Project Details

Etiology of Anemia among mother-child pairs in Sylhet, Bangladesh

Amanda Wendt, PhD, MS

Summary

BACKGROUND: Globally, iron deficiency is estimated to be associated with 50% of all anemia cases, and improving iron intake, primarily through supplements, has long been the primary intervention to reduce anemia. In Bangladesh, low iron deficiency and concurrent high anemia prevalence in some regions calls into question the assumption that half of anemia is attributable to a lack of iron. GAP: The major factors contributing to anemia in some areas of Bangladesh remain uncertain as iron deficiency has been shown to play a minor role and data are sparse regarding hemoglobinopathies and other micronutrient deficiencies. HYPOTHESIS: We hypothesize that iron deficiency is not the major determinant of anemia in the study population of the Food and Agriculture Approaches to Reducing Malnutrition (FAARM) trial, with other nutritional and non-nutritional factors playing a significant role. We aim to explore the specific contributions of hemoglobinopathies and other micronutrient deficiencies to anemia, as well as groundwater iron intake as a protective factor for those with low iron intake from food. METHODS: This study will analyze baseline data collected in the FAARM cluster-randomized controlled field trial which includes approximately 2,600 women and their young children in 96 villages. We will analyze capillary blood from a sub-sample of 864 women (15-30 years) and their children (6-36 months) to examine nutritional and non-nutritional factors contributing to anemia in this population. RESULTS: Pending IMPACT: Better understanding the etiology of anemia in women and children in low-income countries will enable programs to tackle this issue more effectively by tailoring measures to the local causes and widening the scope from iron supplementation alone to increasing intake of additional micronutrients and screening for genetic hemoglobin defects in antenatal care, depending on context.

Publications:

Sinharoy, Sheela S., Jillian L. Waid, Regine Haardörfer, Amanda Wendt, Sabine Gabrysch, and Kathryn M. Yount. "Women's dietary diversity in rural Bangladesh: Pathways through women's empowerment." Maternal & child nutrition 14, no. 1 (2018): e12489.

Wendt, Amanda S., Rob Stephenson, Melissa F. Young, Pankaj Verma, Sridhar Srikantiah, Amy Webb-Girard, Carol J. Hogue, Usha Ramakrishnan, and Reynaldo Martorell. "Identifying bottlenecks in the iron and folic acid supply chain in Bihar, India: a mixed-methods study." BMC health services research 18, no. 1 (2018): 281.

Young, Melissa F., Brietta M. Oaks, Sonia Tandon, Reynaldo Martorell, Kathryn G. Dewey, and Amanda S. Wendt. "Maternal hemoglobin concentrations across pregnancy and maternal and child health: a systematic review and meta‐analysis." Annals of the New York Academy of Sciences 1450, no. 1 (2019): 47.

Wendt, Amanda S., Thalia M. Sparling, Jillian L. Waid, Anna A. Mueller, and Sabine Gabrysch. "Food and Agricultural Approaches to Reducing Malnutrition (FAARM): protocol for a cluster-randomised controlled trial to evaluate the impact of a Homestead Food Production programme on undernutrition in rural Bangladesh." BMJ open 9, no. 7 (2019): e031037.

Wendt, Amanda S., Jillian L. Waid, and Sabine Gabrysch. "Dietary Factors Moderate the Relation between Groundwater Iron and Anemia in Women and Children in Rural Bangladesh." Current developments in nutrition 3, no. 10 (2019): nzz093.

Wendt A., Waid J., Gabrysch S. Etiology of anemia among women and children in rural Bangladesh: an assessment of nutritional and non-nutritional factors. Current Developments in Nutrition 3, suppl 1 (2019): nzz034.P10-115-19

Wendt, A., Waid, J., Müller-Hauser, A., Kyei, N., Sobhan, S., & Gabrysch, S. (2020). Do Hemoglobin Concentration and Anemia Prevalence Differ Between Capillary and Venous Blood and Between Analysis Methods? Current Developments in Nutrition, 4, 922, doi:10.1093/cdn/nzaa053_127