Factors associated with Hb concentration in children aged 6-59 months in the State of Pernambuco, Brazil

Individual, household and national factors associated with iron, vitamin A and zinc deficiencies among children aged 6-59 months in Nepal

Iron, vitamin A and zinc deficiencies are the top three micronutrients contributing to disability-adjusted life years globally. The study assessed the factors associated with iron, vitamin A, and Zinc deficiencies among Nepalese children (n = 1709) aged 6-59 months using data from the 2016 Nepal National Micronutrient Status Survey. The following cut-off points were applied: iron deficiency [ferritin < 12 μg/L or soluble transferrin receptor (sTfR) > 8.3 mg/L], vitamin A deficiency (retinol-binding protein < 0.69 μmol/L) and zinc deficiency (serum zinc < 65 μg/dl for morning sample and <57 μg/dl for afternoon sample). We used multiple logistic regression adjusted for sampling weights and clustering to examine the predictors of micronutrient deficiencies. The prevalence of iron depletion (ferritin), tissue iron (sTfR), vitamin A and zinc deficiencies were 36.7%, 27.6%, 8.5% and 20.4%, respectively. Children were more likely to be iron deficient (ferritin) if aged 6-23 months, stunted, and in a middle-wealth quintile household. Vitamin A deficiency was associated with development region and was higher among children living in severe food-insecure households and those who did not consume fruits. Zinc deficiency was higher among children in rural areas and the poorest wealth quintile. The Government of Nepal should focus on addressing micronutrient deficiencies in the early years, with emphasis on improving food systems, promote healthy diets, among younger and stunted children and provide social cash transfer targeting high-risk development regions, poorest and food insecure households.

Assessment of Anemia Status on Physical Development Skills of Children Under Two Years Old in Aceh, Indonesia

Anemia and iron deficiency can cause detrimental effects on brain development, and continued iron deficiency anemia is known to interfere with development which results in a permanent delay in mental and Motor development. This study investigated the impact of anemia on physical development skills of under two years children in aceh besar district. A cross-sectional study design was applied to 102 under-two years children selected using cluster random sampling technique using village as cluster. A structured questionnaire to determine general characteristics such as maternal age, maternal education, maternal occupational, family income, number of family members and toddlers. Anemia status was assessed by Hemocue 201+ tool, and physical motor development such as gross and fine motor development skills were determined using Denver II instrument. Almost two- thirds of children were anemia, as assessed by blood hemoglobin levels of <11 g/dL, while 34.3% of them were experienced delay in either fine development or gross development skills. The prevalence of children with fine and gross motor development delay was higher in children with suffering from anemia (27.1% and 17.1%) than non-anemia, respectively (3.2% and 9.4%). There was significant association anemia status on fine motor development (r=0.291; p=0.003), while not significant to gross motor development (r=0.092; p=0.357). The prevalence of anemia in children 12-24 mo old was very high, and has an impact on motor development delays, so anemia prevention programs and motor stimulation intervention for under two years children are needed.

Micronutrient Deficiencies and Stunting Were Associated with Socioeconomic Status in Indonesian Children Aged 6-59 Months

Micronutrient deficiencies and stunting are known as a significant problem in most developing countries, including Indonesia. The objective of this study was to analyze the association between micronutrient deficiencies and stunting with socioeconomic status (SES) among Indonesian children aged 6–59 months. This cross-sectional study was part of the South East Asian Nutrition Surveys (SEANUTS). A total of 1008 Indonesian children were included in the study. Anemia, iron deficiency, vitamin A deficiency, vitamin D deficiency, and stunting were identified in this study. Structured questionnaires were used to measure SES. Differences between micronutrient parameters and anthropometric indicators with the SES groups were tested using one-way ANOVA with post-hoc test after adjusted for age, area resident (rural and urban), and sex. The highest prevalence of anemia, stunting, and severe stunting were found to be most significant in the lowest SES group at 45.6%, 29.3%, and 54.5%, respectively. Children from the lowest SES group had significantly lower means of Hb, ferritin, retinol, and HAZ. Severely stunted children had a significantly lower mean of Hb concentration compared to stunted and normal height children. Micronutrient deficiencies, except vitamin D, and stunting, were associated with low SES among Indonesian children aged 6–59 months.

Prevalence and predictors of birth preparedness and complication readiness in the Kassena-Nankana district of Ghana: an analytical cross-sectional study

OBJECTIVES

To assess birth preparedness and complication readiness (BPACR) and associated factors among mothers who had given birth in the past 12 months prior to the study.

DESIGN

An analytical cross-sectional study.

SETTING

The study was carried out in the rural areas of Kassena-Nankana district located in the Upper East Region of Ghana.

PARTICIPANTS

The study population comprised 600 postpartum women who had delivered within the last 12 months prior to the study.

PRIMARY OUTCOME MEASURE

The primary outcome measure was BPACR.

RESULTS

The prevalence of BPACR among recently delivered women was very low as less than 15% were able to mention at least three of the five basic components of birth preparedness/complication readiness that were fulfilled. After adjustment for confounding effect using multivariable logistic regression analysis, high educational level (adjusted OR (AOR)=3.40 (95% CI: 1.88 to 6.15)), better knowledge about obstetric danger signs during pregnancy (AOR=4.88 (95% CI: 2.68 to 8.90)), older women (≥35 years) (AOR=2.59 (95% CI: 1.11 to 6.02)), women of low household wealth index (AOR=4.64 (95% CI: 1.97 to 10.91)) and women who received lower content of antenatal care services (AOR=3.34 (95% CI: 1.69 to 6.60)) were significant predictors of BPACR.

CONCLUSION

This study concludes that BPACR practices were low. High educational attainment of the woman, having adequate knowledge about obstetric danger signs during pregnancy, older women (≥35 years) and women of low household wealth index were significant predictors of BPACR. The predictors identified should be given high priority by health authorities in addressing low prevalence of BPACR.

Camel milk consumption was associated with lower prevalence of anemia among preschool children in rural pastoral districts of Somali, eastern Ethiopia

OBJECTIVE

The aim of this study was to investigate association between consumption of camel milk (CaM) and childhood anemia.

METHODS

A community-based cross-sectional study was conducted with 388 preschool children (24-59 mo of age) in rural pastoral districts of Somali, eastern Ethiopia. We sampled 185 consumers of CaM and 203 who consumed bovine milk (BM). Children were selected from random households with lactating camels or cattle. Hemoglobin (Hb) was measured in the field using a HemoCue instrument. A multivariable logistic regressions model was used in SPSS version 20 to examine association between type of milk consumption and anemia.

RESULTS

Anemia (Hb <11 g/dL) was found in 59.8% of the overall sample, whereas it was 42.7% and 75.4% among CaM and BM consumers, respectively. The odds of anemia among BM consumers (adjusted odds ratio [aOR], 3.12; 95% confidence interval [CI], 1.27-7.66) and children with intestinal parasites (aOR: 3.32; 95% CI, 1.39-7.91) was compared with CaM consumers and children without intestinal parasites, respectively. Increasing age and height-for-age z-score of children were associated with decreased childhood anemia (P < 0.001). Children with anemia consumed a higher volume of BM compared with non-anemic and CaM consumers, too but the consumption was not statistically significant.

CONCLUSION

CaM consumption was associated with lower prevalence of anemia compared with consumption of BM. Promoting use of CaM as complementary food for preschool children in pastoralist areas might be considered an intervention toward reducing anemia.

