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Full-term, peri-urban South African infants under 6 months of age are at risk for early-onset anaemia

  • LN Sibeko (a1), MA Dhansay (a2), KE Charlton (a3), T Johns (a1), ME Van Stuijvenberg (a2) and K Gray-Donald (a1)...

Abstract

Objective:

There is a paucity of data on the micronutrient status of low-income, lactating South African women and their infants under 6 months of age. The aim of this study was to elucidate the level of anaemia and vitamin A deficiency (VAD) in peri-urban breast-feeding women and their young infants.

Design:

Cross-sectional study including anthropometric, biochemical and infant feeding data.

Setting:

Peri-urban settlement in Cape Town, South Africa.

Subjects:

Breast-feeding women (n = 113) and their infants (aged 1–6 months) attending a peri-urban clinic.

Results:

Mean (standard deviation (SD)) haemoglobin (Hb) of the lactating mothers was 12.4 (1.3) gdl−1, with 32% found to be anaemic (Hb < 12 g dl−1). Maternal serum retinol was 49.8 (SD 13.3) μg dl−1, with 4.5% VAD. Using breast milk, mean (SD) retinol concentration was found to be 70.6 (24.6) μg dl−1 and 15.7 (8.3) μg/g milk fat, with 13% below the cut-off level of <8μg/g fat. There was no correlation found between breast milk retinol and infant serum retinol. Z-scores (SD) of height-for-age, weight-for-age and weight-for-height were –0.69 (0.81), 0.89 (1.01) and 1.78 (0.83), respectively. Mean (SD) infant Hb was 10.9 (1.1) g dl−1, with the prevalence of anaemia being 50%, 33% and 12% using Hb cut-offs below 11 g dl−1, 10.5 g dl−1 and 9.5 g dl−1, respectively. Mean (SD) infant serum retinol was 26.9 (7.2) μg dl−1, with 10% being VAD. None of the infants was exclusively breast-fed, 22% were predominantly breast-fed and 787percnt; received complementary (mixed) breast-feeding. Thirty-two per cent of infants received weaning foods at an exceptionally young age (≤1 month old).

Conclusion:

A high rate of anaemia is present in lactating women residing in resource-poor settings. Moreover, their seemingly healthy infants under 6 months of age are at an elevated risk of developing early-onset anaemia and at lower risk of VAD.

