Factors Affecting Ferritin Level in Children of 6 to 59 Months in the Eastern Region of Cameroon

Main Article Content

Sylvie D. Agokeng
Claude T. Tayou
Jules Clement N. Assob
Anna L. Njunda


Aim: Ferritin reflects total iron storage and is also the first laboratory index to decline with iron deficiency. It may be less accurate in children with infectious or inflammatory conditions as an acute phase reactant. Considering the fact that Cameroonian children live in malaria endemic and high risk hookworm infection area, our objective was to study factors affecting Ferritin level including socio-demographic data, child nutrition, anaemia and inflammatory status.

Study Design: A case control study was carried out with anaemic children as cases and non-anaemic as controls.

Place and Duration: Paediatric and laboratory units of the Bertoua regional Hospital, from November 2018 to January 2019.

Methodology: A case control study was carried out in children of 6 to 59 months attending the Bertoua regional hospital. Data were collected and blood distributed in EDTA and dry tubes for full blood count, C - reactive protein (CRP) and Ferritin analysis. Obtained data were analysed with SPSS 21.0 using Pearson’s Chi Square test.

Results: 126 children were included, 63 anaemic (Haemoglobin<11 g/dL) as cases and 63 non anaemic as controls. The Mean age of children was 27.3+/- 15.4 months, the mean haemoglobin was 10.4+/- 1.6 g/dL. Ferritin as state by WHO for the diagnosis of iron deficiency anaemia, was below 30 μg/L in 3.2% independently of anaemic status. Inflammation tested by CRP occurred in 37.3% of children. When the ferritin cut-off value was shifted to 50 μg/L, Ferritin was low in 9.5% thus approaching the stated frequency of iron deficiency obtained recentlyin Cameroon. Mean Ferritin level was 346.5 μg/L.

Conclusion:  The relatively high level of Ferritin showed that iron storage seems to remain intact in most children despite anaemic or inflammatory status. The level of Ferritin in children is highly dependent on haem iron consumption and food diversification also has a role to play.

Anaemia, inflammation, Ferritin, children.

Article Details

How to Cite
Agokeng, S. D., Tayou, C. T., Assob, J. C. N., & Njunda, A. L. (2019). Factors Affecting Ferritin Level in Children of 6 to 59 Months in the Eastern Region of Cameroon. International Blood Research & Reviews, 10(1), 1-8. https://doi.org/10.9734/ibrr/2019/v10i130112
Original Research Article


Franziska Staubli Asobayire, Pierre Adou, Lena Davidsson, James D Cook, and Richard F Hurrell. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: A study in Côte d‘Ivoire. Am J Clin Nutr. 2001;74:6 776-782.

Cornet M, Le Hesran JY, Fievet N, Cot M, Personne P, Gounoue R, et al. Prevalence of and risk factors for anemia in young children in southern Cameroon.Am J Trop Med Hyg. 1998;58: 5606-611.

Nojilana B, Norman R, Dhansay MA, Labadarios D, van Stuijvenberg ME, Bradshaw D. Estimating the burden of disease attributable to iron deficiency anaemia in South Africa in 2000.S Afr Med J. 2007;97:741-46.

Cook JD. Defining optimal body iron. Proc Nutr Soc. 1999;58:489–95.

Yip R, Dallman PR. The roles of inflammation and iron deficiency as causes of anemia. Am J Clin Nutr. 1988;48:1295–300.

Suharno D, West CE, Muhilal, Karyadi D, Hautvast JG. Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. Lancet. 1993;342:1325–328.

Savage D, Gangaidzo I, Lindenbaum J, et al. Vitamin B-12 deficiency is the primary cause of megaloblastic anaemia in Zimbabwe. Br J Haematol. 1994;86:844–50.

Amanda J. Patterson, Wendy J. Brown and David CK. Roberts. Dietary and lifestyle factors influencing iron stores in Australian women: an examination of the role of bio-available dietary iron. Aust J. Nutr Diet. 2001;58:2107-113.

Frederick KE Grant, Reynaldo Martorell, Rafael Flores-Ayala, Conrad R Cole, Laird J Ruth, Usha Ramakrishnanet al. Comparison of indicators of iron deficiency in Kenyan children. Am J Clin Nutr. 2012; 95:51231–1237.

