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.

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.

Comparison of a possession score and a poverty index in predicting anaemia and undernutrition in pre-school children and women of reproductive age in rural and urban Côte d'Ivoire.

OBJECTIVE: To determine whether a possession score or a poverty index best predicts undernutrition and anaemia in women of reproductive age (15-49 years; WRA) and children aged 6-59 months living in Côte d'Ivoire. DESIGN: Anthropometric measurements were converted to Z-scores to assess stunting, wasting and underweight in children, and converted to BMI in WRA. A venous blood sample was drawn, and Hb concentration and Plasmodium spp. infection were determined. A possession score was generated with categories of zero to four possessions. A five-point (quintile) poverty index using household assets was created using principal component analysis. These socio-economic measures were compared for their ability to predict anaemia and malnutrition. SETTING: Data were from a nationally representative survey conducted in Côte d'Ivoire in 2007. SUBJECTS: A sample of 768 WRA and 717 children aged 6-59 months was analysed. RESULTS: Overall, 74·9 % of children and 50·2 % of WRA were anaemic; 39·5 % of the children were stunted, 28·1 % underweight and 12·8 % wasted, while 7·4 % of WRA had BMI < 18·5 kg/m2. In general, there were more stunted and underweight children and thin WRA in rural areas. The poverty index showed a stronger relationship with nutritional status than the possession score; mean Hb difference between the poorest and wealthiest quintiles in children and WRA was 8·2 g/l and 6·5 g/l, respectively (13·9 % and 19·8 % difference in anaemia, respectively; P < 0·001), and Z-scores and BMI were significantly better in the wealthiest quintile (P < 0·001). CONCLUSIONS: The poverty index was generally a better predictor of undernutrition in WRA and pre-school children than the possession score.