Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-26T19:33:25.496Z Has data issue: false hasContentIssue false
  • English
  • Français

Relationships between vitamin A, iron status and helminthiasis in Bangladeshi school children

Published online by Cambridge University Press:  02 January 2007

V Persson ,
F Ahmed ,
M Gebre-Medhin  and
T Greiner
V Persson*
Affiliation:
Section for International Maternal and Child Health (IMCH), Uppsala University, 75185, Uppsala, Sweden.
F Ahmed
Affiliation:
Institute of Nutrition and Food Science, Dhaka University, Dhaka 100, Bangladesh.
M Gebre-Medhin
Affiliation:
Section for International Maternal and Child Health (IMCH), Uppsala University, 75185, Uppsala, Sweden.
T Greiner
Affiliation:
Section for International Maternal and Child Health (IMCH), Uppsala University, 75185, Uppsala, Sweden.
*
*Corresponding author: Email viveka.persson@ich.uu.se
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective

To explore the relationships between biochemical indicators of vitamin A and iron status and the intestinal helminths Ascaris lumbricoides and hookworm in primary school children.

Setting

Two rural governmental schools in northwestern Bangladesh.

Design

Cross-sectional study.

Subjects

The sample consisted of 164 children in grades 3–5.

Methods

Serum retinol and β-carotene (by high-performance liquid chromatography, HPLC), haemoglobin (HemoCue), ferritin (enzyme-linked immunoadsorbent assay, ELIZA) and height and weight were measured. Dietary intake of vitamin A was assessed using a food frequency questionnaire and faecal analyses were done using Stoll's egg-count technique.

Results

The mean serum retinol was 26.8 μg dl−1 and 20% had a level of <20 μg dl−1, the cut-off value for low vitamin A status. There was a strong positive association between serum β-carotene and serum retinol (r = 0.44, P <0.001), suggesting those with higher retinol levels had a higher carotene intake. Thirty-one per cent were anaemic (Hb <11.5 g dl−1), 30% had iron deficiency (serum ferritin <12.0 μg l−1) and 14% were suffering from iron deficiency anaemia. Children with a serum retinol level of 20 μg dl−1 had significantly lower ferritin (14.0 compared to 26.0 μg l−1, P = 0.005) and Hb levels (11.7 compared to 12.4 g dl−1, P = 0.005) than those with higher levels. The proportion of iron deficiency anaemia was significantly greater among children with hookworm. Our data suggest that hookworm exerts its impact on iron status independently of the vitamin A status of the host.

Conclusions

Programmes to improve iron status should consider including both vitamin A prevention programmes and deworming.

Keywords

Vitamin A deficiencyIron deficiencyAnaemiaIron deficiency anaemiaHelminthiasisRetinolBeta-caroteneHaemoglobinFerritinDietary intakePrimary school childrenBangladesh
Type
Research Article
Information
Public Health Nutrition , Volume 3 , Issue 1 , March 2000 , pp. 83 - 89
Copyright
Copyright © CABI Publishing 2000

