To identify factors associated with anemia and describe the severity of micronutrient deficiencies, malaria, in Sierra Leonean children and women.
A nationally representative cross-sectional survey randomly selected children 6-59 months and non-pregnant women 15-49 years of age. Blood samples were collected from children and women to measure the presence of malaria parasites, and inflammation, iron, vitamin A, folate, and vitamin B12 status.
In total, 839 children and 945 non-pregnant women were surveyed. In children, the prevalence of anemia (76.3%) and malaria (52.6%) was high, vitamin A deficiency (17.4%) was moderate, and iron deficiency (5.2%) and iron-deficiency anemia (3.8%) were low. Malaria infection and inflammation were associated with anemia, yet they explained only 25% of anemia cases. In non-pregnant women, 44.8% had anemia and 35.1% had malaria. Iron deficiency (8.3%), iron-deficiency anemia (6.1%), vitamin A deficiency (2.1%) and vitamin B12 deficiency (0.5%) were relatively rare, while folate deficiency was common (79.2%). Iron deficiency, malaria infection, and inflammation were significantly associated with anemia, but, as with children, explained only 25% of anemia cases.
Anemia in children and women is a severe public health problem in Sierra Leone, and vitamin A deficiency is a moderate public-health problem. Malaria and inflammation are the most consistent factors associated with anemia, but together contribute to only 25% of anemia. Iron deficiency was relatively rare and contributed to anemia only in women. Other causes of anemia, such as hemoglobinopathies, should be explored before anemia prevention and control programs are implemented or expanded in this malaria hyper-endemic setting.