Abstract
OBJECTIVES: We aimed to assess prevalence of iron and vitamin A deficiencies in Ugandan mothers and infants using the BRINDA (Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia) adjustment and to ascertain any differences by prevalence of malaria. METHODS: From a prospective birth cohort (N = 5000) conducted in rural Uganda (2014–2016), samples from mothers (n = 1652, at birth) and infants (n = 695, 5–7 m/o) were analyzed for ferritin (FER), soluble transferrin receptor (sTFR), retinol binding protein (RBP), CRP, AGP, hemoglobin (Hb) and malaria. FER, sTFR and RBP were adjusted for inflammation using CRP and AGP. Depleted iron stores were defined as: FER <12 µg/L and <15 µg/L in children and mothers respectively; sTFR >8.3 mg/L for Fe-deficient erythropoiesis; RBP <1.05 µmol/L for vitamin A deficiency; and Hb <110 g/L for anemia. Prevalence estimates were stratified by malaria status. RESULTS: Adjustment for inflammation in mothers increased depleted iron stores (FER) from 7 to 12%, and decreased iron-deficient erythropoiesis (sTFR) from 27 to 22%. For children, adjustment increased depleted Fe stores from 17 to 40%, and iron-deficient erythropoiesis from 76 to 64%. Vitamin A deficiency in mothers was 9% and in infants decreased after adjustment (15% vs 4%). The prevalence of altitude adjusted anemia was 18% in mothers and 72% in infants. The prevalence of tissue iron deficiency (BIS <0 mg/kg) using adjusted sTFR and FER was 10% for mothers and 50% for infants compared to 8% and 34% using unadjusted markers respectively (Tables 1,2). Almost 14% of children (n = 75) were diagnosed with malaria. Malaria prevalence in mothers was low (5%), possibly due to the high (82%) prevalence of IPT prophylaxis reported during pregnancy. No significant differences were found in adjusted versus unadjusted estimates for Fe markers stratifying by malaria. CONCLUSIONS: Fe deficiency adjusted estimates varied by biomarker and were not correlated with malaria in line with BRINDA recommendations. For mothers and children, the prevalence of Fe deficiency (sTFR) and anemia (Hb) were similar, suggesting that a big part of anemia in Uganda could be due to Fe deficiency as opposed to other micronutrients. FUNDING SOURCES: Support provided by Feed the Future Innovation Lab for Nutrition, funded by the United States Agency for International Development (USAID). SUPPORTING TABLES, IMAGES AND/OR GRAPHS: