Advanced search
1 file | 15.02 MB Add to list

Anemia and its association with asymptomatic malaria, iron and zinc deficiencies, and ferroportin Q248H mutation in children aged under 5 years in South Kivu/Democratic Republic of Congo

(2022)
Author
Promoter
(UGent) , (UGent) and Ghislain Bisimwa Balaluka
Organization
Abstract
Anemia is a public health problem with significant health consequences as well as an adverse impact on social and economic development. 47% of children younger than 5 years in the world are affected by anemia, the developing countries account for more than 89% of the burden. Anemia, infection and micronutrient deficiencies significantly contribute to morbidity and mortality in children in sub-Saharan Africa where these conditions often interact. In South Kivu the prevalence of anemia varies between 36%-46.6%. The causes of anemia are multifactorial, including micronutrient deficiencies, infection, hemoglobinopathies (thalassemias or sickle cell disease), genetic disorders like glucose-6-phosphate dehydrogenase deficiency, malaria, helminthiasis, and other causes. In malaria endemic areas, Plasmodium infection remains the major cause of anemia. The ferroportin (FPN) Q248H mutation, has been identified at relatively high frequencies in populations of African ancestry and has been described to protect red blood cells against oxidative stress and malaria infection. The prevalence of FPN Q248H in South Kivu has been estimated between 12% and 14%. In this thesis we describe the main mechanisms causing anemia and the role of FPN Q248H mutation in relation with anemia and malaria in childhood in a Bantu population living in the volcanic region of South Kivu. Chapter one is an overview on anemia and summarizes the biological and known clinical implications of FPN Q248H mutation. Chapter two describes the aims of the thesis. Chapter three describes the results and it is divided into 3 papers. The First paper reports the prevalence of anemia and the relationship with asymptomatic submicroscopic Plasmodium infection. We show that almost 40% of children under 5 years of age were anemic, submicroscopic Plasmodium infection was high (22.3%) and was significantly associated with anemia. The risk factors of anemia in a pediatric population were age under 2 years, history of illness two weeks before, low middle-upper-arm circumference, household size < 10 and Plasmodium infection. In the second paper, we examine the prevalence of FPN Q248H mutation in South Kivu and evaluate its role in Plasmodium infected children and explore its relationship with anemia. We found that the prevalence of FPN Q248H was 11.4%. No difference was observed in the frequencies of malaria or anemia between FPN Q248H mutated children compared to wild type, however, Plasmodium infected carriers of the FPN Q248H mutation had lower hemoglobin level than wild type children. The third paper explores the relationship of anemia and iron and zinc deficiencies. We found iron deficiency in 34.9% and 49.1% of children based on ferritin (adjusted by CRP) and free erythrocyte protoporphyrin (FEP), respectively, and zinc deficiency in 17.6% children. If anemia is present, we found iron deficiency in 31% and 66% of children based on ferritin and FEP,respectively. If anemia is present, zinc deficiency was found in 24.4% of children. When we compared the ferritin and FEP level between anemic and non-anemic children, we found that ferritin was significantly higher in anemic children, FEP was also significantly higher in anemic children, while zinc levels were significantly lower in anemic children. Iron deficiency according to FEP, zinc deficiency, MUACZ<-2, WHZ<-2, submicroscopic Plasmodium infection and recent illness were factors independently associated with anemia. The main findings of the thesis are summarized and discussed in chapter four. The prevalence of anemia in South Kivu remains high, children with low Plasmodium parasitemia detected by loop mediated-isothermal amplification (LAMP) but not by microscopy showed a significantly increased prevalence of anemia. FPN Q248H mutation is associated with more pronounced anemia which suggests that the iron exporting function was more important. A high prevalence of iron deficiency was reported according to FEP. Ferritin, as an acute phase protein, was less suited in this population due to high frequency of infection/inflammation. Iron and zinc deficiencies were found to be independently associated with anemia in a pediatric population. The causes of anemia in children living in South Kivu is multifactorial. Strategies to reduce the burden of anemia should focus on malnutrition and on interventions that reduce the prevalence of infection, more specifically malaria.
Keywords
anemia, malaria, ferroportin polymorphism, iron deficiency, zinc deficiency, South Kivu

Downloads

  • (...).pdf
    • full text (Published version)
    • |
    • UGent only
    • |
    • PDF
    • |
    • 15.02 MB

Citation

Please use this url to cite or link to this publication:

