Wirth JP, Woodruff BA, Engle-Stone R, Namaste SML, Temple V, Petry N, Macdonald B, Suchdev PS, Rohner F, Aaron GJ

June 2017 – American Journal of Clinical Nutrition

Anemia in women of reproductive age (WRA) (age range: 15–49 y) is a global public health problem, and reducing anemia in women by 50% by 2025 is a goal of the World Health Assembly. Using cross-sectional, nationally representative data from 10 surveys (n = 27,018) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA), we examined the associations between anemia and proximal risk factors (e.g., iron and vitamin A deficiencies, inflammation, malaria, and body mass index) and distal risk factors (e.g., education status, household sanitation and hygiene, and urban or rural residence). Analyses were conducted separately and pooled by category of infection burden. Multivariate logistic regression models were constructed for each infection-burden category to identify independent determinants of anemia (hemoglobin concertation <120 g/L). Iron deficiency was consistently associated with anemia in multivariate models, but the proportion of anemic women who were iron deficient was considerably lower in the high-infection group (35%) than in the moderate- and lowinfection groups (65% and 71%, respectively). In the multivariate analysis, inflammation, vitamin A insufficiency, socioeconomic status, and age were also significantly associated with anemia, but malaria and vitamin B-12 and folate deficiencies were not. Anemia-reduction programs for WRA can be improved by considering the underlying infection burden of the population and by assessing the overlap of micronutrient deficiencies and anemia.

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