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Johnston M, O'Sullivan T, Devine A, Wallace R, Costello L, Sambell R. Toddlers may be getting enough iron in long day-care services after all. J Hum Nutr Diet 2023; 36:1901-1911. [PMID: 37143380 DOI: 10.1111/jhn.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 04/16/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Previous research has suggested that toddlers are not provided with adequate dietary iron in long-day care (LDC) services. However, the iron bioavailability provided is unknown. The present study aimed to investigate the amount and bioavailability of iron provided to toddlers aged 2-3 years at LDC services. METHODS A cross-sectional audit was conducted using a 2-day weighed food record of 30 LDC services. Iron provision (not child intake) in LDC services across Perth, Australia was compared with the estimated average requirements (EAR) and LDC services provision guidelines (50% of EAR = 2 mg/day based on a 14% bioavailability factor). Bioavailability was estimated per mealtime using haem and non-haem iron, ascorbic acid, animal protein, calcium, soy, eggs and phytates using two pre-existing algorithms (by A. P. Rickard and colleagues and H. Hallberg and H. Hulten). RESULTS Median iron supplied (2.52 mg/day, interquartile range [IQR] = 2.43-3.17) was above the 50% of EAR of 2.0 mg/day (p < 0.001). Median bioavailable iron was 0.6 mg/day (IQR = 0.54-0.8) using the method of Rickard et al. and 0.51 mg/day (IQR = 0.43, 0.76 using that of Hallberg and Hulthen). The top three foods contributing to iron provision were bread, breakfast cereals and beef. CONCLUSIONS Our results suggest that LDC services in Perth are meeting the minimum recommendation of provision of 50% of the iron EAR, and also that toddlers are provided with sufficient bioavailable iron. Future strategies should focus on promoting food combinations to maintain the iron bioavailability in meals currently served at LDC services.
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Affiliation(s)
- Michaela Johnston
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Therese O'Sullivan
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Ruth Wallace
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Leesa Costello
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ros Sambell
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medical and Health Sciences, Nutrition & Health Innovation Research Institute, Edith Cowan University, Joondalup, WA, Australia
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Khalil MKN, Abd Razak MA, Tahir FA, Sahril N, Shahein NA, Rezali MS, Adnan MAA, Liew SH, Ab Wahab N, Shamsuddin N, Kassim MSA. Prevalence and Risk Factors of Anaemia among Orang Asli Children in Malaysia: A Scoping Review. Nutrients 2023; 15:nu15061493. [PMID: 36986223 PMCID: PMC10053598 DOI: 10.3390/nu15061493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Anaemia continues to be a global public health burden affecting all age groups, particularly children. Indigenous people, including the Orang Asli (OA) population in Malaysia, are at risk of anaemia due to the vast disparities in social determinants of health in their population compared to the non-indigenous population. OBJECTIVES This review aimed to identify the prevalence and risk factors of anaemia among OA children in Malaysia and analyse the knowledge gaps. METHODS A systematic search was conducted in PubMed, Cochrane Library, Scopus and Google Scholar databases. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. RESULTS This review identified six studies involving the participation of OA children from eight subtribes residing in Peninsular Malaysia. The overall prevalence of anaemia among OA children ranged from 21.6 to 80.0%, with iron deficiency anaemia prevalence at 34.0%. The risk factors of anaemia among OA children reported from one study in this review were being younger than ten years old children (AOR 2.11 (95% CI 1.23, 3.63)) and moderate to heavy Ascaris infections (AOR 2.05 (95% CI 1.12, 3.76)). There was no data from OA children from certain age groups and subtribes. Additionally, there is a paucity of data on risk factors for anaemia among OA children from the currently available evidence. CONCLUSION The prevalence of anaemia among OA children poses a moderate to severe public health concern. Therefore, more comprehensive studies in the future are needed to address the gaps identified in this review, primarily regarding anaemia risk factors. This data would encourage policymakers in devising effective national prevention strategies to improve morbidity and mortality among OA children in the future.
