Now .. dumbing this down really far.

"Iron deficiency very uncommon."

N Engl J Med. 2008 Feb 28;358(9):888-99. Links
Severe anemia in Malawian children.
Calis JC, Phiri KS, Faragher EB, Brabin BJ, Bates I, Cuevas LE, de
Haan RJ, Phiri AI, Malange P, Khoka M, Hulshof PJ, van Lieshout L,
Beld MG, Teo YY, Rockett KA, Richardson A, Kwiatkowski DP, Molyneux
ME, van Hensbroek MB.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College
of Medicine, Blantyre, Malawi. job.calis@gmail.com

BACKGROUND:
Severe anemia is a major cause of sickness and death in African
children, yet the causes of anemia in this population have been
inadequately studied.
METHODS:
We conducted a case-control study of 381 preschool children with
severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757
preschool children without severe anemia in urban and rural settings
in Malawi. Causal factors previously associated with severe anemia
were studied. The data were examined by multivariate analysis and
structural equation modeling. RESULTS:
Bacteremia (adjusted odds ratio, 5.3; 95% confidence interval [CI],
2.6 to 10.9), malaria (adjusted odds ratio, 2.3; 95% CI, 1.6 to 3.3),
hookworm (adjusted odds ratio, 4.8; 95% CI, 2.0 to 11.8), human
immunodeficiency virus infection (adjusted odds ratio, 2.0; 95% CI,
1.0 to 3.8), the G6PD(-202/-376) genetic disorder (adjusted odds
ratio, 2.4; 95% CI, 1.3 to 4.4), vitamin A deficiency (adjusted odds
ratio, 2.8; 95% CI, 1.3 to 5.8), and vitamin B12 deficiency (adjusted
odds ratio, 2.2; 95% CI, 1.4 to 3.6) were associated with severe
anemia.
Folate deficiency, sickle cell disease, and laboratory signs of an
abnormal inflammatory response were uncommon.
Iron deficiency was not prevalent in case patients (adjusted odds
ratio, 0.37; 95% CI, 0.22 to 0.60) and was negatively associated with
bacteremia.
Malaria was associated with severe anemia in the urban site (with
seasonal transmission) but not in the rural site (where malaria was
holoendemic).
Seventy-six percent of hookworm infections were found in children
under 2 years of age.
CONCLUSIONS:
There are multiple causes of severe anemia in Malawian preschool
children, but folate and iron deficiencies are not prominent among
them. Even in the presence of malaria parasites, additional or
alternative causes of severe anemia should be considered. Copyright
2008 Massachusetts Medical Society.

PMID: 18305266 [PubMed - indexed for MEDLINE]

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