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Copyright

Corresponding author

*Corresponding author: Email gray-donald@macdonald.mcgill.ca

References

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1World Health Organization. Draft World Declaration on Nutrition. Theme Paper No. 6. In: Major Issues Nutrition Strategies, Proceedings of International Conference on Nutrition: Preventing Specific Nutrient Deficiencies. Rome: Food and Agricultural Organization, 1991. 240.
2United Nations Children's Fund. State of the Worlds Children. New York: Oxford University Press, 1998.
3De Benoist, B. Iron–deficiency anemia: reexamining the nature and magnitude of the public health problem. Journal of Nutrition 2001; 131: 564S.
4Lozoff, B, Jimenez, E, Wolfe, A. Long-term developmental outcome of infants with iron deficiency. New England Journal of Medicine 1991; 325: 687–94.
5Soewondo, S, Husaini, M, Politt, E. Effects of iron deficiency on attention and learning processes in preschool children: Bandung, Indonesia. American Journal of Clinical Nutrition 1989; 50: 667–74.
6Stoltzfus, R. Defining iron-deficiency anemia in public health terms: a time for reflection. Journal of Nutrition 2001; 131: 565S–7S.
7South African Vitamin A Consultative Group. Anthropometric, vitamin A, iron and immunisation coverage status in children aged 6–71 months in South Africa. South African Medical Journal 1996; 86: 354–7.
8Bhaskaram, P. Micronutrient deficiencies in children – the problem and extent. Indian Journal of Pediatrics 1995; 62: 145–56.
9World Heath Organization (WHO)/United Nations Children's Fund. Indicators for Assessing Vitamin A Deficiency and Their Application in Monitoring and Evaluating Intervention Programmes. WHO/NUT/96.10. Geneva: WHO, 1996.
10Kawakami, H, Lönnerdal, B. Isolation and function of a receptor for human lactoferrin in human fetal intestinal brush-border membranes. American Journal of Physiology 1991; 261: G841–6.
11Chappell, JE, Francis, T, Clandinin, MT. Vitamin A and E content of human milk at early stages of lactation. Early Human Development 1985; 11: 157–67.
12Valquist, A, Nilsson, S. Mechanisms for vitamin A transfer from blood to milk in rhesus monkeys. Journal of Nutrition 1979; 109: 1456–63.
13United Nations Children's Fund. UNICEF Global Database Breastfeeding Indicators [online], 2001. Available at http://childinfo.org/eddb/brfeed/test/database.htm. Accessed May 2003
14Richter, LM. The Early Introduction of Solids: An Analysis of Belief and Practices among African Women in Soweto. Report. South Africa: University of the Witwatersrand, 1987.
15Steyn, NP, Badenhorst, CJ, Nel, JH. Breast feeding and weaning practices of Pedi mothers and the dietary intakes of their preschool children. South African Journal of Food Sciences and Nutrition 1993; 5: 10–3.
16Zollner, E, Carlier, ND. Breast feeding and weaning practices in Venda. South African Medical Journal 1993; 83: 580–3.
17Ross, SM, Van Middelkoop, A, Khoza, NC. Breastfeeding practices in a black community. South African Medical Journal 1983; 63: 23–5.
18Statistics South Africa. Census Data from Urban Policy Unit. Pretoria: Statistics South Africa, 1996.
19Catignani, GL, Bieri, JG. Simultaneous determination of retinol and α-tocopherol in serum or plasma by liquid chromatography. Clinical Chemistry 1983; 29: 708–12.
20Lucas, A, Gibbs, JA, Lyster, RL, Baum, JD. Creamatocrit: simple clinical technique for estimating fat concentration and energy value of human milk. British Medical Journal 1978; 1: 1018–20.
21Strobel, M, Heinrich, F, Biesalski, HK. Improved method for rapid determination of vitamin A in small samples of breast milk by HPLC. Journal of Chromatography 2000; 898: 179–83.
22World Health Organization (WHO). Contemporary Patterns of Breastfeeding. Report on the WHO Collaborative Study on Breastfeeding. Geneva: WHO, 1981. 165211.
23World Health Organization (WHO). Indicators for Assessing Breastfeeding Practices. Update No. 10. Genea: WHO, 1997.
24Bourne, LT, Langenhoven, ML, Steyn, K, Jooste, PL, Laubscher, JA, Bourne, DE. Nutritional status of 3–6 year old African children in the Cape Peninsula. East African Medical Journal 1994; 71: 695702.
25Dijkhuizen, MA, Wieringa, FT, West, CEMuherdiyantiningsih Mulilal. Concurrent micronutrient deficiencies in lactating mothers and their infants in Indonesia. American Journal of Clinical Nutrition 2001; 73: 786–91.