Determinants of Anemia Among Children Aged 6 to 59 Months in Dilla Town, Southern Ethiopia: A Facility Based Case Control Study

Background. Globally, anemia is a widespread public health problem associated with increased risk of morbidity and mortality. Under 5 children have greater risk of anemia. The level of burden and the risk factors for anemia vary in different settings. Identifying local factors will have important implications for health intervention programs aimed to tackle the burden. Our study aims to investigate the determinants of anemia among under 5 children in the study area. Methods. Facility based unmatched case control study was conducted among 413 (137 cases and 276 controls) children of Dilla town. Cases were children who had hemoglobin level of less than 11 g/dl and controls were children aged 6 to 59 months with hemoglobin ≥11 g/dl. Quota and simple random sampling was used for cases and controls respectively. Data on socio-demographic, dietary diversity score, food security, anthropometry, hemoglobin level, malaria infection and intestinal parasites were collected. Data were analyzed with SPSS version 25. Bi-variate and multivariate binary logistic regression analysis was used to identify independent determinants of anemia. P-value less than .05 were used to declare statistical significance. Result. In the multivariate analysis, having more than 1 under 5 children in the households (AOR = 3.03, 95%CI = 1.35-6.81), intestinal parasitosis (AOR = 4.42, 95%CI = 2.07-9.44), food insecurity (AOR = 2.75, 95% CI = 1.39-5.45), and stunting (AOR = 6.09, 95% CI = 2.53-14.67) were determinants of anemia among children aged 6 to 59 months. Conclusion. Some of the identified factors are modifiable that could be targeted to reduce childhood anemia. Family planning education, provision of anti-helminthic drugs and ensuring household food security will be beneficial to tackle anemia.

How Effective Is Iron Supplementation During Pregnancy and Childhood in Reducing Anemia Among 6-59 Months Old Children in India?

Objectives: The study sought to identify whether iron and folic acid supplementation of pregnant women and preschool children is associated with child's anemia status and the predictors of anemia among children in India.

Design: Secondary data analysis was performed using the National Family Health Survey 4 data. Multivariable logistic regression was used to identify the adjusted associations between child's anemia status and iron supplementation, both during pregnancy and childhood. Also, a model of significant predictors of anemia among children was fitted.

Setting: India.

Participants: Youngest children (6-59 months) in families.

Results: The adjusted association between supplementation during pregnancy and child's anemia status was significant (p = 0.010), whereas the adjusted association between supplementation during childhood and child's anemia status was insignificant (p = 0.16). The variables independently associated with anemia status of the child included younger age (95% CI 2.67–2.86), child's recent diarrhea (95% CI 1.02–1.14), low birth weight (95% CI 1.17–1.27), current underweight (95% CI 1.14–1.28), diet diversity score (95% CI 0.96–0.98), higher birth order (95% CI 1.01–1.05), mother's current anemia (95% CI 1.68–1.81), months of breastfeeding (95% CI 0.99–1.00), no/primary education (95% CI 1.23–1.35), family's low wealth index (95% CI 1.11–1.23), and backward caste (95% CI 1.04–1.14).

Conclusions: The National Iron Plus Initiative strategy of child's iron supplementation should be evaluated to identify the reasons of its ineffectiveness in anemia reduction. In addition, vulnerable groups of children, i.e., children from poor and less educated families and those with low birth weight, higher birth order, and poor nutritional status, should be targeted first with anemia reduction interventions.

Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data

Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance.

Dynamic Anemia Status from Infancy to Preschool-Age: Evidence from Rural China

Anemia is a serious nutritional deficiency among infants and toddlers in rural China. However, it is unclear how the anemia status changes among China's rural children as they age. This study investigates the prevalence of anemia as children grow from infancy to preschool-age, as well as the dynamic anemia status of children over time. We conducted longitudinal surveys of 1170 children in the Qinba Mountain Area of China in 2013, 2015 and 2017. The results show that 51% of children were anemic in infancy (6-12 months), 24% in toddlerhood (22-30 months) and 19% at preschool-age (49-65 months). An even larger share of children (67%) suffered from anemia at some point over the course of study. The data also show that although only 4% of children were persistently anemic from infancy to preschool-age, 8% of children saw their anemia status deteriorate. We further found that children may be at greater risk for developing anemia, or for having persistent anemia, during the period between toddlerhood and preschool-age. Combined with the finding that children with improving anemia status showed higher cognition than persistently anemic children, there is an urgent need for effective nutritional interventions to combat anemia as children grow, especially between toddlerhood and preschool age.

Perception of childhood anaemia among mothers in Kumasi: a quantitative approach

BACKGROUND

Anaemia is the world's second cause of disability and it affects over half of pre-school children in developing countries and at least 30-40% in industrial countries. In poorer malaria-endemic countries, anemia is one of the commonest preventable causes of death in children under 5 years. This study sought to determine the perceived causes, signs and symptoms as well prevention of childhood anaemia among mothers of children under 5 years in Kumasi, Ghana.

METHODS

A descriptive hospital-based cross-sectional study design with a sample of 228 patients attending the University Hospital, KNUST was used. A simple random sampling technique was applied in sampling and a structured questionnaire was used to collect data which was analyzed using SPSS statistical tools.

RESULTS

The study found that anemia was mostly perceived to be caused by poor feeding practices (43%) and fever (37%). The signs and symptoms mentioned mostly were pale conjunctiva (47%) and pale palm (44%). It was suggested that it could be prevented by giving adequate nutrition (23%), regular deworming (19%) as well as exclusive breastfeeding (25%). Mothers education and the number of children were found to be associated with the perception regarding anaemia as respondents who had completed SHS/A level were 5.14 times likely to have a higher knowledge score on Anaemia (AOR = 5.14; 95% CI; 1.01-21.8). Also, mothers who had 5 to 6 children were 1.65 times likely to have higher knowledge score on Anaemia (AOR = 1.65; 95% CI; 0.02-2.32).

CONCLUSION

Previous experience with Anaemia and higher educational level results in better understanding of Anaemia. Therefore, extensive health education on anemia should be undertaken by the hospital authorities in collaboration with the Ministry of Health to improve knowledge of Anaemia.

Anemia severity among children aged 6-59 months in Gondar town, Ethiopia: a community-based cross-sectional study

Background

Anemia is a public health problem affecting both developed and developing countries. Childhood anemia is associated with serious consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Hence, this study aimed at assessing the prevalence and factors associated with severity of anemia among children aged 6–59 months in Gondar town, northwest Ethiopia.

Method

A community-based cross-sectional study was conducted. A multi-stage sampling technique was employed to select study participants. Socio demographic and socioeconomic data were collected using a pre-tested structured questionnaire. Anthropometric measurements were taken as per WHO recommendation. Hemoglobin (Hb) concentration was measured using a portable HemoCue301 instrument (A Quest Diagnostic Company, Sweden). Mild anemia corresponds to a level of adjusted Hb of 10.0–10.9 g/dl; moderate anemia corresponds to a level of 7.0–9.9 g/dl, while severe anemia corresponds to a level less than 7.0 g/dl. Descriptive statistics were used to describe the study participants. Both bivariable and multivariable ordinal logistic regression were done, and proportional odds ratio (POR) with a 95% confidence interval (CI) was reported to show the strength of association. A p-value < 0.05 was considered statistically significant.

Result

Out of the total of 707 children included in this study, more than half (53.5%) of them were male. The median age of children was 30 months. Two hundred two (28.6%) of children were anemic: 124(17.5%) were mildly anemic, 73(10.3%) were moderately anemic, and 5 (0.7%) were severely anemic. The young age of the child, low frequency of child complementary feeding per day, primary maternal educational status, unmarried maternal marital status, and home delivery were factors associated with severity of childhood anemia.

Conclusion

Anemia among children aged 6–59 months in Gondar Town was a moderate public health problem. Improving access to education, providing regular health education about childcare and child feeding practices, strengthening the socioeconomic support for single-parent families and conducting regular community-based screening are recommended to reduce childhood anemia.

How is dietary diversity related to haematological status of preschool children in Ghana?

