Research Partnership with Developing Countries
A Programme funded by Swiss National Science Foundation (SNSF) and Swiss Agency for Development and Cooperation (SDC)

Aetiology, prevention and control of anaemia in sub-Saharan Africa

Background
Anaemia is a major global health problem. Its aetiology is multifactorial, yet in West Africa low dietary iron intake and parasitic diseases have been identified as the main causes. Anaemia can cause fatigue, impaired cognitive development, and increased morbidity and mortality from infectious diseases. Strategies for prevention and control include increasing dietary iron intake through food fortification or supplementation. It has been suggested that the efficacy of these interventions is enhanced when combined with parasite control. Our own work in Côte d’Ivoire, however, showed no effect of iron fortification and intermittent preventive treatment (IPT) of malaria on anaemia. The lack of efficacy of the IPT intervention might be explained by resistance to the antimalarial drug used, whereas the inefficacy of iron fortification might be due to the use of a poorly absorbed elemental iron powder. Indeed, in Africa, inflammation and infection can blunt the efficacy of iron absorption and utilization of such iron fortificants. However, other factors may also affect Hb levels, including haemoglobinopathies and micronutrient deficiencies.

Objectives
The goal of this project is to further our understanding of the aetiology of anaemia and to investigate how anaemia can be reduced among children in sub-Saharan Africa by using a combination of food-based and parasite-control interventions. There are three specific objectives: (i) to monitor anaemia, helminth infections, malaria parasitaemia, micronutrient deficiencies and haemoglobinopathies in a cohort of individuals; (ii) to investigate the impact of IPT of malaria, anthelminthic treatment and iron fortification in an intervention study; and (iii) to assess changes in iron metabolism in relation to malaria and helminth infections.

Methodology
Our studies will be carried out in Taabo district, central Côte d’Ivoire, and are readily embedded in a new Demographic Surveillance System (DSS) site covering ~30,000 people. In order to elucidate the aetiology of anaemia, blood, urine and stool samples will be collected during repeated cross-sectional surveys from three sentinel groups (infants, school-aged children, women of childbearing age) and samples analyzed for anaemia, iron deficiency (ID), micronutrient deficiencies, haemoglobinopathies, helminths and malaria infection, and chronic inflammation. A 9-month intervention study in school children will be designed to investigate the contribution of malaria and ID to anaemia. The school children will be provided IPT with SP+amodiaquine, anthelminthic drugs and a NaFeEDTA fortified drink or biscuit. Anaemia, ID, helminths, and malaria prevalence will be assessed at baseline and after the intervention. To investigate the effect of helminth infection and malaria on iron metabolism, stable isotopes of iron will be given. Iron absorption and utilization of infected children will be compared to that of children without an infection.

Expected outcomes
The results of this project will clarify the complex relationship between ID, anaemia and infectious diseases.

Foto 1: The main street through the village Léléblé, which is integrated in the Demographic Surveillance Site Taabo, Côte d'Ivoire.

Foto 2: Children playing in the street of Léléblé. Léléblé's population is affected by several infectious diseases (hookworm, malaria, schistosomias,...) and anemia.

                          
      Foto 3: A technician takes a few blood drops from an infant's finger. Research in the Taabo region is carried out in
      close collaboration with the highly motivated local population, local health workers and technicians.

Contact Addresses:

Swiss Coordinator:
Dr. Rita Wegmüller
Institute of Food Science and Nutrition, ETH Zürich
Schmelzbergstrasse 7, LFV E14.1
8092 Zürich, Switzerland
rita.wegmueller@ilw.agrl.ethz.ch

Main Foreign partner:
Prof. Eliézer K. N’Goran
UFR Biosciences, Université d’Abidjan-Cocody
22 B.P. 770
Abidjan, Côte d’Ivoire
eliezerngoran@yahoo.fr

Cooperwation with:
Swiss Tropical Institute, Basel
Centre Suisse de Recherches Scientifiques, Abidjan