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Murphy RD, James KM, Ippolito JR, Barney DE, Miller KM, Murphy NE, Gwin JA, Pasiakos SM, McClung JP, Margolis LM, Hennigar SR. Mild to Moderate Food Deprivation Increases Hepcidin and Results in Hypoferremia and Tissue Iron Sequestration in Mice. J Nutr 2022; 152:2198-2208. [PMID: 35906187 DOI: 10.1093/jn/nxac167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Short-term starvation and severe food deprivation (FD) reduce dietary iron absorption and restricts iron to tissues, thereby limiting the amount of iron available for erythropoiesis. These effects may be mediated by increases in the iron regulatory hormone hepcidin; however, whether mild to moderate FD has similar effects on hepcidin and iron homeostasis is not known. OBJECTIVES To determine the effects of varying magnitudes and durations of FD on hepcidin and indicators of iron status in male and female mice. METHODS Male and female C57BL/6J mice (14 wk old; n = 170) were randomly assigned to consume AIN-93M diets ad libitum (AL) or varying magnitudes of FD (10%, 20%, 40%, 60%, 80%, or 100%). FD was based on the average amount of food consumed by the AL males or females, and food was split into morning and evening meals. Mice were euthanized at 48 h and 1, 2, and 3 wk, and hepcidin and indicators of iron status were measured. Data were analyzed by Pearson correlation and one-way ANOVA. RESULTS Liver hepcidin mRNA was positively correlated with the magnitude of FD at all time points (P < 0.05). At 3 wk, liver hepcidin mRNA increased 3-fold with 10% and 20% FD compared with AL and was positively associated with serum hepcidin (R = 0.627, P < 0.0001). Serum iron was reduced by ∼65% (P ≤ 0.01), and liver nonheme iron concentrations were ∼75% greater (P ≤ 0.01) with 10% and 20% FD for 3 wk compared with AL. Liver hepcidin mRNA at 3 wk was positively correlated with liver Bmp6 (R = 0.765, P < 0.0001) and liver gluconeogenic enzymes (R = >0.667, P < 0.05) but not markers of inflammation (P > 0.05). CONCLUSIONS FD increases hepcidin in male and female mice and results in hypoferremia and tissue iron sequestration. These findings suggest that increased hepcidin with FD may contribute to the disturbances in iron homeostasis with undernutrition.
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Affiliation(s)
- Robert D Murphy
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - Kelsey M James
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - James R Ippolito
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - David E Barney
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - Katelyn M Miller
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
| | - Nancy E Murphy
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Jess A Gwin
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Stefan M Pasiakos
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Lee M Margolis
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Stephen R Hennigar
- Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, FL, USA
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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Ali M, Amin MR, Jarl J, Chisholm N, Saha S. Maternal health status and household food security on determining childhood anemia in Bangladesh -a nationwide cross-sectional study. BMC Public Health 2021; 21:1581. [PMID: 34418981 PMCID: PMC8380337 DOI: 10.1186/s12889-021-11581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The aim of this study was to examine the effect of household food security on childhood anemia in Bangladesh while controlling for socioeconomic and demographic factors. METHODS We used nationally representative Bangladesh Demographic Health Survey (BDHS) 2011 data for this study, the only existing survey including anemia information and household food security. The sample included 2171 children aged 6-59 months and their mothers. Differences between socioeconomic and demographic variables were analyzed using Chi-square test. Univariate and multivariate logistic regression analyses were performed to estimate the effects of different socioeconomic and demographic factors on childhood anemia. We also performed mediation analysis to examine the direct and indirect effect of household food security on childhood anemia. RESULTS In Bangladesh, 53% male (95% CI: 50-56) and 51% female (95% CI: 47-54) children aged 6-59 months were anemic in 2011. The food insecure households have 1.20 times odds (95% CI: 0.97-1.48) of having anemic children comparing to food secure households in the unadjusted model. On the other hand, anemic mothers have 2 times odds (95% CI: 1.67-2.44) of having anemic children comparing to non-anemic mothers. However, household food security is no longer significantly associated with childhood anemia in the adjusted model while mothers' anemia remained a significant factor (OR 1.87: 95% CI: 1.53-2.29). Age of children is the highest associated factor, and the odds are 4.89 (95% CI: 3.21-7.45) for 6-12 months old children comparing to 49-59 months in the adjusted model. Stunting and household wealth are also a significant factor for childhood anemia. Although food security has no significant direct effect on childhood anemia, maternal anemia and childhood stunting mediated that relationship. CONCLUSIONS Future public health policies need to focus on improving mothers' health with focusing on household food security to eliminate childhood anemia.
