Anemia and intestinal parasite infection in school children in rural Vietnam

Objectives: This study hypothesized that besides iron deficiency, intestinal parasites infection is also a determinant of anemia in schoolchildren in rural Vietnam. Methods: 400 primary schoolchildren from 20 primary schools in Tam Nong district, a poor rural area in Vietnam, were randomly selected from enrolment lists. Venous blood (5ml) was collected in a cross sectional study and analyzed for hemoglobin (Hb), serum ferritin (SF), serum transferrin receptor (TfR), serum C-reactive protein (CRP) and total immunoglobulin E (IgE). Stools samples were examined for hookworm, Trichuris, and Ascaris infection. Logistic regression was used to assess the effect of intestinal parasites on anemia. Results: The prevalence of anemia (Hb8.5mg/L) occurred in 2% of the children. The prevalence of intestinal parasites was 92% with the highest prevalence for Trichuris (76%) and Ascaris (71%). More than 30% and 80% of the children showed an elevated CRP (>= 8 mg/L) and IgE (> 90 IU/mL) concentration. Anemia status was borderline significantly associated with SF and not associated with TfR and CRP. The prevalence odds ratio for Trichuris infection was 1.96 (95%CI 1.07-3.59) and 2.00 (95% CI 1.08-3.65) with iron deficiency reflected by TfR and SF, respectively. Conclusion: Anemia is highly prevalent among schoolchildren in Vietnam but may not be associated with iron deficiency. Trichuris infection is associated with a doubled risk of anemia, not mediated through iron deficiency. Chronic infection may play a role in anemia, but needs further investigation.