Association of elevated α1-acid glycoprotein (AGP) and the prevalence of anemia in Nicaraguan preschool children.

BACKGROUND: Anemia status is frequently assessed in cross-sectional surveys. Recently, the assessment of acute phase proteins (APPs) has become more common, primarily for iron and vitamin A biomarkers. Although the so-called "anemia of infection" has been known for years, the relationship between APPs and anemia has been infrequently presented. OBJECTIVE: To assess the relationship between elevated α1-acidglycoprotein (AGP) and the prevalence of anemia among preschool children. METHODS: A nationally representative household-based cross-sectional survey was conducted in 2003-05 in Nicaragua. Blood samples were collected from preschool children 6 to 59.9 months of age and tested for hemoglobin and AGP. Data were also obtained on sex, weight, height, use of iron supplements, maternal education, and urban or rural status. RESULTS: Among the 1420 children assessed, the overall prevalence of anemia was 20.2% and the prevalence of elevated AGP was 24.0%. Children with elevated AGP had an anemia prevalence of 27.9%, compared with 17.8% among those with a normal AGP, for a crude prevalence odds ratio (POR) of 1.8 (p = .010). Accounting for age, maternal educational level, and year of survey using logistic regression, the adjusted POR for the association between elevated AGP and anemia was 1.5 (p = .053). CONCLUSIONS: Children in this survey with an elevated AGP had a higher prevalence of anemia, although after controlling for covariates the p-value did not indicate a statistically significant difference (p = .053). It may be helpful to account for APPs, when this information is available, for purposes of comparing anemia prevalence across populations or within a population over time.

Use of formative research in developing a knowledge translation approach to rotavirus vaccine introduction in developing countries.

BACKGROUND: Rotavirus gastroenteritis is the leading cause of diarrheal disease mortality among children under five, resulting in 450,000 to 700,000 deaths each year, and another 2 million hospitalizations, mostly in the developing world. Nearly every child in the world is infected with rotavirus at least once before they are five years old. Vaccines to prevent rotavirus or minimize its severity are now becoming available, and have already been introduced into the public vaccine programs of several Latin American countries. The World Health Organization (WHO) has made rotavirus vaccine introduction in developing countries a high priority. The WHOs Guidelines for Vaccine Introduction indicates that a key determinant to achieving vaccine introduction is the public health priority of the disease, suggesting that where the disease is not a priority uptake of the vaccine is unlikely. WHO recommends conducting a qualitative analysis of opinions held by the public health community to determine the perceptions of the disease and the priority given to the vaccine. METHODS: This paper presents the formative research results of a qualitative survey of public health providers in five low- and middle-income countries to determine if and to what degree rotavirus is perceived to be a problem and the priority of a vaccine. Open-ended surveys were carried out through focus group discussions and one-on-one interviews. RESULTS: Researchers discovered that in all five countries knowledge of rotavirus was extremely low, and as a result was not considered a high priority. However, diarrhea among young children was considered a high priority among public health providers in the three poorest countries with relatively high levels of child mortality: India, Indonesia, and Nicaragua. CONCLUSION: In the poorest countries, advocacy and communication efforts to raise awareness about rotavirus sufficient for prioritization and accelerated vaccine introduction might benefit from a knowledge translation approach that delivers information and evidence about rotavirus through the broader context of diarrheal disease control, an existing priority, and including information about other new interventions, specifically low-osmolarity oral rehydration solution and zinc treatment.