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Affiliation(s)
- Masum Ali
- Department of Food Business and Development, O’Rahilly Building, University College Cork, Cork, Ireland
| | - Md. Ruhul Amin
- Institute of Nutrition and Food Science (INFS), University of Dhaka, Dhaka, 1000 Bangladesh
| | - Johan Jarl
- Department of Clinical Science (Malmö), Health Economics Unit, Lund University, Medicon Village, Scheelevagen 2, SE-223 63 Lund, Sweden
| | - Nick Chisholm
- Department of Food Business and Development, O’Rahilly Building, University College Cork, Cork, Ireland
- Center for Global Development and Department of Food Business and Development, O’Rahilly Building, University College Cork, Cork, Ireland
| | - Sanjib Saha
- Department of Clinical Science (Malmö), Health Economics Unit, Lund University, Medicon Village, Scheelevagen 2, SE-223 63 Lund, Sweden
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Pasqualino MM, Thorne-Lyman AL, Manohar S, KC A, Shrestha B, Adhikari R, Klemm RD, West KP. The Risk Factors for Child Anemia Are Consistent across 3 National Surveys in Nepal. Curr Dev Nutr 2021; 5:nzab079. [PMID: 34104851 PMCID: PMC8178108 DOI: 10.1093/cdn/nzab079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/08/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue. OBJECTIVES This study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013 to 2016 in Nepal. METHODS Same-season national surveys were administered in 2013, 2014, and 2016 in 63 sites across 21 districts, selected using multistage random sampling, representing the mountains, hills, and Tarai (plains). Among consenting households with children aged 6-59 mo, a random sample of capillary blood was selected each year for anemia assessment using an Hb 201+ hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin <11.0 g/dL with adjustment for altitude, was estimated each year and disaggregated by region and child age. Prevalence ratios were estimated using log-binomial regression models with robust SE or robust Poisson regression when models failed to converge. Interaction terms between each risk factor and year were created to test for consistencies in associations over time. RESULTS The national prevalence of child anemia decreased from 63.3% (95% CI: 59.0%, 67.5%) in 2013 to 51.9% (95% CI: 46.5%, 57.2%) in 2014 and increased to 59.3% (95% CI: 54.7%, 63.8%) in 2016. Across years, prevalence was highest in the Tarai (58.4-70.2%), followed by the mountains (53.0-61.1%) and hills (37.5-51.4%). Nationally and across time, child age and maternal anemia were significantly associated with child anemia. Child diarrhea and stunting, maternal thinness, and poor water and sanitation conditions also showed consistent trends toward higher anemia prevalence. CONCLUSIONS Anemia affects more than half of Nepalese children aged 6-59 mo. Although prevalence varies year to year, the stability of observed risk factors suggests the need to focus on reducing gastrointestinal infection, promoting adequate household sanitation, and improving maternal and child health.
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Affiliation(s)
- Monica M Pasqualino
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew L Thorne-Lyman
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Swetha Manohar
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela KC
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ramesh Adhikari
- Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Rolf D Klemm
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Helen Keller International, New York, NY, USA
| | - Keith P West
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bliznashka L, Arsenault JE, Becquey E, Ruel MT, Olney DK. Using structural equation modelling to understand the contributors to anaemia among young Burkinabe children. MATERNAL & CHILD NUTRITION 2020; 16:e12881. [PMID: 31351027 PMCID: PMC7038887 DOI: 10.1111/mcn.12881] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
Anaemia is a persistent problem among young Burkinabe children, yet population-specific information on its determinants is scant. We used baseline data from an evaluation of Helen Keller International's Enhanced Homestead Food Production Program (n=1210 children) to quantify household-, mother-, and child-level factors associated with anaemia in Burkinabe children aged 6-12 months. We used structural equation modelling to assess a theoretical model, which tested four categories of factors: (a) household food security and dietary diversity, (b) household sanitation and hygiene (latrine and poultry access and bednet ownership), (c) maternal factors (anaemia, stress, cleanliness, and health, hygiene and feeding knowledge and practices), and (d) child nutrition and health (iron deficiency (ID), retinol binding protein (RBP), malaria, and inflammation). The model also included household socio-economic status, size, and polygamy; maternal age and education; and child age and sex. Results showed that ID, malaria, and inflammation were the primary direct determinants of anaemia, contributing 15%, 10%, and 10%, respectively. Maternal knowledge directly explained improved child feeding practices and household bednet ownership. Household dietary diversity directly explained 18% of child feeding practices. Additionally, RBP, child age and sex, and maternal anaemia directly predicted child haemoglobin. Our findings suggest that program effectiveness could be increased by addressing the multiple, context-specific contributors of child anaemia. For young Burkinabe children, anaemia control programs that include interventions to reduce ID, malaria, and inflammation should be tested. Other potential intervention entry points suggested by our model include improving maternal knowledge of optimal health, hygiene, and nutrition practices and household dietary diversity.
