 5-y old Zanzibari children and these relationships change with age

In Zanzibar and other tropical regions, iron deficiency, malaria and multip le helminth infections coexist. We addressed the following questions: 1) Wh at are the predictors of low hemoglobin in Zanzibari preschool children? 2) Are indicators of iron status informative in this population? 3) Does mala ria modify the relation of iron indicators to hemoglobin? We used multivari ate regression to analyze cross-sectional data from a community-based sampl e of rural Zanzibari children who were not ill (n = 490; 4-71 mo of age) in whom we assessed hemoglobin, serum ferritin (SF), erythrocyte protoporphyr in (EP), serum transferrin receptor (TfR), recent fever, malaria parasitemi a and helminth fecal egg counts. Of hemoglobin values, 80% were <100 g/L an d 15.5% were <70 g/L. In children <18 mo of age, 40.2% of hemoglobin values were <70 g/L. Our primary findings were as follows: 1) In children <30 mo old, hemoglobin was associated with malaria but not hookworms, whereas in c hildren greater than or equal to 30 mo, hemoglobin was related to hookworms but not malaria. In the younger age group, male sex and recent fever also predicted lower hemoglobin. 2) The three iron indicators were informative i n this population but did not reflect only iron status. Malaria elevated SF in younger children and TfR and EP in both age groups. Fever elevated SF i n older children and EP in both age groups, but not TfR. 3) Malaria modifie d the relation of all three indicators to hemoglobin. The relation of SF to hemoglobin was weak overall, and absent in malaria-infected children. EP a nd TfR were strongly related to hemoglobin, but this relation was attenuate d by malaria.