Grant: Travel Awards - Institute Community Support

Anemia is a major problem in Cambodia, affecting ~44% of women. The potential causes of anemia include diets poor in nutrition, hereditary disorders that affect the transport of oxygen in the blood, as well as infection and disease. In Cambodia, iron deficiency is often assumed to be a major cause of anemia due to iron-poor diets. Our aim was to investigate the factors associated with anemia (defined by a low hemoglobin concentration) among 450 rural Cambodian women. We also explored the relations between Hb disorders and other blood biomarkers. Over 50% of women had a hereditary disorder of hemoglobin. Of the 420 non-pregnant women, ~30% had anemia (Hb <120 g/L) but very few women had iron deficiency (~2% defined by ferritin <15 ug/L or 19% defined by serum transferrin receptor [sTfR] >8.3 mg/L). Prevalence of anemia was 45% and 11%; and iron deficiency anemia (IDA) was 14% and 1.5% among women with and without hereditary Hb disorders, respectively. Ferritin and sTfR were elevated in women with some Hb disorders, thereby, reducing the effectiveness of these biomarkers to determine if these women indeed were iron deficient. A higher number of women with chronic inflammation (17.5%) had an elevated sTfR than did women without (7.2%, p = 0.03). Although it is currently thought that sTfR is not influenced by inflammation, our data suggest otherwise. Prevalence of folate, vitamin B-12 and A deficiencies were low (all <3%). The strongest predictors of Hb concentration were Hb E homozygous disorders and current pregnancy status. Other predictors were Hb E and Hb CS traits, parity, RBP, log ferritin, and vitamin B-12. Further investigation of the unexpectedly low prevalence of IDA among Cambodian women is warranted, as it can have important implications for the prevention and treatment of iron deficiency and anemia in Cambodia.