Background: The role of dietary diversity on blood biomarkers may be significant, but the evidence is limited. Objective: This study assessed the association between dietary diversity and haematological status of children aged 6-59 months controlling for various known confounders. Design: The analysis in this study is based on the 2014 Ghana Demographic and Health survey data.The study involved 2,388 pre-school children aged 6-59 months who constituted the sub-sample for anaemia assessment. Results: The mean haemoglobin concentration (Hb) was 10.2 g/dl ± 1.50 (95 % CI: 10.1 to 10.3), and anaemia prevalence (Hb < 11 g/dl) among children aged 6-59 months was 66.8 % (CI: 63.7 to 69.8). In multivariable logistic regression analysis,continued breastfeeding [Adjusted odds ratio (AOR) = 1.9 (95% CI: 1.19-2.91], 12-23 months of age (AOR = 2.4 (95% CI: 1.40-3.98), having fever in last two weeks (AOR = 1.7 (95% CI: 1.20-2.45, birth interval ≤ 24 months (AOR = 1.9 (1.20-2.84), and poorest wealth quintile (AOR = 2.6 (95% CI: 1.48-4.48) were positively associated with anaemia. Conclusion: The current study showed that factors other than poor dietary diversity predicted anaemia among children aged 6-59 months in Ghana.

Prevalence of anaemia, deficiencies of iron and vitamin A and their determinants in rural women and young children: a cross-sectional study in Kalalé district of northern Benin

OBJECTIVE

To identify the magnitude of anaemia and deficiencies of Fe (ID) and vitamin A (VAD) and their associated factors among rural women and children.

DESIGN

Cross-sectional, comprising a household, health and nutrition survey and determination of Hb, biochemical (serum concentrations of ferritin, retinol, C-reactive protein and α1-acid glycoprotein) and anthropometric parameters. Multivariate logistic regression examined associations of various factors with anaemia and micronutrient deficiencies.

SETTING

Kalalé district, northern Benin.

SUBJECTS

Mother-child pairs (n 767): non-pregnant women of reproductive age (15-49 years) and children 6-59 months old.

RESULTS

In women, the overall prevalence of anaemia, ID, Fe-deficiency anaemia (IDA) and VAD was 47·7, 18·3, 11·3 and 17·7 %, respectively. A similar pattern for anaemia (82·4 %), ID (23·6 %) and IDA (21·2 %) was observed among children, while VAD was greater at 33·6 %. Greater risk of anaemia, ID and VAD was found for low maternal education, maternal farming activity, maternal health status, low food diversity, lack of fruits and vegetables consumption, low protein foods consumption, high infection, anthropometric deficits, large family size, poor sanitary conditions and low socio-economic status. Strong differences were also observed by ethnicity, women's group participation and source of information. Finally, age had a significant effect in children, with those aged 6-23 months having the highest risk for anaemia and those aged 12-23 months at risk for ID and IDA.

CONCLUSIONS

Anaemia, ID and VAD were high among rural women and their children in northern Benin, although ID accounted for a small proportion of anaemia. Multicentre studies in various parts of the country are needed to substantiate the present results, so that appropriate and beneficial strategies for micronutrient supplementation and interventions to improve food diversity and quality can be planned.

Prevalence and risk factors of anemia in children

OBJECTIVE

To identify the prevalence and factors associated with anemia in children attending Municipal Early Childhood Education Day Care Center (Centros Municipais de Educação Infantil [CMEI]) nurseries in Colombo-PR.

METHODS

Analytical, cross-sectional study with a representative sample of 334 children obtained by stratified cluster sampling, with random selection of 26 nurseries. Data collection was conducted through interviews with parents, assessment of iron intake by direct food weighing, and hemoglobin measurement using the finger-stick test. Bivariate association tests were performed followed by multiple logistic regression adjustment.

RESULTS

The prevalence of anemia was 34.7%. Factors associated with anemia were: maternal age younger than 28 years old (p=0.03), male children (p=0.02), children younger than 24 months (p=0.01), and children who did not consume iron food sources (meat+beans+dark green leafy vegetables) (p=0.02). There was no association between anemia and iron food intake in CMEI. However, iron intake was well below the recommended levels according to the National Education Development Fund resolution, higher prevalence of anemia was observed in children whose intake of iron, heme iron, and nonheme iron was below the median.

CONCLUSIONS

In terms of public health, the prevalence of anemia is characterized as a moderate problem in the studied population and demonstrates the need for coordination of interdisciplinary actions for its reduction in CMEI nurseries.

Prevalence of and factors associated with anemia in school children from Maceió, northeastern Brazil

Background

Anemia is a major public health problem in preschool children in Alagoas, Brazil, especially in the younger population, because of a positive correlation between hemoglobin level and age. However, due to the lack of studies, it is not known how widespread this condition is among older children or how it is associated with socioeconomic status. The aim of this study was to investigate the prevalence of and factors associated with anemia in school children from the city of Maceió, Alagoas state, Brazil. The analysis was stratified to identify any effect modification according to whether they attend public or private schools.

Methods

A cross-sectional study was conducted using probability sampling of 1518 children (9.8 ± 0.5 years of age) attending public (n = 931) and private (n = 587) elementary schools in the municipality. Semi-structured questionnaires were used to obtain socioeconomic, demographic, anthropomorphic, hemoglobin (Hb), and dietary data. Anemia (Hb <11.5 g/dL) was the dependent variable. The measure of association used was prevalence ratio (PR) and respective CI95 %, calculated by Poisson regression with robust variance adjustment, for the crude and adjusted analyses.

Results

The prevalence of anemia was found to be higher amongst the public school children than the private school children (10.8 % vs. 7.0 %; PR = 1.54; CI95 %: 1.1; 2.2). At the public schools, the variables that remained significantly associated with anemia after the multivariate analysis were “consumption of fruits/fruit juices < 2 portions/day” (PR = 2.19; CI95 %: 1.18; 4.06) and “male” (PR = 1.51; CI95 %: 1.001; 2.30). At the private schools, these variables were “working mother” (PR = 2.83; CI95 %: 1.23; 6.52) and “monthly school fees < R$ 188.00” (PR = 3.20; CI95 %: 1.46; 7.03).

Conclusions

In the population under study, anemia constitutes a major health problem, especially among children from public schools. Considering the associated factors and the fact that these children are in a school environment, the promotion of healthy eating habits could constitute an important approach for reducing the prevalence of anemia.

Determinants of anemia among 6-59 months aged children in Bangladesh: evidence from nationally representative data

BACKGROUND

Anemia is a global public health problem but the burden of anemia is disproportionately borne among children in developing countries. Anemia in early stages of life has serious consequences on the growth and development of the children. We examine the prevalence of anemia, possible association between anemia and different socio-economic, demographic, health and other factors among children with ages from 6 to 59 months from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS).

METHODS

Data on hemoglobin (Hb) concentration among the children aged 6-59 months from the most recent BDHS (2011) were used. This nationally representative survey allowed a multistage stratified cluster sampling design and provided data on a wide range of indicators such as fertility, mortality, women and child health, nutrition and other background characteristics. Anemia status was determined using hemoglobin level (<11.0 g/dl), and weighted prevalence of childhood anemia along with 95 % confidence intervals were provided. We also examined the distribution of weighted anemia prevalence across different groups and performed logistic regression to assess the association of anemia with different factors.

RESULTS

A total of 2171 children aged 6-59 months were identified for this analysis, with weighted prevalence of anemia being 51.9 % overall- 47.4 % in urban and 53.1 % in rural regions. Results of a multivariable logistic regression analysis showed that, children below 24 months of age (odds ratio, [OR] 3.01; 95 % confidence interval [CI] 2.38-3.81), and those from an anemic mother (OR 1.80; 95 % CI 1.49-2.18) were at higher risk of anemia. Childhood anemia was significantly associated with chronic malnutrition of child, source of drinking water, household wealth and geographical location (defined by division).

CONCLUSIONS

A high prevalence of anemia among 6-59 months aged children was observed in Bangladesh. Given the negative impact of anemia on the development of children in future, there is an urgent need for effective and efficient remedial public health interventions.