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Affiliation(s)
| | - Mohamad Aznuddin Abd Razak
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Fatin Athirah Tahir
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Norhafizah Sahril
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Nik Adilah Shahein
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Muhammad Solihin Rezali
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Muhammad Azri Adam Adnan
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Siaw Hun Liew
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Nor'ain Ab Wahab
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Norliza Shamsuddin
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Mohd Shaiful Azlan Kassim
- Centre for Family Health Research, Institute for Public Health, Ministry of Health, Shah Alam 40170, Malaysia
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Murtaza SF, Lee LJ, Usaini NN, Gan WY, Sulaiman N. Factors Associated With Anemia Among Orang Asli Children Aged Two to Six Years in Negeri Sembilan, Malaysia. Cureus 2023; 15:e35511. [PMID: 37007386 PMCID: PMC10050992 DOI: 10.7759/cureus.35511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
Abstract
Background Anemia is a global public health problem that needs urgent attention, especially in early childhood. Young children living in remote indigenous communities are vulnerable to anemia. This study aimed to determine factors associated with anemia among children of the Orang Asli (OA) community, aged two to six years old. Methods A cross-sectional study was conducted among 269 OA children, together with their biological non-pregnant mothers. Their mothers were interviewed using a structured questionnaire to gather information on sociodemographic characteristics, sanitation facility and personal hygiene, food security, and dietary diversity. Anthropometric and biochemical assessments were measured using standard protocols. Results One in five of the OA children was anemic (21.2%) and had a low birth weight (20.4%). About 27.7% of the children were underweight, 35.2 % were stunted, 6.1% were wasted, and 5.7% were overweight. One-third of them (35.0%) had parasitic infections and almost all were food-insecure (96.3%). As for the mothers, more than one-third of them were anemic (39.0%), 58.9% had abdominal obesity, and 61.8% were overweight and obese. Parasitic infections (adjusted OR (AOR)=2.49, 95%CI=1.23-5.06), not wearing shoes outside the house (AOR=2.95, 95%CI=1.39-6.27), and mothers with anemia (AOR=2.62, 95%CI=1.30-5.28) were associated with increased risk of anemia among OA children. Conclusion Preventing maternal anemia and strengthening knowledge on sanitation and hygiene could be incorporated into nutrition intervention programs to address anemia issues among OA children.
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Leepile TT, Mokomo K, Bolaane MMM, Jones AD, Takada A, Black JL, Jovel E, Karakochuk CD. Anemia Prevalence and Anthropometric Status of Indigenous Women and Young Children in Rural Botswana: The San People. Nutrients 2021; 13:1105. [PMID: 33800575 PMCID: PMC8066262 DOI: 10.3390/nu13041105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022] Open
Abstract
In Botswana, there is limited data available on the health and nutritional status of the San People (also known as the Basarwa or Bushmen), an Indigenous minority group primarily living in the Ghanzi District. Our aim in this study was to assess anemia prevalence among and anthropometric indices of women and young children in Ghanzi District through a cross-sectional survey. We recruited 367 mother-child pairs (women 15-49 years and children 6-59 months) in nine randomly selected areas. A capillary blood sample was collected, and weight and height were measured. Hemoglobin (Hb) concentration was measured with use of a hemoglobinometer (HemoCue, AB), as per global recommendations. Overall, adjusted anemia prevalence was 12% in non-pregnant women (Hb < 120 g/L), 26% in pregnant women (Hb < 110 g/L), and 42% in children (Hb < 110 g/L), but it varied widely depending on whether or not the controversial factor of ethnicity was adjusted for (range of 6-26%, 22-30%, and 35-68% prevalence, respectively). Thirty-nine percent (n = 133/344) of non-pregnant women and 52% (n = 12/23) of pregnant women were underweight (BMI < 18.5 kg/m2). In children aged 6-23 months, 41% were underweight (weight-for-age z-score < -2 SD), 13% were wasted (weight-for-height z-score < -2 SD), and 65% were stunted (height-for-age z-score < -2 SD); in children aged 24-59 months, 57% were underweight, 13% were wasted, and 66% were stunted. Fifty-six percent (n = 205/367) of women self-reported smoking in any form (rolled cigarettes or snuffing). The high prevalence of smoking among women, underweight status among pregnant women, and anemia, stunting, and wasting among children is of the highest concern for public health and should be addressed in future health and nutrition programming.
