Biochemical and Hematological Markers of Iron Status of the Populations in the Lekie Division of Cameroon

According to the WHO, iron deficiency is the most widespread micronutrient deficiency in the world ¹. In many countries, it represents a real public health problem, and is responsible for 50% of anemia cases worldwide ². Diet is the main cause of iron deficiency in the population and effective prevention requires up-to-date knowledge of the population's iron status ³. This knowledge of the population's iron status is based on the study of a number of markers, both hematological and biochemical; the most common of which are hemoglobin concentration, haematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, C-reactive protein, iron, ferritin and serum transferrin ⁴. The Lekie Division in Cameroon, because of its proximity to the Sanaga River, is a major malaria-endemic area, and is characterised by poor dietary habits ⁵. The need for up-to-date, detailed data on the iron status of this population is essential for effective planning of control measures.

When it comes to health-related activities, women and their children are very often susceptible, and therefore more participative, because of their health vulnerability, unlike men. This could therefore justify the high representation of women in this study. The Eton ethnic group is majority in the Lekie Division, accounting for about 80% of the population, compared with 25% for the Manguissa ethnic group. The population is more concentrated in the rural than in urban areas, due to the high level of agricultural activities. The high school enrolment rate can be explained by the presence of school infrastructures in almost every locality in the Lekie Division. However, the primary level was the most represented in this study, because the population were more concentrated in rural areas, which mostly have primary education facilities, therefore only have access to basic education, except for those who have more resources and are therefore able to continue their studies in urban areas, at higher levels. With regards to the marital status of the participants in the study, it is the high level of education which characterises this study population, and their strong adherence to the Catholic religion, which would be the two major assets in these populations' knowledge could be advantages associated with marital stability, which would therefore justify the observed predominance of married people. The Lekie Division is a major agricultural production area, due to its proximity to River Sanaga and the fertility of its soil. Its proximity to the capital city provides a great opportunity for actors in the field, and therefore justifies the fact that agriculture appears to be the main activity pursued by the people of this Division. These results were similar to that obtained in the Democratic Republic of Congo.¹

The mean values of hematological parameters in Table 1 showed no significant difference for ethnicity, unlike for gender. The hemoglobin concentration specifically was higher in men (12.54±2.07) than in women (11.91±1.51). This result could be justified by the fact that women are physiologically more prone to blood loss, and therefore to iron loss, than men.⁸ The lowest hemoglobin concentration was observed in children under 5 years of age (10.46±1.71). Children under 5 are a major target for anemia, not only because of their vulnerability to malaria and other pathologies associated with anaemia, but also because of their very poor diet. There was no significant difference between the various parameters for the place of residence. However, hemoglobin concentration was higher in rural than in urban areas. As mentioned above, this can be explained by the fact that in rural areas there is less pollution, which is a source of mosquitoes, and there is a slightly higher consumption of mineral-rich fruit and vegetables than in urban areas. Occupations showed significant differences for all hematological parameters. In general, the working population (employees, farmers, informal workers) had higher mean hemoglobin and hematocrit values than those unemployed. This could be explained by the fact that income from an activity can promote better access to healthcare and a balanced diet for an individual or group of individuals. For the level of education, the mean values of hematological parameters showed significant differences. The highest mean hemoglobin and hematocrit values were observed in people with higher levels of education. In fact, a higher level of education generally implies a better knowledge of hygiene and dietary recommendations and their benefits, which could justify the results observed. With regard to marital status, the highest mean hemoglobin and hematocrit values were observed in married people, which could be justified by the fact that marriage creates a certain stability and synergy of efforts, which very often generates a better economic return, favouring better access to healthcare and a balanced diet. ¹⁰

The mean values of the biochemical parameters in Table 2 showed no significant differences by ethnic group or gender. Concentrations of serum iron and ferritin specifically were higher in men than in women. As mentioned above, this result could be justified by the fact that, from a physiological point of view, women are more prone to blood loss, and therefore to iron loss, than men, as iron is a major mineral making up hemoglobin in the blood. In terms of age group, the lowest serum iron concentration was observed in adolescents aged 5 to 14 (73.89±4.29), while subjects aged 50 and over had the best biochemical profile. This result was different from that of ⁹. Like children under 5, adolescents aged 5 to 14 are also a major target for anemia, not only because of their vulnerability to malaria and other pathologies associated with anemia, but also because their diet is very often poor, which could therefore justify these results. There were significant differences in the various parameters relating to the environment in which the children lived. However, the biochemical profile was better for subjects living in rural areas than for those living in urban areas. The reason for this seems to be the same as that mentioned above, i.e. in rural areas, pollution, which is a source of mosquitoes, is not very prevalent and therefore limits cases of anemia. In addition, there is a slightly higher consumption of fruit and vegetables rich in minerals, particularly iron, in rural areas than in urban areas. Occupations showed significant differences for all biochemical parameters. Generally, the working population (employees, farmers, informal workers) had higher mean values for biochemical profile parameters than those unemployed. Once again, this could be explained by the fact that income from an activity favours better access to healthcare and to a balanced and more diversified diet for an individual or a group of individuals. There were no significant differences in the mean values of biochemical parameters for level of education. The highest average serum iron concentration was observed in people with higher levels of education. A high level of education is therefore associated with a good biochemical profile. With regards to the marital status of the participants, the highest mean values for biochemical parameters were observed among widows/widowers, followed by married people. Indeed, it is known that marriage creates a certain stability and synergy of effort, which consequently generates better economic performance, favouring better access to healthcare and a balanced diet, which would therefore justify this result. Similarly, widows and widowers usually inherit and manage the benefits of the synergy of effort built up during marriage, and can therefore still have access to better healthcare and nutrition.¹⁰

At the end of this study, it is important to note that the mean values of biochemical and haematological markers in the population of the Lekie Division were good for all socio-demographic parameters, with the exception of hemoglobin concentration, which remains critical, requiring particular attention in this locality, but above all urgent intervention is needed to prevent the situation from deteriorating further, especially as the consequences are fatal and sometimes irreversible.

Noah Guy : conceptualization, study design, data collection, data analysis and interpretation, drafting of the manuscript, reviewing of the manuscript. ; Fokou Elie : conceptualization, study design, literature review, data interpretation, revision of the manuscript. ; Bebbe Fadimatou : study design, literature review, data interpretation, revision of the manuscript. ; Eposi Haddison : study design, literature review, data interpretation, revision of the manuscript. ; Mbassi Manga Gilbert G : study design, literature review, data collection, revision of the manuscript. ; Kemzeu Raoul : study design, literature review, data collection, revision of the manuscript. ; Nomo Nga Genevieve : study design, literature review, data collection, revision of the manuscript. ; Vicky Ama Moor : study design, data interpretation, revision of the manuscript.

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