Domellöf M.Dewey KG, Lönnerdal B, Cohen RJ, Hernell O.The diagnostic criteria for iron deficiency in infants should be re-evaluated. JNutr.2002;132:3680-3686.

Jay H, Lubin Mitchell, Gail H, Abby G. Ershow. Sample size and power for case-control studies when exposures are continuous. Stat Med.1988;7:3363-376.

Huguette Turgeon O’Brien, Rosanne Blanchet, Doris Gagné, Julie Lauzière, Carole Vézina. Using soluble transferrin Receptor and taking inflammation into account when defining serum ferritin cut-offs improved the diagnosis of iron deficiency in a group of Canadian preschool Inuit children from Nunavik. Anemia. pages, ID 6430214. 2016;10.

Phiri KS, Calis JCJ, A Siyasiya, Bates I, Brabin BM, Boele van Hensbroek. New cut-off values for ferritin and soluble transferrin receptor for the assessment of iron deficiency in children in a high infection pressure area. Bmj Journals. 2018;62:12.

American medical association, world medical declaration of Helsinki ethical principles for medical research involving human subjects. JAMA. 2013;310:20.

Rosa ML. Semedo, Marta MAS, Santos Mirian R, Baião, Ronir R, Luiz, Gloria V. da Veiga. Prevalence of Anaemia and Associated Factors among Children below Five Years of Age in Cape Verde, West Africa. J Health Popul Nutr. 2014;32(4): 646–657.

Mirza Sultan Ahmad, Hadia Farooq, Sumaira Noor Maham, Zonaira Qayyum, Abdul Waheed, and Waqar Nasir. Frequency of Anemia and Iron Deficiency among Children Starting First Year of School Life and Their Association with Weight and Height. Anemia. 2018;5.

ID 8906258.

Olufunke Odunlade, Olugbenga Adeodu, Joshua Owa, Efere Obuotor. Iron deficiency, still a rarity in children with sickle cell anemia in Ile-Ife, Nigeria. Hematol Transfus Cell Ther. 2019;41: 3216-221.

Zainab Alghamdi. Iron Status of Infants and Toddlers Age 6 to 18 Months and Association with Type of Milk Consumed from DNSIYC Secondary Analysis. J Nutr Food Sci. 2017;7:596.
DOI: 10.4172/2155-9600.1000596

Namaste SM, Rohner F, Huang J. Adjusting ferritin concentrations for inflammation: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106:1359S–371S.

Soliman G, Azmi M, El Said S. Prevalence of anemia in Egypt (Al-Gharbia Governorate). Egypt J Hosp Med. 2007; 28:395-305.

Thomas DW, Hinchliffe RF, Briggs C, Macdougall IC, Littlewood T, Cavill I. Guideline for the laboratory diagnosis of functional iron deficiency. Br. J. Haematol. 2013;161:5639–648.

Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics 2014;6:4748-753.

Cappellini MD, Comin-Colet J, de Francisco A, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. Am J. Hematol. 2017;92:101068-1078.

De Franceschi L, Iolascon A, Taher A, Cappellini MD. Clinical management of iron deficiency anemia in adults: Systemic review on advances in diagnosis and treatment. Eur J. Int. Med. 2017;42:16-23.

Camaschella C. New insights into iron deficiency and iron deficiency anaemia. Blood Reviews. 2017;31(4):225–233.

Archer NM, Brugnara C. Diagnosis of iron-deficient states. Crit Rev Clin Lab Sci. 2015;52(5):256-272.

Sherwin De Souza, Anita Shet, Prasanna Kumar Kapavarapu and Arun S. Shet. Evaluating biomarkers of iron deficiency anemia in anemia of inflammation. Blood. 2013;122:21,948.

Giridhar Kanuri, Deepti Chichula, Ritica Sawhney, Kevin Kuriakose, Sherwin De’Souza, Faye Pais, Karthika Arumugam, Arun S. Shet. Optimizing diagnostic biomarkers of iron deficiency anemia in community-dwelling Indian women and preschool children. Haematologica. 2018; 103:121991-1996.

Drakesmith H. Next-Generation Bio-markers for Iron Status. Nestle Nutrition Institute workshop series. 2016;84:59-69.