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Affiliation(s)
- Lilia Bliznashka
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
- Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Joanne E. Arsenault
- Program in International and Community NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Elodie Becquey
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
| | - Marie T. Ruel
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
| | - Deanna K. Olney
- Poverty, Health and Nutrition DivisionInternational Food Policy Research Institute (IFPRI)WashingtonDC
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Rahman MS, Mushfiquee M, Masud MS, Howlader T. Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011. PLoS One 2019; 14:e0219170. [PMID: 31269082 PMCID: PMC6609031 DOI: 10.1371/journal.pone.0219170] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 06/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Bangladesh is one of the most anemia prone countries in South Asia. Children of age under five years and women of reproductive age are particularly vulnerable in this region. Although several studies have investigated the risk factors of anemia, only few have explored its association with malnutrition, despite its high prevalence in the same group. The objective of this paper is to investigate the association of malnutrition with anemia by conducting separate analyses for under-five children and women of reproductive age using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. METHODS Two binary outcome variables are considered separately: presence of anemia in children under five years of age (Hb<11.0 g/dl) and presence of anemia in women of childbearing age (Hb<12.0 g/dl). The exposures of interest corresponding to these two outcomes are stunting (low height-for-age) and low BMI (<18.5 kg/m2), respectively. Preliminary analysis involves estimating the association between exposure and outcome while controlling for a single confounder by computing adjusted odds ratios (adjOR) using the Cochran-Mantel-Haenszel approach in stratified analysis. Later, associations between the exposures and outcomes are estimated separately for under-five children and women of reproductive age by fitting multivariable regression models that adjust simultaneously for several confounders. RESULTS The prevalence of anemia is found to be higher among both the stunted children and women with low BMI compared to their healthy counterparts (Children: 56% vs 48%; women: 50% vs 43%). Furthermore, stunted children and women with low BMI have significantly increased odds of developing anemia, as reflected by the adjusted ORs of 1.76 (95% CI:1.10-2.83) and 1.81 (95% CI: 1.11-3.48), respectively. The association of stunting with anemia in children was modified by their age and socio-economic condition, where risk of being anemic decreases with increasing age but with a lower rate for stunted children from richest family. In addition, stunted children of anemic mothers are at greater risk of being anemic compared to non-stunted children of anemic or non-anemic mothers. Again the association between BMI and anemia in women is modified by the level of education, with risk of anemia being lowest among women with low BMI and higher education. CONCLUSION Evidence-based policies targeting the vulnerable groups are required to combat anemia and nutritional deficiencies simultaneously under the same program.
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Affiliation(s)
- M. Shafiqur Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Muntaha Mushfiquee
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Mohammad Shahed Masud
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
| | - Tamanna Howlader
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh
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Mya KS, Kyaw AT, Tun T. Feeding practices and nutritional status of children age 6-23 months in Myanmar: A secondary analysis of the 2015-16 Demographic and Health Survey. PLoS One 2019; 14:e0209044. [PMID: 30601848 PMCID: PMC6314612 DOI: 10.1371/journal.pone.0209044] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/27/2018] [Indexed: 01/05/2023] Open
Abstract
Nutritional deficiencies are a major problem among developing countries including Myanmar. They can occur in all age groups, but the impact is more severe among children age 6–23 months as this period is critical for child development, and irreversible damages can occur due to nutritional deficiencies. Proper infant and young child feeding practices are pivotal to tackle nutritional problems and to prevent irreversible consequences among children. To assess the current feeding practices and associations with nutritional status, we conducted a secondary data analysis using the 2015–16 Myanmar Demographic and Health Survey. Multiple logistic regression analysis was done adjusting for covariates and the results were presented by adjusted odds ratios with 95% confidence intervals. A total of 1,222 children age 6–23 months were included in this analysis. Twenty percent were stunted and 43% were moderately anemic. Only 16% of children received a minimum acceptable diet, 25% received diverse food groups, 58% were fed with minimum meal frequency, 85% currently breastfed, and 59% consumed iron-rich foods. Breastfeeding reduced the odds of being stunted. Male sex, perceived small birth size, mother with short stature, and working mother were significant predictors of stunting. Iron-rich food consumption was inversely associated with moderate anemia. Male sex and maternal anemia were also significant predictors of moderate anemia. The study concluded that stunting and anemia among young children in Myanmar are major public health challenges that need urgent action. While further prospective research is needed to determine the effect of feeding practice on linear growth, interventions such as iron supplementation, and nutritional education programs according to the World Health Organization complementary feeding guidelines could help prevent stunting and childhood anemia and might reduce their prevalence in Myanmar.
