Prevalence and public health relevance of micronutrient deficiencies and undernutrition in pre-school children and women of reproductive age in Côte d'Ivoire, West Africa

Abstract

Objective: To provide nationally representative data on the prevalence of anaemia, vitamin A and Fe deficiencies among pre-school age children (pre-SAC) and non-pregnant women of reproductive age (WRA), and on vitamin B₁₂ and folate deficiencies in WRA, and the influence of inflammation on their interpretation.

Design: A cross-sectional survey to measure anthropometry, malaria parasitaemia and micronutrient status. Specifically, blood samples were analysed for Hb, plasma ferritin, soluble transferrin receptors, C-reactive protein, α₁-acid glycoprotein, retinol-binding protein, vitamin B₁₂ and folate.

Setting: Côte d'Ivoire in 2007.

Subjects: Nine hundred and twenty-eight WRA and 879 pre-SAC.

Results: In WRA, prevalence of Plasmodium parasitaemia (5 %) was low, but inflammation (34 %) was higher. Anaemia was a severe public health problem and prevalence differed by residency and eco-region. Inflammation-adjusted Fe deficiency was highest in urban areas (20 %). Nationally, folate deficiency was 86 %, higher in urban areas and varied by eco-region. Prevalence of vitamin B₁₂ deficiency was low but higher in the rural areas and the north. Inflammation-adjusted vitamin A deficiency was very low (1 %). In pre-SAC, prevalence of inflammation (67 %) and Plasmodium parasites (25 %) was high; the latter was associated with poverty, rural residency and higher ferritin concentrations. Anaemia was classified as a severe public health problem (72 %), and was higher in rural areas (76 %) and the north (87 %). A quarter of pre-SAC suffered from vitamin A deficiency (inflammation-adjusted) and prevalence of undernutrition was high.

Conclusions: Prevalence of inflammation, Plasmodium parasitaemia and micronutrient deficiencies were high in Côte d'Ivoire, particularly in pre-SAC. Nutritional interventions should be accompanied by strategies to reduce exposure to infections.

Fig. 1

Prevalence of anaemia (, rural; , urban), malaria parasitaemia (, rural; , urban), iron deficiency (, rural; , urban) and vitamin A deficiency (, rural; , urban) by age and residency in pre-school children aged 6–59 months, Côte d'Ivoire, 2007. Anaemia, Hb <110 g/l; iron deficiency, ferritin <12 μg/l; vitamin A deficiency, retinol-binding protein <0·7 μmol/l

Fig. 2

Prevalence of Plasmodium spp. by poverty index and residency (, rural; , urban) in pre-school children aged 6–59 months, Côte d'Ivoire, 2007