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Affiliation(s)
- Tebogo T. Leepile
- Integrated Studies in Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (T.T.L.); (J.L.B.); (E.J.)
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | | | - Maitseo M. M. Bolaane
- San Research Centre, Botswana and the Department of History, University of Botswana, Gaborone, Botswana;
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA;
| | - Akira Takada
- Centre for African Area Studies, Kyoto University, Kyoto 606-8304, Japan;
| | - Jennifer L. Black
- Integrated Studies in Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (T.T.L.); (J.L.B.); (E.J.)
- Department of Food, Nutrition, and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- The Peter Wall Institute for Advanced Studies, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - Eduardo Jovel
- Integrated Studies in Land and Food Systems, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (T.T.L.); (J.L.B.); (E.J.)
| | - Crystal D. Karakochuk
- BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Food, Nutrition, and Health, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Leonard D, Buettner P, McDermott R, Makrides M. The iron content of healthy diets for one day for breastfed babies and young children. Nutr Diet 2021; 78:415-423. [PMID: 33594814 DOI: 10.1111/1747-0080.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS Early childhood anaemia due to iron deficiency is widespread in remote communities across northern Australia. Current recommendations for healthy food to complement breastfeeding at age 6 to 23 months include iron-rich and iron-enriched foods. An electronic nutrient analysis was undertaken to assess the iron content of hypothetical healthy diets for breastfed babies and young children aged 6 to 23 months in Australia, in comparison with their estimated requirements. METHODS Hypothetical diets for 1 day were developed that were consistent with the Foundation Diets for breastfed infants 6 to 12 months and for toddlers 13 to 23 months. Nutrient content was derived using the Australian Food Composition database in FoodWorks 10. The iron content of these two diets were compared with Estimated Average Requirements (EARs) and Recommended Dietary Intakes (RDIs) for iron for infants aged 7 to 12 months and children aged 1 to 3 years. RESULTS The iron content of the hypothetical diet for breastfed infants aged 6 to 12 months (5.8 mg) was less than the EAR (7 mg, 83%) and the RDI (11 mg, 53%). For young breastfed children aged 13 to 23 months, the iron content of the hypothetical diet was 4.4 mg; above the EAR (4 mg, 110%) but less than RDI (9 mg, 49%). CONCLUSIONS Breastfeeding has health and neurodevelopmental benefits for infants and young children that are particularly important in remote Australia where food insecurity and poor nutrition compromise health and wellbeing. Adequate iron intake is also important for neurodevelopment in early life but healthy diets for breastfed babies and young children may have insufficient iron content to meet requirements. The upcoming revision of the Australian Dietary Guidelines provides an opportunity to consider this issue.
