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. 2017 Jul 3;9(7):693.
doi: 10.3390/nu9070693.

Prevalence of Inherited Hemoglobin Disorders and Relationships with Anemia and Micronutrient Status among Children in Yaoundé and Douala, Cameroon

Reina Engle-Stone  1 , Thomas N Williams  2 , Martin Nankap  3 , Alex Ndjebayi  4 , Marie-Madeleine Gimou  5 , Yannick Oyono  6 , Ann Tarini  7 , Kenneth H Brown  8   9 , Ralph Green  10
Affiliations

Prevalence of Inherited Hemoglobin Disorders and Relationships with Anemia and Micronutrient Status among Children in Yaoundé and Douala, Cameroon

Reina Engle-Stone et al. Nutrients. .

Abstract

Information on the etiology of anemia is necessary to design effective anemia control programs. Our objective was to measure the prevalence of inherited hemoglobin disorders (IHD) in a representative sample of children in urban Cameroon, and examine the relationships between IHD and anemia. In a cluster survey of children 12-59 months of age (n = 291) in Yaoundé and Douala, we assessed hemoglobin (Hb), malaria infection, and plasma indicators of inflammation and micronutrient status. Hb S was detected by HPLC, and α⁺thalassemia (3.7 kb deletions) by PCR. Anemia (Hb < 110 g/L), inflammation, and malaria were present in 45%, 46%, and 8% of children. A total of 13.7% of children had HbAS, 1.6% had HbSS, and 30.6% and 3.1% had heterozygous and homozygous α⁺thalassemia. The prevalence of anemia was greater among HbAS compared to HbAA children (60.3 vs. 42.0%, p = 0.038), although mean Hb concentrations did not differ, p = 0.38). Hb and anemia prevalence did not differ among children with or without single gene deletion α⁺thalassemia. In multi-variable models, anemia was independently predicted by HbAS, HbSS, malaria, iron deficiency (ID; inflammation-adjusted ferritin <12 µg/L), higher C-reactive protein, lower plasma folate, and younger age. Elevated soluble transferrin receptor concentration (>8.3 mg/L) was associated with younger age, malaria, greater mean reticulocyte counts, inflammation, HbSS genotype, and ID. IHD are prevalent but contribute modestly to anemia among children in urban Cameroon.

Keywords: anemia; children; hemoglobinopathy; iron; sickle cell; thalassemia.

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Conflict of interest statement

The authors declare no conflict of interest. The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Kernel density plots illustrating the distribution of hemoglobin concentrations among: (a) children with HbAA (n = 250), HbAS (n = 40), and Hb SS (n = 5) genotypes; and (b) among children with none (n = 190; α α/α α), one (n = 89; α–/α α), or two (n = 9; α–/α–) alpha-globin deletions.
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