Anaemia and iron deficiency in peri-urban school children born in a National HIV Prevention Programme in Zimbabwe: A cross-sectional study

Objective: To determine the prevalence of anaemia, iron deficiency and iron deficiency anaemia in school children who were born in a national HIV prevention programme.Design: This was a community based cross-sectional study.Setting: A resource poor peri-urban setting with high prevalence of HIV infection.Subjects: School aged children six to 10 years old who were born in a national mother-to-child HIV prevention programme.Main Outcome Measures: Haemoglobin (Hb), serum Ferritin (F) and serum Transferrin receptor (sTfR) levels.Results: Three hundred and eighteen children were recruited including 21 HIV positive. The prevalence of anaemia (Hb <11.5 grams per litre), iron deficiency (F<15 micrograms per litre) and iron deficiency anaemia (Hb < 11.5 g/L and either F <15µg/L or sTfR > 8.3µg/L) were 15%, 4% and 2% respectively. When a higher cut-off for ferritin of 30 micrograms per litre was applied to adjust for high infection disease burden, iron deficiency prevalence increased to 32% and iron deficiency anaemia increased to 5%. Anaemia was 4.9 (C.I 1.9-12.4) times more likely to occur in HIV infected children compared to the HIV uninfected children. Maternal HIV status at birth was not related to presence of anaemia in the school children.Conclusion: Anaemia was of mild public health significance in this cohort of children. Iron deficiency anaemia contributed less than a quarter of the cases of anaemia. HIV infection was an important determinant for presence of anaemia. Therefore continued efforts to eliminate paediatric HIV infection as a way of reducing anaemia in children are essential