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Center for Human Nutrition, Department of International Health, The Johns Hopkins University, Baltimore, MD;
*
Ministry of Health, Zanzibar, Tanzania;
Communicable Diseases Prevention and Control, World Health Organization, Geneva, Switzerland; and
**
Ivo de Carneri Foundation, Milan, Italy
2To whom correspondence should be addressed.
In Zanzibar and other tropical regions, iron deficiency, malaria and
multiple helminth infections coexist. We addressed the following
questions: 1) What are the predictors of low hemoglobin
in Zanzibari preschool children? 2) Are indicators of
iron status informative in this population? 3) Does
malaria modify the relation of iron indicators to hemoglobin? We used
multivariate regression to analyze cross-sectional data from a
community-based sample of rural Zanzibari children who were not ill
(n = 490; 4–71 mo of age) in whom we assessed
hemoglobin, serum ferritin (SF), erythrocyte protoporphyrin (EP), serum
transferrin receptor (TfR), recent fever, malaria parasitemia and
helminth fecal egg counts. Of hemoglobin values, 80% were <100 g/L
and 15.5% were <70 g/L. In children <18 mo of age, 40.2% of
hemoglobin values were <70 g/L. Our primary findings were as follows:
1) In children <30 mo old, hemoglobin was associated
with malaria but not hookworms, whereas in children 
30 mo, hemoglobin
was related to hookworms but not malaria. In the younger age group,
male sex and recent fever also predicted lower hemoglobin.
2) The three iron indicators were informative in this
population but did not reflect only iron status. Malaria elevated SF in
younger children and TfR and EP in both age groups. Fever elevated SF
in older children and EP in both age groups, but not TfR.
3) Malaria modified the relation of all three indicators
to hemoglobin. The relation of SF to hemoglobin was weak overall, and
absent in malaria-infected children. EP and TfR were strongly
related to hemoglobin, but this relation was attenuated by
malaria.
KEY WORDS: • iron • anemia • malaria • children • helminth infection • nutrition assessment
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