MLA
Lunfugulo Bahati, Yvette. Anemia and Its Association with Asymptomatic Malaria, Iron and Zinc Deficiencies, and Ferroportin Q248H Mutation in Children Aged under 5 Years in South Kivu/Democratic Republic of Congo. Ghent University. Faculty of Medicine and Health Sciences, 2022.
APA
Lunfugulo Bahati, Y. (2022). Anemia and its association with asymptomatic malaria, iron and zinc deficiencies, and ferroportin Q248H mutation in children aged under 5 years in South Kivu/Democratic Republic of Congo. Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium.
Chicago author-date
Lunfugulo Bahati, Yvette. 2022. “Anemia and Its Association with Asymptomatic Malaria, Iron and Zinc Deficiencies, and Ferroportin Q248H Mutation in Children Aged under 5 Years in South Kivu/Democratic Republic of Congo.” Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
Chicago author-date (all authors)
Lunfugulo Bahati, Yvette. 2022. “Anemia and Its Association with Asymptomatic Malaria, Iron and Zinc Deficiencies, and Ferroportin Q248H Mutation in Children Aged under 5 Years in South Kivu/Democratic Republic of Congo.” Ghent, Belgium: Ghent University. Faculty of Medicine and Health Sciences.
Vancouver
1.
Lunfugulo Bahati Y. Anemia and its association with asymptomatic malaria, iron and zinc deficiencies, and ferroportin Q248H mutation in children aged under 5 years in South Kivu/Democratic Republic of Congo. [Ghent, Belgium]: Ghent University. Faculty of Medicine and Health Sciences; 2022.
IEEE
[1]
Y. Lunfugulo Bahati, “Anemia and its association with asymptomatic malaria, iron and zinc deficiencies, and ferroportin Q248H mutation in children aged under 5 years in South Kivu/Democratic Republic of Congo,” Ghent University. Faculty of Medicine and Health Sciences, Ghent, Belgium, 2022.
@phdthesis{8761223,
  abstract     = {{Anemia is a public health problem with significant health consequences as well as an adverse impact on social and economic development. 47% of children younger than 5 years in the world are affected by anemia, the developing countries account for more than 89% of the burden.
Anemia, infection and micronutrient deficiencies significantly contribute to morbidity and mortality in children in sub-Saharan Africa where these conditions often interact. In South Kivu the prevalence of anemia varies between 36%-46.6%. The causes of anemia are multifactorial, including micronutrient deficiencies, infection, hemoglobinopathies (thalassemias or sickle cell disease), genetic disorders like glucose-6-phosphate dehydrogenase deficiency, malaria,
helminthiasis, and other causes. In malaria endemic areas, Plasmodium infection remains the major cause of anemia. The ferroportin (FPN) Q248H mutation, has been identified at relatively high frequencies in populations of African ancestry and has been described to protect red blood cells against oxidative stress and malaria infection. The prevalence of FPN Q248H in South Kivu has been estimated between 12% and 14%. In this thesis we describe the main mechanisms causing anemia and the role of FPN Q248H mutation in relation with anemia and malaria in
childhood in a Bantu population living in the volcanic region of South Kivu. Chapter one is an overview on anemia and summarizes the biological and known clinical implications of FPN Q248H mutation. Chapter two describes the aims of the thesis. Chapter three describes the results and it is divided into 3 papers. The First paper reports the prevalence of anemia and the relationship with asymptomatic submicroscopic Plasmodium infection. We show that almost 40% of children under 5 years of age were anemic, submicroscopic Plasmodium infection was high (22.3%) and
was significantly associated with anemia. The risk factors of anemia in a pediatric population were age under 2 years, history of illness two weeks before, low middle-upper-arm circumference, household size < 10 and Plasmodium infection. In the second paper, we examine the prevalence of FPN Q248H mutation in South Kivu and evaluate its role in Plasmodium infected children and explore its relationship with anemia. We found that the prevalence of FPN Q248H
was 11.4%. No difference was observed in the frequencies of malaria or anemia between FPN Q248H mutated children compared to wild type, however, Plasmodium infected carriers of the FPN Q248H mutation had lower hemoglobin level than wild type children. The third paper explores the relationship of anemia and iron and zinc deficiencies. We found iron deficiency in 34.9% and 49.1% of children based on ferritin (adjusted by CRP) and free erythrocyte protoporphyrin (FEP), respectively, and zinc deficiency in 17.6% children. If anemia is present, we found iron deficiency in 31% and 66% of children based on ferritin and FEP,respectively. If anemia is present, zinc deficiency was found in 24.4% of children. When we compared the ferritin and FEP level between anemic and non-anemic children, we found that ferritin was significantly higher in anemic children, FEP was also significantly higher in anemic children, while zinc levels
were significantly lower in anemic children. Iron deficiency according to FEP, zinc deficiency, MUACZ<-2, WHZ<-2, submicroscopic Plasmodium infection and recent illness were factors independently associated with anemia.
The main findings of the thesis are summarized and discussed in chapter four. The prevalence of anemia in South Kivu remains high, children with low Plasmodium parasitemia detected by loop mediated-isothermal amplification (LAMP) but not by microscopy showed a significantly increased prevalence of anemia. FPN Q248H mutation is associated with more pronounced anemia which suggests that the iron exporting function was more important. A high prevalence of iron deficiency was reported according to FEP. Ferritin, as an acute phase protein, was less suited in this population due to high frequency of infection/inflammation. Iron and zinc deficiencies were found to be independently associated with anemia in a pediatric population. The causes of anemia in children living in South Kivu is multifactorial. Strategies to reduce the burden of anemia should focus on malnutrition and on interventions that reduce the prevalence
of infection, more specifically malaria.}},
  author       = {{Lunfugulo Bahati, Yvette}},
  keywords     = {{anemia,malaria,ferroportin polymorphism,iron deficiency,zinc deficiency,South Kivu}},
  language     = {{eng}},
  pages        = {{135}},
  publisher    = {{Ghent University. Faculty of Medicine and Health Sciences}},
  school       = {{Ghent University}},
  title        = {{Anemia and its association with asymptomatic malaria, iron and zinc deficiencies, and ferroportin Q248H mutation in children aged under 5 years in South Kivu/Democratic Republic of Congo}},
  year         = {{2022}},
}