Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal

Anemia and iron deficiency during pregnancy are prevalent in developing cou ntries, but their causes are not always known. We assessed the prevalence a nd severity of anemia and iron deficiency and their association with helmin ths, malaria and vitamin A deficiency in a community-based sample of 336 pr egnant women in the plains of Nepal. Hemoglobin, erythrocyte protoporphyrin (EP) and serum ferritin were assessed in venous blood samples. Overall, 72 .6% of women were anemic (hemoglobin < 110 g/L), 19.9% had moderate to seve re anemia (hemoglobin < 90 g/L) and 80.6% had iron deficiency (EP > 70 mu m ol/mol heme or serum ferritin < 10 mu g/L). Eighty-eight percent of cases o f anemia were associated with iron deficiency. More than half of the women (54.2%) had a low serum retinol concentration (<1.05 mu mol/L), 74.2% were infected with hookworms and 19.8% had Plasmodium vivax malaria parasitemia. Hemoglobin, EP and serum ferritin concentrations were significantly worse and the prevalence of anemia, elevated EP and low serum ferritin was increa sed with increasing intensity of hookworm infection. Hookworm infection int ensity was the strongest predictor of iron status, especially of depleted i ron stores. Low serum retinol was most strongly associated with mild anemia , whereas P. vivax malaria and hookworm infection intensity were stronger p redictors of moderate to severe anemia. These findings reinforce the need f or programs to consider reducing the prevalence of hookworm, malaria infect ion and vitamin A deficiency where indicated, in addition to providing iron supplements to effectively control anemia.