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Affiliation(s)
- Kyaw Swa Mya
- Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
- * E-mail: ,
| | - Aung Tin Kyaw
- Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
| | - Thandar Tun
- Department of Biostatistics and Medical Demography, University of Public Health, Yangon, Myanmar
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7
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Campbell RK, Aguayo VM, Kang Y, Dzed L, Joshi V, Waid JL, Gupta SD, Haselow N, West, KP. Epidemiology of anaemia in children, adolescent girls, and women in Bhutan. MATERNAL & CHILD NUTRITION 2018; 14 Suppl 4:e12740. [PMID: 30499252 PMCID: PMC6948218 DOI: 10.1111/mcn.12740] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/24/2018] [Accepted: 10/19/2018] [Indexed: 12/24/2022]
Abstract
Anaemia inhibits health and development in Bhutan. We estimated anaemia prevalence and explored risk factors in children and women using data from Bhutan's National Nutrition Survey 2015. Prevalence was calculated using life-stage-specific cut-offs adjusted for altitude and survey design. Risk factors were evaluated in modified Poisson regressions. Anaemia affected 42%, 29%, 36%, and 28% of children, adolescent girls, and non-pregnant and pregnant women, respectively. Risk of anaemia was greater in children who were younger (RR 2.0, 95% CI [1.7, 2.3] and RR 1.9, 95% CI [1.6, 2.3], respectively, for 12-23 and 6-11 vs. 24-59 months), male (1.2, 1.1-1.4, ref.: female), and stunted (1.2, 1.0-1.3, ref.: height-for-age ≥ -2z). Older (15-19 years) versus younger (10-14 years) adolescents were at higher risk (1.5, 1.2-1.8), as were adolescents living at home versus at school (1.2, 0.9-1.6) and those working versus studying (1.3, 1.0-1.7). Among adult women, anaemia risk increased with age (1.2, 1.0-1.4 and 1.3, 1.1-1.5, for 30-39 and 40-49, respectively, vs. 20-29 years) and was higher for women without schooling (1.1, 1.0-1.3, vs. primary schooling), who were unmarried or separated (1.4, 1.2-1.7 and 1.3, 1.1-1.6, respectively, vs. married), without a child <5 years (1.1, 1.0-1.3), and lacking improved sanitation (1.1, 1.0-1.3). High coverage of antennal iron and folic acid supplementation may contribute to the lower prevalence of anaemia among pregnant women and women with young children. Expansion of iron supplementation programmes, fortification, and other strategies to improve dietary iron intake may reduce the prevalence of anaemia, but causes of anaemia other than iron deficiency (e.g., thalassemias) should also be investigated.
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Affiliation(s)
- Rebecca K. Campbell
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | | | - Yunhee Kang
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
| | - Laigden Dzed
- Ministry of HealthGovernment of BhutanThimphuBhutan
| | | | | | | | - Nancy Haselow
- Regional Office for AsiaHelen Keller InternationalPhnom PehnCambodia
| | - Keith P. West,
- Center for Human Nutrition, Department of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
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Zhang Y, Jin L, Liu JM, Ye R, Ren A. Maternal haemoglobin concentrations before and during pregnancy as determinants of the concentrations of children at 3-5 years of age: A large follow-up study. Eur J Clin Nutr 2018; 73:1102-1109. [PMID: 30120385 DOI: 10.1038/s41430-018-0284-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/01/2018] [Accepted: 07/26/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the association between haemoglobin (Hb) concentrations in mothers before and during pregnancy and those in children at 3-5 years of age. METHODS The study included 78,923 women who conceived during 1993-1996 and delivered a singleton live infant. Maternal Hb concentrations were measured at pre-pregnancy health check-up and first prenatal visit, and during the second and third trimester. Hb concentrations of children born to these women were measured at 3-5 years of age. Associations between Hb levels in mothers and children were examined. Unconditional logistic regression was used to explore the association between maternal Hb levels and risk for anaemia in children. RESULTS Maternal Hb levels before and during pregnancy were positively associated with children's Hb levels. Using maternal Hb ≥ 130 g/L as the referent, the risk for anaemia in children at 3-5 years of age was higher when maternal second trimester Hb concentrations were 70-99 g/L (odds ratio [OR] = 1.76, 95% confidence interval [CI] = 1.56-1.99), 100-109 g/L (OR = 1.45, 95% CI = 1.29-1.64), and 110-119 g/L (OR = 1.18, 95% CI = 1.04-1.33). Children were 1.52 and 1.23-times more likely to suffer from anaemia when maternal third trimester Hb concentrations were 70-99 and 100-109 g/L, respectively. A pre-pregnancy Hb concentration of 80-109 g/L and first prenatal visit Hb concentrations of 80-109 and 100-119 g/L were also associated with increased risks for childhood anaemia. CONCLUSION Low maternal Hb concentrations before or during pregnancy increase the risk for anaemia in children at 3-5 years of age.