26Stoltzfus, RJ, Dreyfuss, ML. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Washington, DC: ILSI Press, 1998. 139.
27United Nations Children's Fund/World Health Organization (WHO). Prevention and Control of Iron Deficiency Anemia in Women and Children. Geneva: WHO, 1999.
28World Health Organization (WHO). Indicators and Strategies for Iron Deficiency and Anemia Programmes. Report of the WHO/UNICEF/UNU Consultation. Geneva: WHO, 1993.
29Domellof, M, Dewey, KG, Lonnerdal, B, Cohen, RJ, Hernell, O. The diagnostic criteria for iron deficiency in infants should be reevaluated. Journal of Nutrition 2002; 132: 3680–6.
30Kirsten, GF, Heese, HD, Villiers, S, Dempster, WS, Varkevisser, HE, Hoffman, M. The prevalence of iron deficiency in apparently healthy Cape coloured infants. South African Medical Journal 1984; 65: 378–80.
31Grajeda, R, Pérez-Escamilla, R, Dewey, KG. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2mo of age. American Journal of Clinical Nutrition 1997; 65: 425–31.
32Geethanath, RM, Ramji, S, Thirupuram, S, Rao, YN. Effect of timing of cord clamping on the iron status of infants at 3 months. Indian Pediatrics 1997; 34: 103–6.
33Halvorsen, S. Iron balance between mother and infant during pregnancy and breastfeeding. Acta Paediatrica 2000; 89: 625–7.
34Lartey, A, Manu, A, Brown, KH, Dewey, KG. Predictors of micronutrient status among six- to twelve-month-old breast-fed Ghanaian infants. Journal of Nutrition 2000; 130: 199207.
35Michaelsen, KF, Milman, N, Samuelson, G. A longitudinal study of iron status in healthy Danish infants: effects of early iron status, growth velocity and dietary factors. Acta Paediatrica 1995; 84: 1035–44.
36Willows, ND, Morel, J, Gray-Donald, K. Prevalence of anemia among James Bay Cree infants of northern Quebec. Canadian Medical Association Journal 2000; 162: 323–6.
37Sauberlich, HE, Hodges, RE, Wallace, DL, Kolder, H, Canham, JE, Hood, J, et al. Vitamin A metabolism and requirements in the human studied with the use of labeled retinol. Vitamins & Hormones 1974; 32: 251–75.
38Rice, AL, Stoltzfus, RJ, de Francisco, A, Kjolhede, CL. Evaluation of serum retinol, the modified-relative-dose-response ratio, and breast-milk vitamin A as indicators of response to postpartum maternal vitamin A supplementation. American Journal of Clinical Nutrition 2000; 71: 799806.
39Newman, V. Vitamin A and breast-feeding: a comparison of data from developed and developing countries. Food and Nutrition Bulletin 1994; 15: 161–76.
40Wahed, MA, Alverez, JO, Rahman, MM. Subclinical vitamin A deficiency in young infants from Bangladesh. Nutrition Research 1997; 17: 591–8.
41Stoltzfus, RJ, Underwood, BA. Breast-milk vitamin A as an indicator of the vitamin A status of women and infants. Bulletin of the World Health Organization 1995; 73: 703–11.
42Faber, M, Benade, AJ. Nutritional status and dietary practices of 4–24 months old children from a rural South African community. Public Health Nutrition 1999; 2: 179–85.
43Mahalanabis, D. Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study. British Medical Journal 1991; 303: 493–6.
44Okolo, SN, Onwuanaku, C, Okonji, M, Vanderjagt, DJ, Milson, M, Churchwell, C, et al. Concentration of eight trace minerals in milk and sera of mother–infant pairs in Northern Nigeria. Journal of Tropical Pediatrics 2000; 46: 160–2.
45Saarinen, UM, Siimes, MA, Dallman, PR. Iron absorption in infants: high bio-availability of breast milk iron as indicated by the extrinsic tag method of iron absorption and by the concentration of serum ferritin. Journal of Pediatrics 1977; 91: 36–9.
46Dallman, PR, Siimes, MA, Stekel, A. Iron deficiency in infancy and childhood. American Journal of Clinical Nutrition 1980; 33: 86118.
47Oski, FA, Landaw, SA. Inhibition of iron absorption from human milk by baby food. American Journal of Diseases of Children 1980; 134: 459–60.

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Full-term, peri-urban South African infants under 6 months of age are at risk for early-onset anaemia

  • LN Sibeko (a1), MA Dhansay (a2), KE Charlton (a3), T Johns (a1), ME Van Stuijvenberg (a2) and K Gray-Donald (a1)...

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