References

1WHO. Preventing and Controlling Iron Deficiency Anaemia through Primary Health Care. A Guide for Health Administrators and Programme Managers. Geneva: World Health Organization, 1989.Google Scholar
2Ahmed, K, Hassan, N. Nutrition Survey of Bangladesh 1981–82. Dhaka: Institute of Nutrition and Food Science, 1983.Google Scholar
3Ahmed, F, Khan, M and, Karim, R, et al. Serum retinol and biochemical measures of iron status in adolescent schoolgirls in urban Bangladesh. Eur. J. Clin. Nutr. 1996; 50: 346–51.Google ScholarPubMed
4Bloem, MV, Wedel, M, Egger, RJ, et al. Iron metabolism and vitamin deficiency in children in northeast Thailand. Am. J. Clin. Nutr. 1989; 50: 332–8.CrossRefGoogle ScholarPubMed
5Wolde-Gebriel, Z, West, C, Haile Gebru Tadesse, A, et al. Interrelationship between vitamin A, iodine and iron status in school children in Shoa Region, Central Ethiopia. Br. J. Nutr. 1993; 70: 593–607.CrossRefGoogle Scholar
6Meija, LA, Chew, F.Haematological effect of supplementation anemic children with vitamin A alone and in combination with iron. Am. J. Clin. Nutr. 1988; 48: 595–600.CrossRefGoogle Scholar
7Cohen, N, Rahman, H, Sprague, J, Jalil, M, Leemhuis de Regt, E, Mitra, M.Prevalence and determinants of nutritional blindness in Bangladesh children. World Health Stat. Q. 1985; 38: 317–30.Google Scholar
8ACC/SCN. 25th Session: Working Group on Vitamin A Deficiency, 1998. The Year of Vitamin A. Oslo, Norway: United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition, 1998.Google Scholar
9WHO/UNICEF. Global Prevalence of Vitamin A Deficiency. WHO Micronutrient Deficiency Information System (MDIS), Working Paper No. 2. WHO/UNICEF Doc. WHO/NUT/95.3. Geneva: World Health Organization, 1995.Google Scholar
10Ahmed, F, Barua, S, Mohiduzzaman, M, et al. Interaction between growth and nutrient status in shool-age children of urban Bangladesh. Am. J. Clin. Nutr. 1993; 58: 334–8.CrossRefGoogle Scholar
11Hussain, A, Kvåle, G.Serum vitamin A in relation to socio-economic, demographic and dietary characteristics in Bangladeshi children. Acta Paediatr. 1996; 85: 971–6.CrossRefGoogle ScholarPubMed
12Martin, J, Keymer, A, Isherwood, R, Wainwright, S.The prevalence and intensity of Ascaris lumbricoides infections in moslem children from northern Bangladesh. Trans. R. Soc. Trop. Med. Hyg. 1983; 77: 702–6.CrossRefGoogle ScholarPubMed
13Hall, A, Anwar, KS, Tomkins, AM. Intensity of reinfection with Ascaris lumbricoides and its implications for parasite control. Lancet 1992; 330: 1253–7.CrossRefGoogle Scholar
14Sivakumar, B, Reddy, V.Absorption of vitamin A in children with ascariasis. J. Trop. Med. Hyg. 1975; 78: 114–15.Google ScholarPubMed
15Jalal, F, Nesheim, M, Agus, Z, Sanjur, D, Habicht, J.Serum retinol concentrations in children are affected by food sources of beta-carotene, fat intake, and anthelmintic drug treatment. Am. J. Clin. Nutr. 1998 68, 623–9.CrossRefGoogle ScholarPubMed
16Pritchard, DI, Quinnell, RJ, Moustafa, M, et al. Hookworm (Necator americanus) infection and storage iron depletion. Trans. R. Soc. Trop. Med. Hyg. 1991; 85: 235–8.CrossRefGoogle ScholarPubMed
17Stoltzfus, RJ, Chwaya, HM, Tielsch, JM, Schulze, KJ, Albonico, M, Savioli, L.Epidemiology of iron deficiency anemia in Zanzibari schoolchildren: the importance of hookworms. Am. J. Clin. Nutr. 1997; 65(1): 153–9.CrossRefGoogle ScholarPubMed
18Roche, M, Larysse, M.The nature and causes of ‘hookworm anemia’. Am. J. Trop. Med. 1966; 15: 1031–100.Google ScholarPubMed
19Farid, Z, Nichols, J, Bassily, S, Schulert, A.Blood loss in pure Ancylostoma duodenale infection in Egyptian farmers. Am. J. Trop. Med. Hyg. 1965; 14: 375–8.CrossRefGoogle ScholarPubMed
20Larysse, M, Roche, M.The relationship between anemia and hookworm infection: results of surveys of rural Venezuelan population. Am. J. Hyg. 1964; 79: 279–301.Google Scholar
21Dreyfuss, ML, Shrestha, JB, Khatry, EK, Stoltzfus, RJ, Albonico, M, Savioli, L.Relationship between iron status and helminth infection among pregnant women in Nepal (Abstract). FASEB J. 1996; 10: A730.Google Scholar