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Affiliation(s)
- Yiting Zhang
- Health Care Department, Haidian Maternal and Child Health Hospital, Beijing, 100080, China.,Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China
| | - Lei Jin
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Jian-Meng Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Rongwei Ye
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China. .,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
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Matias SL, Mridha MK, Young RT, Khan MSA, Siddiqui Z, Ullah MB, Vosti SA, Dewey KG. Prenatal and Postnatal Supplementation with Lipid-Based Nutrient Supplements Reduces Anemia and Iron Deficiency in 18-Month-Old Bangladeshi Children: A Cluster-Randomized Effectiveness Trial. J Nutr 2018; 148:1167-1176. [PMID: 29901736 DOI: 10.1093/jn/nxy078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/26/2018] [Indexed: 11/13/2022] Open
Abstract
Background Anemia, iron deficiency (ID), and iron deficiency anemia (IDA) among young children are public health concerns in developing countries. Objective We evaluated the effects of small-quantity lipid-based nutrient supplements (LNSs) and micronutrient powder (MNP) on anemia, ID, and IDA in 18-mo-old Bangladeshi children. Methods We enrolled 4011 pregnant women in a cluster-randomized effectiveness trial with 4 arms-1) LNS-LNS: LNSs (including 20 mg Fe) for women daily during pregnancy and 6 mo postpartum and LNSs (including 9 mg Fe) for children daily from 6 to 24 mo of age (LNS-C); 2) IFA-LNS: iron (60 mg) and folic acid (IFA) for women daily during pregnancy and every other day for 3 mo postpartum and LNS-C for children; 3) IFA-MNP: IFA for women, and MNP (including 10 mg Fe) for children daily from 6 to 24 mo; and 4) IFA-Control: IFA for women and no child supplement. Hemoglobin, serum ferritin, and soluble transferrin receptor (sTfR) were assessed in a subsample of children (n = 1121) at 18 mo to identify anemia (hemoglobin <110g/L), ID (ferritin <12 µg/L or sTfR >8.3 mg/L), and IDA. Data were analyzed with the use of mixed-effects modeling. Results Compared with the IFA-Control arm, hemoglobin was higher in the LNS-LNS and IFA-LNS arms and ferritin was higher and sTfR was lower in the LNS-LNS, IFA-LNS, and IFA-MNP arms; LNS-LNS children had reduced odds of anemia (OR: 0.46; 95% CI: 0.25, 0.84), high sTfR (OR: 0.47; 95% CI: 0.29, 0.73), and ID (OR: 0.45; 95% CI: 0.28, 0.71); and all 3 groups had lower odds of low ferritin [corrected for inflammation; OR (95% CI)-LNS-LNS: 0.29 (0.13, 0.63); IFA-LNS: 0.25 (0.11, 0.59); and IFA-MNP: 0.37 (0.18, 0.76)] and IDA [LNS-LNS: 0.35 (0.18, 0.67); IFA-LNS: 0.45 (0.24,0.85); and IFA-MNP: 0.47 (0.26, 0.87)]. Conclusions Home fortification using LNSs or MNP reduced IDA in 18-mo-old Bangladeshi children. The provision of LNSs in both pregnancy and childhood also reduced child anemia and ID. These findings are relevant to programs targeting similar populations. This trial was registered at www.clinicaltrials.gov as NCT01715038.
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Affiliation(s)
| | - Malay K Mridha
- Department of Nutrition, BRAC University, Dhaka, Bangladesh
| | | | - Md Showkat A Khan
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Zakia Siddiqui
- Initiative for Climate Change and Health, Health System and Population Studies Division, International Center for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Stephen A Vosti
- Agricultural and Resource Economics, University of California, Davis, Davis, CA
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Uyoga MA, Karanja S, Paganini D, Cercamondi CI, Zimmermann SA, Ngugi B, Holding P, Moretti D, Zimmermann MB. Duration of exclusive breastfeeding is a positive predictor of iron status in 6- to 10-month-old infants in rural Kenya. MATERNAL & CHILD NUTRITION 2017; 13:e12386. [PMID: 27896919 PMCID: PMC6866116 DOI: 10.1111/mcn.12386] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/26/2016] [Accepted: 08/23/2016] [Indexed: 12/24/2022]
Abstract
The prevalence of iron-deficiency anemia (IDA) is high in infants in Sub-Saharan Africa. Exclusive breastfeeding of infants to 6 months of age is recommended by the World Health Organization, but breast milk is low in iron. Some studies suggest exclusive breastfeeding, although beneficial for the infant, may increase risk for IDA in resource-limited settings. The objective of this study was to determine if duration of exclusive breastfeeding is associated with anemia and iron deficiency in rural Kenyan infants. This was a cross-sectional study of 6-10-month-old infants (n = 134) in southern coastal Kenya. Anthropometrics, hemoglobin (Hb), plasma ferritin (PF), soluble transferrin receptor (sTfR), and C-reactive protein were measured. Body iron stores were calculated from the sTfR/PF ratio. Socioeconomic factors, duration of exclusive breastfeeding, nature of complementary diet, and demographic characteristics were determined using a questionnaire. Mean ± SD age of the infants was 7.7 ± 0.8 months. Prevalence of anemia, ID, and IDA were 74.6%, 82.1%, and 64.9%, respectively. Months of exclusive breastfeeding correlated positively with Hb (r = 0.187; p < .05) and negatively with sTfR (r = -0.246; p < .05). sTfR concentrations were lower in infants exclusively breastfed at least 6 months compared with those exclusively breastfed for less than 6 months (7.6 (6.3, 9) vs. 8.9 (6.7, 13.4); p < .05). Controlling for gender, birth weight, and inflammation, months spent exclusively breastfeeding was a significant negative predictor of sTfR and a positive predictor of Hb (p < .05). The IDA prevalence in rural Kenyan infants is high, and greater duration of exclusive breastfeeding predicts better iron status and higher Hb in this age group.
