Prévalence et déterminants de l’anémie chez le jeune enfant en Afrique francophone – Implication de la carence en fer

• Published in: Archives de pédiatrie : organe officiel de la Société française de pédiatrie Vol. 22; no. 11; pp. 1188 - 1197
• Main Authors: Diouf, S., Folquet, M., Mbofung, K., Ndiaye, O., Brou, K., Dupont, C., N’dri, D., Vuillerod, M., Azaïs-Braesco, V., Tetanye, E.
• Format: Journal Article
• Language: French
• Published: Elsevier SAS 01-11-2015
• ISSN: 0929-693X; 1769-664X
• DOI: 10.1016/j.arcped.2015.08.015

L’anémie et la carence en fer sont des questions de santé publique majeures au niveau mondial. Ce travail synthétise la situation existant chez l’enfant de 6 mois à 5ans dans 11 pays d’Afrique francophone, à partir d’études démographiques de santé récentes et d’une recherche bibliographique complémentaire. La prévalence de l’anémie (taux d’hémoglobine [Hb]<11g/L) chez les enfants s’établit à 72,4 % (60,2–87,8 %) ; elle est légèrement plus élevée chez les jeunes enfants, notamment pour les formes sévères, que chez les enfants de plus de 3ans. Près de 50 % des femmes en âge de procréer sont anémiées. Moins de la moitié des enfants consomment régulièrement des aliments riches en fer et seulement 12,6 % d’entre eux reçoivent des suppléments de fer. La malnutrition (protéino-énergétique et vitaminique) contribue à la survenue d’une anémie. L’existence d’un statut inflammatoire, d’origine infectieuse ou parasitaire, modifie certains critères d’évaluation de la carence en fer dont le diagnostic devient alors délicat. Dans les populations étudiées, le niveau de prévalence du paludisme et des infections intestinales et respiratoires, et leur distribution suggèrent toutefois qu’une large partie des anémies observées seraient ferriprives. Ceci justifie les vastes programmes de fortification en fer de la farine mis en œuvre dans la quasi-totalité de la zone étudiée. Bien que leur efficacité n’ait pas encore été formellement évaluée, une amélioration semble se dessiner. Elle reste cependant modérée et des actions complémentaires sont nécessaires.
Anemia and iron deficiency are major public health issues worldwide and particularly in Africa. Reliable information about their prevalence and associated factors is required to allow for effective actions. In this study, we used data from recent (2006–2012) large population health surveys, carried out in 11 French-speaking African countries (Benin, Burkina Faso, Cameroon, Congo Brazzaville, Ivory Coast, Gabon, Guinea, Mali, Niger, Democratic Republic of Congo, and Senegal). Hemoglobin (Hb) was assessed and demographic and health-related parameters were obtained from nation-representative samples of children aged 6–59 months. Anemia (Hb<11g/dL) was found in 72.4% of the children (60.2–87.8%), with no gender difference but a slightly lower incidence in older children (62% at age 4–5 years versus 85% at age 9 months), especially for the more severe forms (2.1% versus 8.7%, respectively). Anemia was only slightly but significantly affected by location (75.5% in rural areas versus 67.3% in towns), income (79.8% in lower quintile of income versus 62.3% in higher quintile), or maternal education (74.1% in children from non-educated mothers versus 62.4% in children whose mothers had secondary education). Nearly 50% of women of child-bearing age had anemia. In the countries that report this information, less than 50% (17–65%) of children consumed iron-rich foods regularly and only 12% (7.4–20.5%) received iron supplementation. Infection and parasitism are known to affect some markers of iron status, because of the inflammatory reaction, thereby making the diagnosis of iron deficiency difficult. In the study countries, acute respiratory diseases and diarrhea affected 6.2 and 15.6% of children aged between 6 and 59 months, respectively; their distribution according to age and location is very different from the one of anemia, which is also the case for the distribution of malaria. It is thus likely that a large part of the anemia observed in young children is due to iron deficiency, although further research is needed to confirm this. This fully justifies the nationwide programs of iron fortification of flour, currently undergoing in most countries of French-speaking Africa. Their formal evaluation is still pending but the initial data suggest some efficacy, although far from optimal. It is thus likely that a more holistic approach, including iron fortification, actions against undernutrition and parasitism in children, and actions in favor of improving young women's iron and nutritional status, together with appropriate communication and education objectives, would be more effective.