Socio-economic and demographic determinants of childhood anemia

OBJECTIVE

To evaluate socio-economic and demographic determinants of anemia among Indian children aged 6-59 months.

METHODS

Statistical analysis was performed on the cross-sectional weighted sample of 40,885 children from 2005 to 2006 National Family Health Survey by using multinomial logistic regression to assess the significance of some risk factors in different degrees of child anemia. Anemia was diagnosed by World Health Organization (WHO) cut-off points on hemoglobin level. Pearson's chi-squared test was applied to justify the associations of anemia with different categories of the study population.

RESULTS

The prevalence of anemia was 69.5%; 26.2% mild, 40.4% moderate, and 2.9% severe anemia. Overall prevalence rate, along with mild and moderate cases, showed an increasing trend up to 2 years of age and then decreased. Rural children had a higher prevalence rate. Of 28 Indian states in the study, 10 states showed very high prevalence, the highest being Bihar (77.9%). Higher birth order, high index of poverty, low level of maternal education, mother's anemia, non-intake of iron supplements during pregnancy, and vegetarian mother increased the risks of all types of anemia among children (p<0.05). Christian population was at lower risk; and Scheduled Caste, Scheduled Tribe, and Other Backward Class categories were at higher risk of anemia.

CONCLUSION

The results suggest a need for proper planning and implementation of preventive measures to combat child anemia. Economically under-privileged groups, maternal nutrition and education, and birth control measures should be priorities in the programs.

Positive Effect of Large Birth Intervals on Early Childhood Hemoglobin Levels in Africa Is Limited to Girls: Cross-Sectional DHS Study

Background

Short birth intervals are independently associated with increased risk of adverse maternal, perinatal, infant and child outcomes. Anemia in children, which is highly prevalent in Africa, is associated with an increased risk of morbidity and mortality. Birth spacing is advocated as a tool to reduce anemia in preschool African children, but the role of gender differences and contextual factors has been neglected. The present study aims to determine to what extent the length of preceding birth interval influences the hemoglobin levels of African preschool children in general, as well as for boys and girls separately, and which contextual factors thereby play a crucial role.

Methods and Findings

This cross-sectional study uses data from Demographic and Health Surveys (DHS) conducted between 2003 and 2011 in 20 African countries. All preschool children aged 6–59 months with a valid hemoglobin measurement and a preceding birth interval of 7–72 months as well as their corresponding multigravida mothers aged 21–49 years were included in the study. Hemoglobin levels of children and mothers were measured in g/l, while birth intervals were calculated as months difference between consecutive births. Multivariate analyses were done to examine the relationship between length of preceding birth interval and child hemoglobin levels, adjusted for factors at the individual, household, community, district, and country level. A positive linear relationship was observed between birth interval and the 49,260 included children’s hemoglobin level, whereby age and sex of the child, hemoglobin level of the mother, household wealth, mother’s education and urbanization of place of residence also showed positive associations. In the interaction models, the effect of a month increase in birth interval is associated with an average increase of 0.025 g/l in hemoglobin level (P = 0.001) in girls, while for boys the effect was not significant. In addition, for girls, the effect of length of preceding birth interval was highest in young mothers and mothers with higher hemoglobin levels, while for boys, the highest effect was noticed for those living in more highly educated regions. Finally, significantly higher hemoglobin levels of girls compared to boys were observed at birth but with increasing age, the sex difference in hemoglobin level gradually becomes smaller.

Conclusions

A longer birth interval has a modest positive effect on early childhood hemoglobin levels of girls, and this effect is strongest when their mothers are in their early twenties and have a high hemoglobin level. Remarkably, although the physiological iron requirement is higher for boys than girls, birth spacing has little influence on hemoglobin levels of preschool boys. We speculate that the preference for male offspring in large parts of Africa significantly influences nutritional patterns of African preschool boys and girls, and as such also determines the different effect of birth spacing. Finally, gender aspects should be considered in intervention programs that aim to improve anemia in African children.

Nutritional iron deficiency anemia: magnitude and its predictors among school age children, southwest Ethiopia: a community based cross-sectional study

BACKGROUND

Iron deficiency anemia (IDA) is a global public health problem among school age children, which retards psychomotor development and impairs cognitive performance. There is limited data on prevalence and risk factors for IDA.

OBJECTIVE

The aim of this study was to determine the prevalence, severity, and predictors of nutritional IDA in school age children in Southwest Ethiopia.

METHODOLOGY

A community based cross-sectional study was conducted in Jimma Town, Southwest Ethiopia from April to July 2013. A total of 616 school children aged 6 to 12 years were included in the study using multistage sampling technique. A structured questionnaire was used to collect sociodemographic data. Five milliliter venous blood was collected from each child for hematological examinations. Anemia was defined as a hemoglobin level lower than 11.5 g/dl and 12 g/dl for age group of 5-11 years and 12-15 years, respectively. Iron deficiency anemia was defined when serum iron and ferritin levels are below 10 µmol/l and 15 µg/dl, respectively. Moreover, fresh stool specimen was collected for diagnosis of intestinal parasitic infection. Stained thick and thin blood films were examined for detection of Plasmodium infection and study of red blood cell morphology. Dietary patterns of the study subjects were assessed using food frequency questionnaire and anthropometric measurements were done. Data were analyzed using SPSS V-20.0 for windows.

RESULT

Overall, prevalence of anemia was 43.7%, and that of IDA was 37.4%. Not-consuming protein source foods [AOR = 2.30, 95%CI(1.04,5.14)], not-consuming dairy products [AOR = 1.83, 95%CI(1.14,5.14)], not-consuming discretionary calories [AOR = 2.77, 95%CI(1.42,5.40)], low family income [AOR = 6.14, 95%CI(2.90,12.9)] and intestinal parasitic infections [AOR = 1.45, 95%CI(1.23, 5. 27)] were predictors of IDA.

CONCLUSION

Iron deficiency anemia is a moderate public health problem in the study site. Dietary deficiencies and intestinal parasitic infections were predictors of IDA. Therefore, emphasis should be given to the strategies for the prevention of risk factors for IDA.

[Timing of clamping and factors associated with iron stores in full-term newborns]

OBJECTIVE

To analyze the impact of timing of clamping and obstetric, biological and socioeconomic factors on the iron stores of full-term newborns.

METHODS

Cross-sectional study between October 2011 and July 2012 in which hematological parameters were evaluated for newborns in Viçosa, MG, Southeastern Brazil. It involved collecting 7 mL of umbilical cord blood from 144 full-term not underweight newborns. The parameters investigated were complete blood count, serum iron, ferritin and C-reactive protein. The time of umbilical cord clamping was measured using a digital timer without interfering in the procedures of childbirth. The birth data were collected from Live Birth Certificates and other information was obtained from the mother through a questionnaire applied in the first month postpartum. Analysis of multiple linear regression was then used to estimate the influence of biological, obstetrics and socioeconomic factors on the ferritin levels at birth.

RESULTS

The median ferritin was 130.3 µg/L (n = 129, minimum = 16.4; maximum = 420.5 µg/L), the mean serum iron was 137.9 μg/dL (n = 144, SD = 39.29) and mean hemoglobin was 14.7 g/dL (n = 144, SD = 1.47). The median time of cord clamping was 36 seconds, ranging between 7 and 100. The bivariate analysis detected an association between ferritin levels and color of the child, timing clamping of 60 seconds, type of delivery, the presence of gestational diabetes and per capita family income. In multivariate analysis, the variables per capita income, number of antenatal visits and length at birth accounted for 22.0% of variation in ferritin levels.

CONCLUSIONS

Iron stores at birth were influenced by biological, obstetric and social characteristics. Tackling anemia should involve creating policies aimed at reducing social inequalities, improving the quality of antenatal care, as well as implementing a criterion of delayed clamping of the umbilical cord within the guidelines of labor.