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Affiliation(s)
- Mary A. Uyoga
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
- International Centre for Behavioural StudiesMombasaKenya
| | - Simon Karanja
- School of Public HealthJomo Kenyatta University of Agriculture and TechnologyNairobiKenya
| | - Daniela Paganini
- Human Nutrition LaboratorySwiss Federal Institute of TechnologyZürichSwitzerland
| | - Colin I. Cercamondi
- Human Nutrition LaboratorySwiss Federal Institute of TechnologyZürichSwitzerland
| | | | - Benjamin Ngugi
- Centre for Microbiology ResearchKenya Medical Research Institute (KEMRI)NairobiKenya
| | - Penny Holding
- International Centre for Behavioural StudiesMombasaKenya
| | - Diego Moretti
- Human Nutrition LaboratorySwiss Federal Institute of TechnologyZürichSwitzerland
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11
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Manikam L, Robinson A, Kuah JY, Vaidya HJ, Alexander EC, Miller GW, Singh KK, Dawe V, Ahmed S, Lingam R, Lakhanpaul M. A systematic review of complementary feeding practices in South Asian infants and young children: the Bangladesh perspective. BMC Nutr 2017; 3:56. [PMID: 32153836 PMCID: PMC7050712 DOI: 10.1186/s40795-017-0176-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/28/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sub-optimal nutrition among children remains a problem across South Asia (SA). Appropriate complementary feeding practices (CFP) can greatly reduce this risk. The primary objective of this systematic review (SR) of CF studies was to assess timing, dietary diversity, meal frequency and influencing factors in children under two in Bangladesh. METHODS Searches included English-language research published between January 2000 and June 2016 within MEDLINE, EMBASE, Global Health, Web of Science, OVID Maternity & Infant Care, BanglaJOL, Cochrane Library, CINAHL, POPLINE and WHO Global Health Library. Eligibility criteria: primary research concerning the adequacy of complementary feeding practices in South Asian children aged 0-2 years and/or their families. We excluded interventional papers and those focusing exclusively on breast-feeding. In total 45,712 titles and abstracts were screened against inclusion criteria, 860 of which received independent full text review by two reviewers. 36 papers relevant to Bangladesh were identified. The 'EPPI-Centre Weight of Evidence Framework' was used to objectively assess each study's value in answering the review question. As per WHO Infant and Young Children Feeding Guidelines (IYCF), introduction of CF was assessed as the proportion of infants aged 6-8 months who received solid, semi-solid or soft foods. Search terms were: "children", "feeding" and "Asians" with their derivatives. Two researchers undertook study selection, data extraction and quality appraisal. RESULTS Three cohort, 30 cross-sectional and 3 mixed methods studies were included. Despite adopting the WHO IYCF Guidelines, sub-optimal CF practices were found in many studies. Timely initiation of CF practices ranged from 24 to 83%. Achieved minimum dietary diversity ranged from 25% to 44% and minimum meal frequency from 33% to 81%. Influencing factors included maternal education, poor knowledge of CF practices and socioeconomic variables. CONCLUSIONS This is the first systematic review to evaluate CF practices in Bangladesh. Despite adoption of the WHO IYCF guidelines, inadequate CFP remain in communities across Bangladesh. TRIAL REGISTRATION PROSPERO Registration No: CRD42014014025.
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Affiliation(s)
- Logan Manikam
- Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | | | - Jia Ying Kuah
- King’s College London GKT School of Medical Education, Guy’s Campus, London, SE1 1UL UK
| | - Hrisheekesh J. Vaidya
- Imperial College School of Medicine, Faculty Building South Kensington Campus, London, SW7 2AZ UK
| | - Emma C. Alexander
- King’s College London GKT School of Medical Education, Guy’s Campus, London, SE1 1UL UK
| | - George W. Miller
- Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT UK
| | - Kunjshri K. Singh
- King’s College London GKT School of Medical Education, Guy’s Campus, London, SE1 1UL UK
| | - Victoria Dawe
- King’s College London GKT School of Medical Education, Guy’s Campus, London, SE1 1UL UK
| | - Sonia Ahmed
- Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Raghu Lingam
- Institute of Health & Society, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Monica Lakhanpaul
- Population, Policy & Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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12
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Hong J, Chang JY, Shin S, Oh S. Breastfeeding and Red Meat Intake Are Associated with Iron Status in Healthy Korean Weaning-age Infants. J Korean Med Sci 2017; 32:974-984. [PMID: 28480656 PMCID: PMC5426231 DOI: 10.3346/jkms.2017.32.6.974] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/19/2017] [Indexed: 11/20/2022] Open
Abstract
The present study investigated risk factors for iron deficiency (ID) and iron deficiency anemia (IDA) during late infancy, including feeding type and complementary feeding (CF) practice. Healthy term Korean infants (8-15 months) were weighed, and questionnaires regarding delivery, feeding, and weaning were completed by their caregivers. We also examined levels of hemoglobin, serum iron/total iron-binding capacity, serum ferritin, and mean corpuscular volume (MCV). Among 619 infants, ID and IDA were present in 174 infants (28.1%) and 87 infants (14.0%), respectively. The 288 infants with exclusively/mostly breastfeeding until late infancy (BFL) were most likely to exhibit ID (53.1%) and IDA (28.1%). The risk of ID was independently associated with BFL (adjusted odds ratio [aOR], 47.5; 95% confidence interval [CI], 18.3-122.9), male sex (aOR, 1.9; 95% CI, 1.2-2.9), fold weight gain (aOR, 2.6; 95% CI, 1.5-4.6), and perceived inadequacy of red meat intake (aOR, 1.7; 95% CI, 1.0-2.7). In addition to the risk factors for ID, Cesarean section delivery (aOR, 1.9; 95% CI, 1.1-3.2) and low parental CF-related knowledge (aOR, 2.8; 95% CI, 1.5-5.2) were risk factors for IDA. In conclusion, prolonged breastfeeding and perceived inadequacy of red meat intake may be among the important feeding-related risk factors of ID and IDA. Therefore, more meticulous education and monitoring of iron-rich food intake, such as red meat, with iron supplementation or iron status testing during late infancy if necessary, should be considered for breastfed Korean infants, especially for those with additional risk factors for ID or IDA.