22Stoltzfus, RJ, Dreyfuss, ML, Hababuu, MC, Albonico, M.Hookworm control as a strategy to prevent iron deficiency. Nutr. Rev. 1997; 55: 223–32.CrossRefGoogle ScholarPubMed
23Beaton, G, Kelly, A, Kevany, J, Martorell, R, Mason, J. Appropriate Use of Anthropometric Indices in Children. ACC/SCN State of the Art Series Nutrition Policy Discussion Paper No. 7. Geneva: United Nations Administrative Committee on Coordination/Sub-Committee on Nutrition, 1990.Google Scholar
24Suzuki, N. Color Atlas of Human Helminth Eggs. Tokyo: JAPC and JOICEP, 1981.Google Scholar
25WHO. Measuring Change in Nutritional Status. Geneva: World Health Organization, 1988.Google Scholar
26FAO. Requirements of Vitamin A, Iron, Folate, and Vitamin B-12. FAO Food and Nutrition Series No. 23. Rome: Food and Agricultural Organization, 1988.Google Scholar
27WHO. Prevention and Control of Intestinal Parasitic Infections. Geneva: World Health Organization, 1987.Google Scholar
28WHO/UNICEF. Indicators for Assessing Vitamin A Deficiency and their Application in Monitoring and Evaluating Intervention Programs. Geneva: World Health Organization, United Nations Children's Fund, 1994.Google Scholar
29UNICEF BBoSa. Progotir Pathey. Progress Toward the Achievment of the Goals for the 1990s. Bangladesh Bureau of Statistics, Ministry of Planning, Government of the People's Republic of Bangladesh and UNICEF, 1995.Google Scholar
30De Pee, S, West, CE, Permaesih, D, Martuti, S, Muhilal, Hautvast JG. Orange fruit is more effective than are dark-green, leafy vegetables in increasing serum concentrations of retinol and beta-carotene in schoolchildren in Indonesia. Am. J. Clin. Nutr. 1998; 68(5): 1058–67.CrossRefGoogle ScholarPubMed
31Hussain, A, Kvåle, G.Sustainability of a nutrition education programme to prevent night-blindness in Bangladesh. Trop. Med. Int. Health 1996; 1: 43–51.CrossRefGoogle ScholarPubMed
32Saha, A, Ahmad, K.Anemia in two rural Bangladesh communities, with and without the supply of safe drinking water. Bangladesh J. Nutr. 1991; 4: 1–8.Google Scholar
33Saha, A, Ahmad, K.Iron and micronutrient supplementation after deworming: an effective measure to raise hemoglobin level of anemic children in rural Bangladesh. Bangladesh J. Nutr. 1989; 2: 1–7.Google Scholar
34Salmatullah QYusuf HKM. Report of the Iodine Deficiency Disorders Indicator Study in Savar, Bangladesh. Dhaka: University of Dhaka, 1997.Google Scholar
35Ahmed, F, Khan, MR, Mohiduzzaman, M, et al. Relationship between growth and nutrient status in school children of urban Bangladesh. In: Said, HM, Rahman, MA, Abdulla, M, Vohora, SB, Athar, M, eds. Proceedings of the International Symposium on Trace Elements and Liver Diseases. Karachi, Pakistan: Hamdard Foundation, 1996; 26–33.Google Scholar
36Gillespie, S, Johnston, J. Expert Consultation on Anemia Determinants and Interventions. Ottawa: Micronutrient Initiatives, 1998.Google Scholar
37Lipschitz, D, Cook, J, Finch, C.A clinical evaluation of serum ferritin as an index of iron stores. N. Engl. J. Med. 1974; 290: 1213–16.CrossRefGoogle ScholarPubMed
38Hulthén, L, Lindstedt, G, Hallberg, L.Effect of a mild infection on serum ferritin concentration – clinical and epidemiological implications. Eur. J. Clin. Nutr. 1998; 52: 376–9.CrossRefGoogle ScholarPubMed
39Punnonen, K, Irjala, K, Rajamäki, A.Serum transferrin receptor and its ratio to serum ferritin in the diagnosis of iron deficiency. Blood 1997; 89: 1052–7.CrossRefGoogle ScholarPubMed
40Mast, A, Blinder, MA, Gronowski, AM, Chumley, C, Scott, MG. Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin. Chem. 1998; 44: 45–51.CrossRefGoogle ScholarPubMed
41Suharno, D, Muhilal Vitamin A and nutritional anaemia. Food Nutr. Bull. 1996; 17: 7–10.CrossRefGoogle Scholar
42Bloem, M.Interdependence of vitamin A and iron: an important association for programmes of anemia control. Proc. Nutr. Soc. 1995; 54: 501–8.CrossRefGoogle Scholar
43WHO. Report of the WHO Informal Consultation on the Use of Chemotherapy for the Control of Morbidity due to Soil-transmitted Nematodes in Humans. WHO Schistosomiasis and Intestinal Parasites Unit Division of Control of Tropical Diseases Report No. WHO/CTD/SIP/96.2. Geneva: World Health Organization, 1996.Google Scholar