Tendência temporal e fatores determinantes da anemia em crianças de duas faixas etárias (6-23 e 24-59 meses) no Estado de Pernambuco, Brasil, 1997-2006

Para analisar a tendência temporal da anemia e de fatores associados em crianças de 6-23 e de 24-59 meses no Estado de Pernambuco, Brasil, foram utilizados os dados de dois inquéritos de saúde e nutrição. As amostras totalizaram 777 e 993 crianças de 6-59 meses, respectivamente na II PESN/1997 e na III PESN/2006. As variáveis exploratórias foram agrupadas em cinco níveis hierárquicos: fatores socioeconômicos; índice econômico e índice ambiental; fatores maternos; assistência à saúde e nutrição; morbidade e estado nutricional, analisadas pela regressão múltipla de Poisson. Entre os dois inquéritos, as prevalências de anemia apresentaram uma diminuição de 11,7% e 33,4%, respectivamente, para as crianças de 6-23 e de 24-59 meses. Na análise de tendência temporal apenas o tercil inferior do índice ambiental permaneceu como fator determinante da anemia para as crianças de 6-23 meses, e o tercil inferior do índice econômico se manteve estatisticamente significativo nas crianças de 24-59 meses. Conclui-se que houve diminuição mais significativa da anemia no grupo de 24-59 meses.

Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries

Addressing the complex, multi-factorial causes of childhood anaemia is best done through integrated packages of interventions. We hypothesized that due to reduced child vulnerability, a "buffering" of risk associated with known causes of anaemia would be observed among children living in areas benefiting from a community-based health and nutrition program intervention. Cross-sectional data on the nutrition and health status of children 24-59 mo (N=2405) were obtained in 2000 and 2004 from program evaluation surveys in Ghana, Malawi and Tanzania. Linear regression models estimated the association between haemoglobin and immediate, underlying and basic causes of child anaemia and variation in this association between years. Lower haemoglobin levels were observed in children assessed in 2000 compared to 2004 (difference -3.30 g/L), children from Tanzania (-9.15 g/L) and Malawi (-2.96 g/L) compared to Ghana, and the youngest (24-35 mo) compared to oldest age group (48-59 mo; -5.43 g/L). Children who were stunted, malaria positive and recently ill also had lower haemoglobin, independent of age, sex and other underlying and basic causes of anaemia. Despite ongoing morbidity, risk of lower haemoglobin decreased for children with malaria and recent illness, suggesting decreased vulnerability to their anaemia-producing effects. Stunting remained an independent and unbuffered risk factor. Reducing chronic undernutrition is required in order to further reduce child vulnerability and ensure maximum impact of anaemia control programs. Buffering the impact of child morbidity on haemoglobin levels, including malaria, may be achieved in certain settings.

Genetic hemoglobin disorders, infection, and deficiencies of iron and vitamin A determine anemia in young Cambodian children

In Cambodia, many factors may complicate the detection of iron deficiency. In a cross-sectional survey, we assessed the role of genetic hemoglobin (Hb) disorders, iron deficiency, vitamin A deficiency, infections, and other factors on Hb in young Cambodian children. Data on sociodemographic status, morbidity, and growth were collected from children (n = 3124) aged 6 to 59 mo selected from 3 rural provinces and Phnom Penh municipality. Blood samples were collected (n = 2695) for complete blood count, Hb type (by DNA analysis), ferritin, soluble transferrin receptor (sTfR), retinol-binding protein (RBP), C-reactive protein, and α(1)-acid glycoprotein (AGP). Genetic Hb disorders, anemia, and vitamin A deficiency were more common in rural than in urban provinces (P < 0.001): 60.0 vs. 40.0%, 58.2 vs. 32.7%, and 7.4 vs. 3.1%, respectively. Major determinants of Hb were age group, Hb type, ferritin, sTfR, RBP, AGP >1.0 g/L (P < 0.001), and rural setting (P < 0.05). Age group, Hb type, RBP, elevated AGP, and rural setting also influenced ferritin and sTfR (P < 0.02). Multiple factors affected anemia status, including the following: age groups 6-11.99 mo (OR: 6.1; 95% CI: 4.3, 8.7) and 12-23.99 mo (OR: 2.7; 95% CI: 2.1, 3.6); Hb type, notably Hb EE (OR: 18.5; 95% CI: 8.5, 40.4); low ferritin (OR: 3.2; 95% CI: 2.2, 4.7); elevated AGP (OR: 1.4; 95% CI: 1.2,1.7); rural setting (OR: 2.3; 95% CI: 1.7, 3.1); low RBP (OR: 3.6; 95% CI: 2.2, 5.9); and elevated sTfR (OR: 2.1; 95% CI: 1.7, 2.7). In Cambodia, where a high prevalence of genetic Hb disorders exists, ferritin and sTfR are of limited use for assessing the prevalence of iron deficiency. New low-cost methods for detecting genetic Hb disorders are urgently required.

Temporal trends and anaemia-associated factors in 6- to 59-month-old children in Northeast Brazil

OBJECTIVE

To analyse the trends and factors associated with anaemia in 6- to 59-month-old children in Northeast Brazil.

DESIGN

Cross-sectional study assessed information from the second and third Pernambuco State Health and Nutrition Surveys carried out in 1997 and 2006. A multiple regression analysis was performed from a conceptual model addressing biological and socio-economic factors, housing and sanitation conditions, maternal factors, health care and nutrition, consumption, morbidity and nutritional status. Poisson's regression with robust variance was used.

SETTING

Pernambuco, Brazil.

SUBJECTS

A total of 777 and 993 children, respectively, in the second and third Pernambuco State Health and Nutrition Surveys.

RESULTS

The prevalence of anaemia (Hb < 11 g/dl) decreased by 19·3 % (40·9 % down to 33·0 %) between surveys. Maternal education level (less than 8 years in school), households ranked in the lowest environmental index tertile and children between 6 and 23 months of age were the variables common to the final models in the surveys of 1997 and 2006. Elements like living in rural areas, household income less than two minimum official wages and low birth weight were still present in the final model of the 1997 survey. Households ranked in the lowest economic index tertile were associated with anaemia in the model of the 2006 survey.

CONCLUSIONS

The study results are quite encouraging from the perspective of reducing the prevalence of anaemia. Maternal education level, environmental conditions and child age were determinant factors in both surveys, and economic factors were determinant in 2006.

Anaemia among Egyptian Children between 2000 and 2005: trends and predictors

Anaemia remains the most prevalent nutritional disorder among women and children in the Middle East and North Africa region. We examined anaemia trends using data from the Egyptian Demographic and Health Surveys. Between 2000 and 2005, the prevalence of anaemia (defined as haemoglobin concentrations <11 g dL(-1) ) increased from 37.04% to over 52% among Egyptian children between 12 months and 36 months of age. We examined the associations of these changes with food consumption, vitamin A administration, recent illness, immunization status, socio-demographic factors and a child's anaemic status. Children under the age of 24 months who had recently been sick and those who resided in Upper Egypt were significantly more likely to be anaemic. Despite significant improvements in water and sanitation facilities, maternal education and asset-based household wealth, there were marked declines in the consumption of nutritive foods and increases in the prevalence of childhood diarrhoea between 2000 and 2005. Placing these analyses in the broader context of Egyptian economic trends suggests that the nutritional basket consumed by Egyptian households between 2000 and 2005 may have shifted towards less nutritive foods with lower costs per calorie, probably in response to economic difficulties and increasing food prices. Shifts in dietary consumption, in conjunction with increases in diarrhoea, are likely contributing to the rapid increase in childhood anaemia in Egypt between 2000 and 2005. National-level fortification efforts may be one way to combat rising levels of anaemia among Egyptian women and children.