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Affiliation(s)
- Jeana Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ju Young Chang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Sue Shin
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Laboratory Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sohee Oh
- Department of Medical Statistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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13
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Clark KM, Li M, Zhu B, Liang F, Shao J, Zhang Y, Ji C, Zhao Z, Kaciroti N, Lozoff B. Breastfeeding, Mixed, or Formula Feeding at 9 Months of Age and the Prevalence of Iron Deficiency and Iron Deficiency Anemia in Two Cohorts of Infants in China. J Pediatr 2017; 181:56-61. [PMID: 27836288 PMCID: PMC5274569 DOI: 10.1016/j.jpeds.2016.10.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/25/2016] [Accepted: 10/12/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess associations between breastfeeding and iron status at 9 months of age in 2 samples of Chinese infants. STUDY DESIGN Associations between feeding at 9 months of age (breastfed as sole milk source, mixed fed, or formula fed) and iron deficiency anemia (IDA), iron deficiency, and iron sufficiency were determined in infants from Zhejiang (n = 142) and Hebei (n= 813) provinces. Iron deficiency was defined as body iron < 0 mg/kg, and IDA as iron deficiency + hemoglobin < 110 g/L. Multiple logistic regression assessed associations between feeding pattern and iron status. RESULTS Breastfeeding was associated with iron status (P < .001). In Zhejiang, 27.5% of breastfed infants had IDA compared with 0% of formula-fed infants. The odds of iron deficiency/IDA were increased in breastfed and mixed-fed infants compared with formula-fed infants: breastfed vs formula-fed OR, 28.8 (95% CI, 3.7-226.4) and mixed-fed vs formula-fed OR, 11.0 (95% CI, 1.2-103.2). In Hebei, 44.0% of breastfed infants had IDA compared with 2.8% of formula-fed infants. With covariable adjustment, odds of IDA were increased in breastfed and mixed-fed groups: breastfed vs formula-fed OR, 78.8 (95% CI, 27.2-228.1) and mixed-fed vs formula-fed OR, 21.0 (95% CI, 7.3-60.9). CONCLUSIONS In both cohorts, the odds of iron deficiency/IDA at 9 months of age were increased in breastfed and mixed-fed infants, and iron deficiency/IDA was common. Although the benefits of breastfeeding are indisputable, these findings add to the evidence that breastfeeding in later infancy identifies infants at risk for iron deficiency/IDA in many settings. Protocols for detecting and preventing iron deficiency/IDA in breastfed infants are needed. TRIAL REGISTRATION ClinicalTrials.gov: NCT00642863 and NCT00613717.
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Affiliation(s)
- Katy M. Clark
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Bingquan Zhu
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Furong Liang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Shao
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Yueyang Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chai Ji
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Zhengyan Zhao
- Department of Child Health Care, Zhejiang University Children’s Hospital, Hangzhou, China
| | - Niko Kaciroti
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA
| | - Betsy Lozoff
- Center for Human Growth and Development, University of Michigan, Ann Arbor, USA,Department of Pediatrics and Communicable Diseases, CS Mott Children’s Hospital, University of Michigan, USA
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14
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Kuziga F, Adoke Y, Wanyenze RK. Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: a cross- sectional study. BMC Pediatr 2017; 17:25. [PMID: 28100200 PMCID: PMC5242053 DOI: 10.1186/s12887-017-0782-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 01/03/2017] [Indexed: 12/31/2022] Open
Abstract
Background Anaemia is one of the major causes of death among children under five years in Africa, with a prevalence of 64.6% among pre-school children. In 2014, we conducted a cross-sectional study in Namutumba district in East-central Uganda to determine the prevalence and factors associated with anaemia among children aged 6 to 59 months. Methods We conducted a household survey in 376 randomly selected households. One child aged 6 to 59 months was randomly sampled from each selected household. A structured questionnaire administered to an adult caregiver was used to collect household data. Blood was collected by finger or heel prick to estimate the haemoglobin level using a portable haemocue analyser. Anthropometric data including age, weight and height was collected for each child. A modified poisson regression model was used to determine the correlates of anaemia, prevalence ratios and their 95% confidence intervals (CI). Results The prevalence of anaemia was high (58.8%) and was highest among children aged 12 to 23 months (68.5%) and males (61.3%). About 27.7% children were stunted. Children aged 6–11 and 12–23 months were more likely to be anaemic (APR = 1.12; 95% CI: 1.05–1.19 and APR = 1.12; 95% CI: 1.00–1.24 respectively), Resident of Magada and Namutumba (urban areas) were less likely to be anaemic (APR = 0.89; 95% CI: 0.87–0.91and APR = 0.86; 95% CI: 0. 85–0.88 respectively). Children of caretakers of a big family size (seven or more children) and with any formal education were less likely to be anaemic (APR = 0.94; 95% CI: 0.89–0.99 and APR = 0.93; 95% CI: 0.87–0.99). Stunting (HAZ scores) was a predictor of anaemia (APR = 1.07; 95% CI: 1.02–1.12). Conclusion Anaemia is highly prevalent among children and there is need to invest in measures to prevent anaemia, especially among children in the rural areas.