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Affiliation(s)
- Dympna Leonard
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Petra Buettner
- Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Robyn McDermott
- Public Health Medicine, University of South Australia, Adelaide, South Australia, Australia
| | - Maria Makrides
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Phillips J, Brunette R, Hefler M, Brimblecombe J, Kearns T. How Barunga Aboriginal community implemented and sustained an anaemia program - A case study evaluation. Health Promot J Austr 2021; 32 Suppl 2:332-350. [PMID: 33455038 DOI: 10.1002/hpja.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Anaemia persists as a public health issue in many Aboriginal communities despite having standard practice guidelines. This case study reveals how Barunga Aboriginal Community in the Northern Territory (NT), Australia, implemented an Anaemia Program (1998-2016) which contributed to low anaemia prevalence in children aged under 5 years. METHODS This retrospective qualitative case study used purposive sampling to describe the Anaemia Program and factors influencing its implementation. Themes were developed from convergence of three data sources: interviews, program observation and document review. Data were inductively analysed by an Aboriginal and non-Aboriginal researcher and themes were validated by Barunga community health practitioners and compared to practice guidelines and implementation literature. RESULTS Health practitioners reported that the Anaemia Program contributed to a marked reduction in childhood anaemia prevalence over time. This was supported by available prevalence data. The locally adapted Anaemia Program was unique in the NT with a novel approach to community supplementation for anaemia prevention in addition to anaemia treatment. Supportive implementation influences included: Aboriginal leadership and the use of culturally supportive processes which reinforced the development of trust and strong relationships facilitating community acceptance of the Program. Routine, opportunistic and flexible health care practice, a holistic approach and a stable, skilled and experienced team sustained program implementation. CONCLUSIONS The holistic and successful Barunga Anaemia Program is supported by evidence and guidelines for treating and preventing childhood anaemia. The contextualisation of these guidelines aligned with the literature on effective Aboriginal primary health care implementation. SO WHAT?: This Anaemia Program provides a model for implementation of evidence-informed guidelines in an Aboriginal primary health care setting.
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Affiliation(s)
- Jodi Phillips
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,School of Medicine, Faculty of Health Deakin University Waurn Ponds, Geelong, VIC, Australia
| | - Raelene Brunette
- Sunrise Health Service Aboriginal Corporation, Katherine, NT, Australia
| | - Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - Julie Brimblecombe
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Therese Kearns
- Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
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Elmardi KA, Adam I, Malik EM, Ibrahim AA, Elhassan AH, Kafy HT, Nawai LM, Abdin MS, Kremers S. Anaemia prevalence and determinants in under 5 years children: findings of a cross-sectional population-based study in Sudan. BMC Pediatr 2020; 20:538. [PMID: 33250057 PMCID: PMC7702668 DOI: 10.1186/s12887-020-02434-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Early childhood is an age at risk of anaemia and its deleterious consequences. In Sudan, there is limited evidence on the prevalence and determinant of anaemia in under-five children. This study was conducted in Sudan to assess the prevalence of anaemia in children and to identify its determinants. Methods We conducted a household survey involving children aged 6 months to 5 years in November 2016. A representative population was sampled across rural, urban and camps settlements across 18 states in Sudan. We used a pre-designed questionnaire data collection. Haemoglobin (Hb) level and malaria infection were checked. In this cross-sectional study, we dichotomized the outcome variable and performed logistic regression analyses. Results A total of 3094 children under 5 years enrolled in the study, 1566 (50.6%) of them were female and 690 (22.3%) of them were under 2 years old. Anaemia prevalence in the whole cohort (6 months - < 5 years) was 49.4% and the mean haemoglobin concentration was 108.1 (standard deviation (SD): 15.4) g/L. The prevalence in younger (6 months - < 2 years) children (61.9%) was higher than in older (2 - < 5 years) children (45.6%) (p < 0.001). Severe anaemia (Hb < 70 g/L) prevalence in the whole population was 1.6%. Age (Odds ratio (OR) 2.25, 95% confidence interval (95%CI) 1.75–2.90, p < 0.001), type of place of residence (OR 0.37, 95%CI 0.18–0.74, p = 0.005), maternal anaemia (OR 1.74, 95%CI 1.39–2.17, p < 0.001), and malaria infection (OR 2.82, 95%CI 1.56–5.11, p < 0.001) were the identified predictors of anaemia in the whole cohort. In younger children, only the economic class was an anaemia predictor, with a lower anaemia risk among the rich wealth class (OR 2.70, 95%CI 1.29–5.62, p = 0.008). However, in older children, three anaemia predictors were identified. These are maternal anaemia (OR 1.79, 95%CI 1.40–2.28, < 0.001), malaria infection (OR 2.77, 95%CI 1.48–5.21, p = 0.002), and type of residency (where camps’ residents were less likely affected with anaemia than rural children (OR 0.38, 95%CI 0.17–0.87, p = 0.022)). Conclusions About half of the under-5 children in Sudan are anaemic, with worse prevalence in younger children. Efforts targeted at improving socio-economic status, decreasing maternal anaemia and childhood malaria infection may mitigate this alarming trend. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-020-02434-w.