Prevalência da anemia e fatores associados em crianças de seis a 59 meses de Pernambuco

OBJETIVO: Estimar a prevalência de anemia e identificar seus fatores associados em crianças de seis a 59 meses. MÉTODOS: Estudo transversal com dados da III Pesquisa Estadual de Saúde e Nutrição/Pernambuco em amostra representativa de 1.403 crianças para as áreas urbana e rural. A anemia foi diagnosticada pela dosagem da hemoglobina. A análise multivariada foi realizada a partir de um modelo hierárquico, utilizando a regressão de Poisson, com variância robusta para estimar a razão de prevalência em função de variáveis: biológicas, de morbidade e estado nutricional da criança, socioeconômicas, de habitação, de saneamento e fatores maternos. RESULTADOS: A prevalência ponderada de anemia foi de 32,8%: 31,5% na área urbana e 36,6% na rural. Na área urbana, as variáveis que se associaram significantemente à anemia foram: escolaridade materna, bens de consumo, número de crianças menores de cinco anos no domicílio, tratamento da água de beber, idade e anemia materna e idade da criança. Na área rural, apenas a idade materna e a idade da criança associaram-se de modo significante à anemia. CONCLUSÕES: A prevalência de anemia nas crianças pernambucanas é semelhante nas áreas urbana e rural. Os fatores associados à anemia apresentados devem ser considerados no planejamento de medidas efetivas para o seu controle.

Alimentação complementar e estado nutricional de crianças menores de dois anos atendidas no Programa Saúde da Família em Acrelândia, Acre, Amazônia Ocidental Brasileira

Com objetivo de investigar o estado nutricional e alimentação complementar em crianças de 6 a 24 meses, residentes na Amazônia Ocidental Brasileira, um estudo transversal foi realizado na área urbana do Município de Acrelândia, Estado do Acre, com 164 crianças. As prevalências de déficit de estatura/idade e anemia foram de 12% e 40%, respectivamente, e de deficiência de ferro isolada, de 85%. Os níveis séricos das vitaminas A e B12 estavam baixos em 15% e 12% das crianças, respectivamente. Houve baixo consumo alimentar dos seguintes nutrientes (% de crianças abaixo das recomendações): ácido fólico (33%), vitamina C (40%), vitamina A (42%), zinco (46%) e ferro (71%). A biodisponibilidade de ferro da dieta foi de 8%. Observou-se baixo consumo de frutas, hortaliças e carnes, com consumo excessivo de leite de vaca e mingau.

Anemia e deficiência de ferro em pré-escolares da Amazônia Ocidental brasileira: prevalência e fatores associados

Estudo transversal de base populacional que investigou prevalênciasde anemia e fatores associados à anemia, anemia ferropriva e deficiência de ferro entre crianças de 6 a 60 meses da área urbana de dois municípios do Acre, Brasil (N = 624). Dosagens de hemoglobina sanguínea, ferritina e receptor solúvel de transferrina plasmáticas foram realizadas mediante sangue venoso. Condições sócio-econômicas, demográficas e de morbidade foram obtidas por questionário. Razões de prevalências foram calculadas por regressão de Poisson em modelo hierárquico. As prevalências de anemia, anemia ferropriva e deficiência de ferro foram de 30,6%, 20,9% e 43,5%, respectivamente. Menores de 24 meses apresentaram maior risco para anemia, anemia ferropriva e deficiência de ferro. Pertencer ao maior tercil do índice de riqueza conferiu proteção contra anemia ferropriva (RP = 0,62; IC95%: 0,40-0,98). Pertencer ao maior quartil do índice estatura/idade foi protetor contra anemia (0,62; 0,44-0,86) e anemia ferropriva (0,51; 0,33-0,79), e ocorrência recente de diarréia representou risco (anemia: 1,47; 1,12-1,92 e anemia ferropriva: 1,44; 1,03-2,01). A infestação por geohelmintos conferiu risco para anemia, anemia ferropriva e deficiência de ferro.

Social and biological determinants of iron deficiency anemia

This cross-sectional study aimed to identify the social and biological determinants of anemia in children enrolled in the Brazilian Income Transfer Program (PBF). The study evaluated 446 children (69.1% of the total enrolled) ranging from 6 to 84 months of age, of whom 262 were receiving the income transfer (60.2% of the beneficiaries) and 184 were not (87.6% of the non-beneficiaries). Testing for anemia was performed with the Hemocue portable hemoglobinometer, and the cutoff points were set at 11.0 and 11.5g/dL, according to age bracket. The data were analyzed using Poisson hierarchical regression with robust variance for multivariate analysis. There was no difference in the anemia prevalence rates between the beneficiary and non-beneficiary groups. Risk factors for anemia were low paternal schooling, cesarean birth, consumption of untreated water, stunting, and age less than 24 months. Prevalence of anemia in the group of non-beneficiary children under two years of age was significantly higher than in the beneficiary group in the same age bracket, suggesting the importance of the PBF income transfer for preventing anemia in children.

Fatores associados à ocorrência de anemia em crianças menores de seis anos: uma revisão sistemática dos estudos populacionais

OBJETIVOS: revisar os artigos publicados de 1997 a 2010, com amostras populacionais representativas para crianças menores de seis anos, que estimaram a prevalência da anemia e/ou deficiência de ferro e seus fatores associados, por meio da análise laboratorial de hemoglobina ou ferritina. MÉTODOS: os artigos foram revisados sistematicamente, utilizando as palavras-chaves: anemia, iron-deficiency; anemia, iron-deficiency/epidemiology; anemia, iron-deficiency/etiology; child, preschool e risk factors nas bases de dados PubMed, SciELO e LILACS. RESULTADOS: os fatores mais citados foram: idade da criança, escolaridade materna, renda familiar, diarréia, área geográfica, índice de riqueza do domicílio, peso ao nascer, indicador altura/idade, indicador peso/altura, etnia, sexo, densidade de ferro e calorias provenientes do leite de vaca. A idade da criança foi comum nos estudos nacionais e internacionais. A escolaridade materna e fatores socio-econômicos e ambientais mostraram associação com a anemia nos estudos realizados nas regiões em desenvolvimento. O sobrepeso e a exposição passiva ao fumo surgem como variáveis pouco investigadas. CONCLUSÕES: a análise demonstra a multiplicidade de fatores associados à anemia/deficiência de ferro existentes em diferentes contextos.

Diagnosis of iron deficiency anemia in children of Northeast Brazil

OBJECTIVE: To diagnose iron deficiency anemia in children. METHODS: The study was conducted with a sample of 301 children aged six to 30 months attending public daycare centers in the city of Recife, Northeast Brazil, in 2004. The diagnoses of anemia were based on a combination of different hematological and biochemical parameters: hemoglobin, mean corpuscular volume, ferritin, C-reactive protein, transferrin saturation and transferrin receptor. The chi-square test and ANOVA were used in the statistical analysis. RESULTS: Of all children studied, 92.4% had anemia (Hb <110 g/L) and 28.9% had moderate/severe anemia (Hb <90 g/L). Lower levels of hemoglobin were found in children aged 6-17 months. Iron deficiency was found in 51.5% of children using ferritin (<12 μg/L) as parameter. Taking into consideration the combination of hemoglobin level, ferritin and transferrin receptor, 58.1% had anemia with iron deficiency, 34.2% had anemia without iron deficiency and 2.3% had iron deficiency without anemia. Mean ferritin concentration was significantly higher in children with high C-reactive protein when compared with those with normal levels (22.1 vs. 14.8 µg/L). CONCLUSIONS: The use of several biochemical and hematological parameters allowed to diagnosing iron deficiency anemia in two thirds of children, suggesting a need to identify other determinants of anemia without iron deficiency.

Determinants of anemia among preschool children in the Philippines

OBJECTIVE

Our objective was to identify the determinants of anemia among rural Filipino children aged 12-71 months.

