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 relation to malaria, gravida, and dietary iron status in rural pregnant Malawian women.

DESIGN

In this self-selected sample, haemoglobin, haematocrit, red cell indices, serum ferritin, serum iron, serum transferrin, and serum transferrin receptor (TfR) were measured. Infection was assessed by a malaria slide, serum 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 gestation while attending a rural antenatal clinic in Southern Malawi; 36% were primagravid; 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 < or = 50 microg/l and Hb <110 g/l) while an additional seven with malaria were classified with ID without anaemia. In malarial-free subjects, 32% were classified with IDA (serum ferritin <12 microg/l and Hb <110 g/l) and 17% with ID (serum ferritin <12 microg/l; Hb > or = 110 g/l). Serum TfR concentrations were elevated in anaemic women (P<0.01). In non-malarial parasitaemic subjects, serum TfR 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 (mainly fish) only 9%. Malarial parasitaemia and intakes of available iron impacted significantly on iron status.

CONCLUSION

Anaemia prevalence from all causes was high (that is, 69%); three 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. Opportunities for Micronutrient Interventions (OMNI) Project. Natural Sciences and Engineering Research Council of Canada.