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Affiliation(s)
- Khalid Abdelmutalab Elmardi
- Health Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan.
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | | | - Abdalla Ahmed Ibrahim
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | | | - Hmooda Toto Kafy
- Directorate General of Primary Health Care, Federal Ministry of Health, Khartoum, Sudan
| | - Lubna Mohammed Nawai
- Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Mujahid Sheikhedin Abdin
- Health Information, Monitoring and Evaluation and Evidence Department, Federal Ministry of Health, Khartoum, Sudan
| | - Stef Kremers
- Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
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Leonard D, Buettner P, Thompson F, Makrides M, McDermott R. Early childhood anaemia more than doubles the risk of developmental vulnerability at school-age among Aboriginal and Torres Strait Islander children of remote Far North Queensland: Findings of a retrospective cohort study. Nutr Diet 2020; 77:298-309. [PMID: 31914484 PMCID: PMC7317940 DOI: 10.1111/1747-0080.12602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/15/2019] [Accepted: 11/25/2019] [Indexed: 11/28/2022]
Abstract
AIMS Early childhood anaemia, usually attributed to iron deficiency, is associated with persistent detrimental effects on child development. This study investigates the association of anaemia between age six and 23 months with indicators of childhood development at school-age among children of remote Aboriginal and Torres Strait Islander communities of Far North Queensland. METHODS The triennial Australian Early Development Census (AEDC) encompasses five domains of early childhood development-physical health and wellbeing, social competence, emotional maturity, language and cognitive skills (school-based), communication skills and general knowledge. AEDC 2012 and 2015 assessments were linked with health information for children and their mothers from remote Aboriginal and Torres Strait Islander communities of Far North Queensland. RESULTS AEDC assessments were available for 250 children who had measurements of haemoglobin recorded at age 6 to 23 months. More children who had had early childhood anaemia (n = 66/143, 46.2%, [37.9%, 54.4%]) were developmentally vulnerable on two or more domains compared to those who had not been anaemic (n = 25/107, 23.4% [15.2%, 31.5%], P < .001). Multivariable analysis confirmed that early childhood anaemia more than doubled the risk of developmental vulnerability (OR 2.2 [1.1, 4.3] P = .020) at school age. CONCLUSIONS Early childhood anaemia is a risk factor for developmental vulnerability at school-age in this setting. Interventions combining nutrition promotion and multi-micronutrient food fortification, are effective in prevention of early childhood anaemia. Such interventions could also improve early childhood development and subsequent educational achievement.
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Affiliation(s)
- Dympna Leonard
- Australian Institute of Tropical Health and MedicineJames Cook UniversityCairnsQueenslandAustralia
| | - Petra Buettner
- Australian Institute of Tropical Health and MedicineJames Cook UniversityCairnsQueenslandAustralia
- Tropical Health Solutions Pty LtdTownsvilleQueenslandAustralia
| | - Fintan Thompson
- Australian Institute of Tropical Health and MedicineJames Cook UniversityCairnsQueenslandAustralia
| | - Maria Makrides
- Healthy Mothers, Babies and ChildrenSouth Australian Health and Medical Research InstituteAdelaideSouth AustraliaAustralia
- Discipline of Paediatrics, School of MedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Robyn McDermott
- Australian Institute of Tropical Health and MedicineJames Cook UniversityCairnsQueenslandAustralia
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