METHODS

A cross-sectional survey was conducted among 2090 preschool children from 8 rural villages in Cebu, an area non-endemic for malaria and schistosomiasis. Hemoglobin (Hb) concentration was determined using a HemoCue hemoglobinometer and zinc protoporphyrin (ZPP) concentration was measured with a hematofluorometer. A 3-day non-consecutive 24-hour food recall interview with the child's primary caregiver was done to estimate the child's dietary intake. Stool analysis for presence of soil-transmitted helminths was performed through a concentration technique. A separate interview on household socio-economic status with the child's primary caregiver was conducted.

RESULTS

Mean Hb concentration was 12.0 g/dL (SD 1.3). 16.1% were anemic. Age and sex had a significant interaction in their effect on Hb concentration. Females had higher Hb concentration between 12 to 23 months of age. Hb levels equalize between the 2 genders at around 24 months and increase with similar increments until 71 months of age. All dietary parameters improved Hb concentration with increasing intake. In the multiple regression, however, only the index for bioavailable iron and vitamin C intakes remained independent factors. None of the helminths or combination of helminths had significant effects on Hb concentration. Among the socio-economic variables, maternal educational attainment and water supply were significant independent factors. Mean ZPP concentration was 72.07 (SD 46.45) and 30.8% were iron deficient. As with Hb concentration, age and sex had a significant interaction in their effect on ZPP concentration, with females having lower ZPP levels before 24 months of age. Bioavailable iron (animal iron + 0.3*plant iron) had a significant effect on ZPP concentration at levels of at least 15% of the iron requirement. This was seen even after controlling for multivitamin supplementation.

CONCLUSION

The control of anemia among preschoolers can be achieved through a combination of various nutritional interventions such as micronutrient supplementation, food fortification and nutrition education. Our findings emphasize the importance of a multi-sectoral approach to nutritional problems--the importance of empowering women (through engagement and education) and of maintaining a healthy physical environment (water and sanitation) are often peripheral concerns of nutritionists. Our study highlights the importance of supporting initiatives that address these issues not only for their core benefit, but also for the potential benefit to nutrition.

Iron status of adolescent girls from two boarding schools in southern Benin

Iron deficiency (ID) is the most prevalent micronutrient deficiency in the world, particularly in developing countries. Blood samples and a qualitative FFQ on Fe- and vitamin C-rich foods were obtained in 180 adolescent girls aged 12 to 17 years living in two boarding schools from south Benin. ID, defined as serum ferritin either <20μg/l or 20–50μg/l, plus two of the following parameters: serum Fe<11μmol/l, total iron-binding capacity>73μmol/l or transferrin saturation<20%, was found in 32% of subjects. Anaemia (Hb<120g/l) was found in 51% of adolescents, while 24% suffered from iron-deficiency anaemia (IDA) (ID and Hb<20g/l). After adjusting for confounding factors (age, mother's and father's occupation, household size) in a logistic regression equation, subjects having a low meat consumption (beef, mutton, pork) (<4 times/week) were more than twice as likely to suffer from ID (OR=2·43; 95% CI 1·72, 3·35;P=0·04). Adolescents consuming less fruits (<4 times/week) also had a higher likelihood of suffering from ID (OR=1·53; 95% CI 1·31, 2·80;P=0·03). Finally, subjects whose meat consumption was low were twice as likely to suffer from IDA (OR=2·24; 95% CI 1·01, 4·96;P=0·04). The prevalence of ID represents an important health problem in these Beninese adolescent girls. A higher consumption of Fe-rich foods and of promoters of Fe absorption (meat factor and vitamin C) is recommended to prevent ID deficiency in these subjects.

Child health and nutrition in the Western Brazilian Amazon: population-based surveys in two counties in Acre State

The article presents prevalence rates for malnutrition, intestinal parasitic infections, anemia, and iron deficiency in under-five children in a population-based cross-sectional survey performed in the urban area of two counties in the Western Brazilian Amazon, Assis Brasil (n = 200) and Acrelandia (n = 477). Available data included: (a) weight and height measurements, standardized as z-scores using the 1977 NCHS reference population, (b) diagnosis of current intestinal parasitic infection, (c) blood hemoglobin levels, and (d) plasma ferritin and soluble transferrin receptor levels. Overall prevalence rates of low weight-for-height, low weight-for-age, and low height-for-age were 3.7%, 8.7%, and 7.5%, respectively, with similar figures in the two towns. Intestinal parasites were detected in 32.5% children; helminths were uncommon. Anemia and iron deficiency were diagnosed in 30.6% and 43.5% of the children, respectively. Evidence of anemia was found in only 47.6% of the children with depleted iron reserves, indicating that hemoglobin measurement alone would severely underestimate the magnitude of iron deficiency in this population. In both towns, anemia and malnutrition were significantly more prevalent among children in the lowest socioeconomic stratum.

[Dietary iron and iron deficiency anemia among adolescent girls from Benin]

BACKGROUND

Iron deficiency anemia affects a large number of women in developing countries, especially during childbearing years. Few studies determined the association between estimated absorbable iron intakes and iron deficiency.

METHODS

The association between dietary iron intake and iron status was studied in 100 adolescent girls aged 14-16 years from Benin. Fifty adolescents were boarding at the school, while 50 lived at home. Biochemical indices of iron status included: hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, serum iron, total iron-binding capacity and % transferrin saturation. Dietary intakes were obtained by two 24-hour recalls and absorbable iron intakes were estimated using Monsen's model. The probability approach was used to estimate inadequacy in iron intake.

RESULTS

While 73% of adolescents met the recommendations for dietary iron intake, only 27% had estimated absorbable iron intake above the average requirement for absorbed iron. Non-heme iron represented 97.2% of the total iron intake. Forty three percent of subjects were anemic (hemoglobin<120 g/l). Iron deficiency defined by a four-model index based on > or =2 abnormal values in the four independent indicators of iron status used (serum iron, total iron-binding capacity, mean corpuscular volume, mean corpuscular hemoglobin concentration) was present in 14% of the subjects, while 13% had iron deficiency anaemia (hemoglobin<120 g/l+four-model index). Using a multiple regression analysis, total absorbable iron intakes (including iron supplements) were highly and positively associated with hemoglobin and hematocrit concentrations (P=0.000001 and P=0.00007 respectively).

CONCLUSION

In this group of adolescents, total absorbable iron intakes were related to iron deficiency. Efforts should be made to increase the heme iron content of the diet and the bioavailability of non-heme iron by promoting affordable local foods rich in iron and promoters of iron absorption (Vitamin C and meat, poultry and fish factor).

Fatores de risco de anemia em lactentes matriculados em creches públicas ou filantrópicas de São Paulo

OBJETIVO: Identificar e quantificar os fatores de risco de anemia em lactentes matriculados em creches públicas ou filantrópicas no município de São Paulo e discutir o impacto das ações da creche no controle desta carência nutricional específica. MÉTODO: Estudo seccional compreendendo 212 lactentes de duas creches públicas e três filantrópicas. Foram realizadas entrevistas com as mães, coleta de sangue por punção digital e antropometria. Considerou-se como anemia, hemoglobina inferior a 11g/dL. Foi ajustado um modelo de regressão logística para fatores de risco entre grupos de lactentes com e sem anemia. RESULTADOS: A prevalência de anemia foi de 51,9%. O modelo logístico final foi composto por 4 variáveis: presença de 1 ou mais irmãos menores que 5 anos (Odds Ratio=2,57; p=0,005); estar freqüentando creche de administração exclusivamente pública (Odds Ratio=2,12; p=0,020); uso de aleitamento materno exclusivo inferior a 2 meses (Odds Ratio=1,88; p=0,044), e idade inferior a 15 meses (Odds Ratio=2,32; p=0,006). CONCLUSÃO:Concluiu-se que a alta prevalência de anemia evidencia a ineficiência das creches estudadas para controlar e prevenir esta carência nutricional; portanto, cabe ao planejador de saúde considerar os riscos de anemia identificados e quantificados quando da elaboração de programas de controle e prevenção.