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Affiliation(s)
- Fiona Kuziga
- Makerere University School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Yeka Adoke
- Makerere University School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Rhoda K Wanyenze
- Makerere University School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda
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15
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Sarma H, Uddin MF, Harbour C, Ahmed T. Factors Influencing Child Feeding Practices Related to Home Fortification With Micronutrient Powder Among Caregivers of Under-5 Children in Bangladesh. Food Nutr Bull 2016; 37:340-352. [PMID: 27130573 DOI: 10.1177/0379572116645916] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anemia is a major public health concern in Bangladesh, affecting about 51% of under-5 children. There are a number of strategies to overcome this micronutrient-deficiency burden, and home fortification (HF) with micronutrient powder (MNP) is one of them. OBJECTIVE As part of an evaluation of an HF with MNP intervention program, we conducted a qualitative study to understand the factors influencing demand, purchase, and utilization of MNP by caregivers of under-5 children. METHODS We purposively selected study participants from 5 subdistricts and 1 urban slum in Bangladesh where HF with Pushtikona (a brand name of MNP) program is available. Data were collected through household observations and conducting in-depth interviews and focus group discussions with caregivers, grandmothers, and fathers of under-5 children. RESULTS Our study showed that caregivers were initially cautious, using Pushtikona on a trial basis, and afterward they employed various strategies to get their children to eat food fortified with Pushtikona. Barriers to acceptance and use of Pushtikona included inappropriate initiation of complementary feeding, discouragement from influential family members as well as miscommunication, conflicting information, and irregular visits by the health workers who sell Pushtikona to caregivers. Based on these findings, we characterized the users of Pushtikona as regular, ever, irregular, and never. CONCLUSION The evidence suggests that focusing on counseling caregivers and other family members on the importance of MNP and on age-appropriate feeding practices will be critical to the success of this intervention program as will regular visits by health workers and improved service delivery.
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Affiliation(s)
- Haribondhu Sarma
- 1 Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | - Md Fakhar Uddin
- 1 Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- 1 Nutrition and Clinical Services Division, icddr, b, Dhaka, Bangladesh
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Kamruzzaman M, Rabbani MG, Saw A, Sayem MA, Hossain MG. Differentials in the prevalence of anemia among non-pregnant, ever-married women in Bangladesh: multilevel logistic regression analysis of data from the 2011 Bangladesh Demographic and Health Survey. BMC WOMENS HEALTH 2015. [PMID: 26219633 PMCID: PMC4517492 DOI: 10.1186/s12905-015-0211-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Anemia is one of the most common public health problems globally, and high prevalence has been reported among women of reproductive age, especially in developing countries. This study was conducted to evaluate differentials in the prevalence of anemia among non-pregnant, ever-married women of reproductive age in Bangladesh, and to examine associations with demographic, socioeconomic, and nutritional factors. Methods Data for this cross-sectional study were taken from the 2011 Bangladesh Demographic and Health Survey (BDHS). In a sub-sample of one-third of the households, all ever-married women of reproductive age (15 to 49 years) were selected for the biomarker component of the survey, including anemia. The sample size for our study was 5,293. Data were analyzed using multilevel logistic regression analysis. Results The prevalence of anemia among non-pregnant, ever-married women was 41.3 % (urban: 37.2 % and rural: 43.5 %). Among anemic women, 35.5 % had mild anemia, 5.6 % had moderate anemia, and 0.2 % had severe anemia. Women with no education were more likely to be anemic than those with secondary education (p < 0.01) or higher education (p < 0.01). Undernourished women (BMI < 18.5) were at greater risk of anemia (p < 0.01) compared with normal women, overweight women, and obese women. Anemia was less pronounced among non-pregnant women using contraception (p < 0.05), Muslim women (p < 0.01), and women living in rich households (p < 0.01). Conclusions The prevalence of anemia among non-pregnant, ever-married women in Bangladesh is high. Illiteracy, poverty, and undernutrition are contributing factors.
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Affiliation(s)
- Md Kamruzzaman
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
| | - Md Golam Rabbani
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
| | - Aik Saw
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), University of Malaya, Kuala Lumpur, Malaysia.
| | - Md Abu Sayem
- Divisional TB Expert-Rangpur, National Tuberculosis Control Program, Directorate General of Health Services, Dhaka, Bangladesh.
| | - Md Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
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