Prevalence of Anemia, Iron-Deficiency Anemia, and Associated Factors among Children Aged 1–5 Years in the Rural, Malaria-Endemic Setting of Popokabaka, Democratic Republic of Congo: A Cross-Sectional Study

Mala Ali Mapatano 1,Tor A. Strand

Elin Lovise F. Gjengedal
Pierre Zalagile Akilimali and Ingunn Marie S. Engebretsen
Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, 5009 Bergen, Norway
Faculty of Environmental Sciences and Natural Resource Management, Norwegian University of Life Sciences, 1432 Aas, Norway
Nutrients 2021, 13(3), 1010;
Received: 14 February 2021 / Revised: 12 March 2021 / Accepted: 18 March 2021 / Published: 21 March 2021


Iron deficiency (ID), the leading cause of anemia and the most common nutritional deficiency globally, is not well reported among children in malaria-endemic settings, and little is known about its contribution to anemia in these settings. We aimed to assess the prevalence of anemia, the role of ID using multiple parameters, and the factors associated with anemia in a malaria-endemic rural area. We conducted a community-based cross-sectional study of 432 children aged 1–5 years from the Popokabaka Health Zone, Democratic Republic of Congo. Sociodemographic characteristics, medical history, anthropometric parameters, and biochemical parameters were considered. Hemoglobin and malaria prevalence were assessed using rapid finger-prick capillary blood testing in the field. Venous blood samples were analyzed for serum ferritin, serum iron, total iron-binding capacity, and C-reactive protein (CRP) in a laboratory. Anemia was found in 294 out of 432 (68%) patients. Malaria was found in 375 out of 432 (87%), and ID in 1.8% according to diagnosis by adjusted ferritin only and in 12.9% according to transferrin saturation. ID indicators were not significantly correlated with low hemoglobin levels. Malaria, fever, and CRP > 5 mg/L were major factors associated with anemia in Popokabaka. Anemia control should focus on treating inflammatory conditions and infectious diseases among children in such settings.