Consumo alimentar de macro e micronutrientes de crianças menores de cinco anos no Estado de Pernambuco, Brasil

OBJETIVO: analisar o consumo alimentar de macro e micronutrientes, com base na Dietary Reference Intakes, das crianças menores de cinco anos do Estado de Pernambuco, considerando três áreas geográficas: Região Metropolitana do Recife, Interior Urbano e Interior Rural. MÉTODOS: a amostra constitui-se de 948 crianças menores de cinco anos de idade, com representatividade para o Estado de Pernambuco e suas três áreas geográficas. O consumo alimentar foi registrado mediante o recordatório de 24 horas e foram analisadas as medianas e prevalências de inadequação dos macro e micronutrientes de acordo com as Dietary Reference Intakes. RESULTADOS: o déficit de energia e micronutrientes mostrou-se prevalente nas crianças, em todas as faixas etárias e áreas geográficas; entretanto, o consumo de proteínas apresentou-se acima dos valores de referência. A prevalência de inadequação dos micronutrientes foi elevada, principalmente de ferro e zinco, nas crianças acima de 12 meses de idade. Os resultados no Interior Rural foram os mais baixos para todos os nutrientes analisados. CONCLUSÕES: o consumo alimentar das crianças do Estado de Pernambuco demonstrou déficit de energia, de macro e micronutrientes. Espera-se que estes resultados possam servir como subsídios para implementação de políticas de nutrição e alimentação no Estado, visando prevenir os principais distúrbios nutricionais em menores de cinco anos.

Phenotypic and genotypic heterogeneity in Gaucher disease type 1: a comparison between Brazil and the rest of the world

Type 1 Gaucher disease, the most common lysosomal storage disorder, results from deficiency of glucocerebrosidase causing pathologic accumulation of glucocerebroside. The disease is characterized by marked variation in age of onset and degree of anemia, thrombocytopenia, hepatosplenomegaly, and skeletal disease. Most published data on Gaucher disease come from populations with large proportions of Ashkenazi-Jewish patients, who tend to have less severe disease. We compared selected demographic, clinical, and genetic parameters for Brazilian (N = 221) and rest-of-world (N = 1477) type 1 Gaucher disease patients entered into the ICGG Gaucher Registry since 1991. We also compared Brazilian patients to non-Ashkenazi rest-of-world patients (N = 692) to determine if differences were the result of fewer Brazilian Ashkenazi-Jewish patients (0.5% vs 45.0%). The Brazilian cohort differed significantly (p < 0.05) from the rest-of-world and rest-of-world non-Ashkenazi cohort, respectively, in the following measures: higher proportion of females (59.7% vs 50.4% and 49.7%), lower mean age at diagnosis (17.1 vs 24.1 and 18.8), and higher proportions of patients with anemia (55.5% vs 29.9% and 35.7%), bone pain (57.7% vs 33.7% and 35%), bone crises (16.1% vs 6.5% and 7.4%), and lytic lesions (17.0% vs 7.6% and 7.4%). The most common genotype in Brazil was N370S/L444P (c1448T-->C/c1226A-->C) (46.8% versus 16.3% and 25.7%). These data highlight the genetic and phenotypic heterogeneity among geographic populations of type 1 Gaucher patients and suggest that as a group, Brazilian patients may have a more aggressive form of the disease than rest-of-world patients. The findings also emphasize the need for caution in making generalizations about Gaucher disease across demographic groups.

Concentração de hemoglobina e anemia em crianças no Estado de Pernambuco, Brasil: fatores sócio-econômicos e de consumo alimentar associados

Este estudo teve como objetivo avaliar a associação entre a concentração de hemoglobina e prevalência de anemia com variáveis sócio-econômicas e de consumo alimentar. O estudo seccional, realizado em Pernambuco, Brasil, no ano 1997, utilizou a amostragem em três estágios. A amostra compreendeu 746 crianças de 6-59 meses, nas quais foram realizados dosagem de hemoglobina e inquérito dietético recordatório de 24 horas. A prevalência de anemia foi de 40,6%, sendo maior no Interior Rural e diminuindo com o aumento da idade, da renda e da escolaridade materna. A maioria das crianças (88,9%) consumia leite de vaca. A anemia apresentou tendência de aumento com a elevação da proporção de calorias do leite e de redução com o aumento da densidade de ferro (total, heme e não-heme). A idade da criança, a área geográfica, a renda familiar per capita, a escolaridade materna, a densidade de ferro e a proporção de calorias do leite de vaca na dieta são fatores determinantes da anemia no grupo estudado.

Screening results of anaemia among infants in a village in Okinawa, Japan: a cross-sectional study

The aim of this study is to highlight the baseline characteristics of the results of a screening test for anaemia among infants in a village in Okinawa, Japan. The groups were classified into two; infants with and without anaemia. A total of 201 infants were screened at 3-4 months, 9-10 months and 18 months. The study showed that gestational age and BMI were predictive of anaemia at 3-4 months of age. At 9-10 months, types of feeding and weight ratio were the only factors that were found to be significantly predictive of anaemia. However, no factor was found to be predictive of anaemia at 18 months. Anaemia cases were found to occur at 3-4 months and 9-10 months. Most of the anaemia cases have successfully undergone treatment.

Iron deficiency due to consumption of a habitual diet low in bioavailable iron: a longitudinal cohort study in Moroccan children

BACKGROUND

In many developing countries, cereal and legume-based diets contain low amounts of bioavailable iron, which may increase the risk of iron deficiency.

OBJECTIVE

The objective was to measure change in iron status in Moroccan children who consumed their habitual diet containing low amounts of bioavailable iron.

DESIGN

The design was a prospective, longitudinal, free-living cohort study in iron-replete, nonanemic 6-10-y-old children (n = 126). Hemoglobin, serum ferritin, and transferrin receptor were measured at baseline. The children then consumed their habitual cereal and legume-based diet for 15 mo, when their iron status was retested. We used weighed food records and direct food analysis to calculate dietary iron intake and iron bioavailability. On the basis of the change in hemoglobin and body iron stores calculated from the serum transferrin receptor-to-ferritin ratio, iron balance and iron absorption were estimated over the 15-mo period.

RESULTS

Mean daily iron intake was 10.8 mg/d, 97% of which was nonheme iron. Estimated nonheme-iron bioavailability from algorithms was 1.0-4.3% adjusted for low body iron stores. Over 15 mo, the mean change in total body iron was -142 mg, and mean iron absorption was estimated to be 0.22 mg/d, or 2% of dietary iron. Mean hemoglobin concentration decreased 12 g/L. At 15 mo, 75% of the cohort had deficits in tissue iron, and one-third had mild iron deficiency anemia.

CONCLUSION

Low iron bioavailability from legume and cereal-based diets is a cause of iron deficiency anemia in children in rural Africa.

Childhood anemia prevalence and associated factors in Salvador, Bahia, Brazil

A cross-sectional study was conducted in 1996 to estimate the prevalence of anemia in a stratified sample of 603 preschool children and identify factors associated with the disease. Hemoglobin assays were conducted in finger-prick blood samples using a Hemocue hemoglobinometer. Anemia was defined as hemoglobin below 11.0g/dl. Logistic regression analysis was used to evaluate the potential associations. Observed anemia prevalence was 46.3%. Associated factors were: the 6-12-month and 12-24-month age brackets, the lowest tertiles for iron density and protein content dietary intake, and any degree of deficit in the height-for-age anthropometric parameter. Inadequate physical, sanitary, and environmental conditions in the home were associated with a significantly increased risk of anemia. Anemia constitutes an important health problem in this study's child population. Improvements in living conditions and dietary quality could contribute to a reduction in anemia prevalence.