Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition

Anemia and intestinal parasites in Mbya Guarani children, Misiones, Argentina

This study aimed to assess the prevalence of anemia in children of two Guarani communities in Misiones, Argentina, and to analyze its association with socioenvironmental and parasitic factors. This cross-sectional study took place in two villages, Koen Ju and Kaa Poty, and included Mbya Guarani children aged 6 months to 14 years. A multivariable analysis was performed to evaluate the association of anemia with the presence of intestinal parasites. Altogether, 162 children were included in the study: 53.1% were boys, 32.7% had low weight-for-age, and 22.2% low height-for-age. Nearly half (46.9%, n=76) had anemia, which was mainly mild (92.1%), with a few moderate cases (7.9%). Of the 109 children who underwent testing for intestinal parasites, 89 (81.7%) had at least one, and 53 (59.5%) had more than one. The main parasite was Blastocystis hominis (49.5%), followed by Entamoeba coli (47.7%), hookworms (36.7%), and Ascaris lumbricoides (31.5%). In the multivariable analysis, anemia was associated with intestinal parasitosis (adjusted odds ratio [OR] 4.24, 95% confidence interval [CI] 1.08-16.5; p=0.038) and male sex (adjusted OR 2.66; 95% CI 1.08-6.47; p= 0.01). Overall, we found that both anemia and intestinal parasites are common in the pediatric population of the Guarani ethnic group. Intestinal parasites and male sex were associated with the presence of anemia.

Social vulnerability among Brazilian children in early childhood: a scoping review

OBJECTIVE

To identify, map, and describe studies involving Brazilian children in early childhood in situations of social vulnerability.

SOURCE OF DATA

A scoping review including full articles published in Portuguese and English up to March 2023, with no temporal restrictions. Searches were conducted in the MEDLINE/PubMed, Scielo, EMBASE, Cochrane, Scopus, CINAHL, Web of Science, PEDro, and LILACS databases. Journal metrics, sample characteristics, study area, characterization of the situation of social vulnerability, and study outcomes were extracted.

SUMMARY OF THE FINDINGS

Seventy-six articles involving a total of 107.740 children in early childhood were included in this study. These studies presented relevant findings, including the temporal publication trend, the variability of social vulnerability indicators, the scarcity of intervention studies, and the fact that 100% of eligible studies were from the health area. Negative outcomes were associated with the condition of social vulnerability in almost the entire sample, reinforcing the need for government policies capable of protecting early childhood from the effects of social vulnerability.

CONCLUSION

This scoping review mapped important findings involving Brazilian children in social vulnerability. It also identified literature gaps such as the need for intervention and multisectoral studies among health, education, and social protection.

The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model

BACKGROUND

Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa.

OBJECTIVE

To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa.

METHODS

The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model.

RESULTS

The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia.

CONCLUSION

Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.

Application of machine learning methods for predicting childhood anaemia: Analysis of Ethiopian Demographic Health Survey of 2016

Childhood anaemia is a public health problem in Ethiopia. Machine learning (ML) is a growing in medicine field to predict diseases. Diagnosis of childhood anaemia is resource intensive. The aim of this study is to apply machine learning (ML) algorithm to predict childhood anaemia using socio-demographic, economic, and maternal and child related variables. The study used data from 2016 Ethiopian demographic health survey (EDHS). We used Python software version 3.11 to apply and test ML algorithms through logistic regression, Random Forest (RF), Decision Tree, and K-Nearest Neighbours (KNN). We evaluated the performance of each of the ML algorithms using discrimination and calibration parameters. The predictive performance of the algorithms was between 60% and 66%. The logistic regression model was the best predictive model of ML with accuracy (66%), sensitivity (82%), specificity (42%), and AUC (69%), followed by RF with accuracy (64%), sensitivity (79%), specificity (42%), and AUC (63%). The logistic regression and the RF models of ML showed poorest family, child age category between 6 and 23 months, uneducated mother, unemployed mother, and stunting as high importance predictors of childhood anaemia. Applying logistic regression and RF models of ML can detect combinations of predictors of childhood anaemia that can be used in primary health care professionals.

Prevalence of and factors associated with childhood anaemia in remote villages of the Peruvian Amazon: a cross-sectional study and geospatial analysis

BACKGROUND

Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages.

METHODS

To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1-9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function.

RESULTS

Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking water was surface water (prevalence ratio [PR] 1.26 [95% CI 1.14 to 1.40], p<0.001) and who were in the lowest SES tercile (PR 1.16 [95% CI 1.02 to 1.32], p=0.021). Moderate-or-worse anaemia was more common among boys (PR 1.32 [95% CI 1.09 to 1.60], p=0.005). No evidence of geospatial clustering was found.

CONCLUSIONS

Remote villages of the Amazon would benefit from interventions for childhood anaemia and the poorest households would have the most to gain. Integrating anaemia screening into neglected tropical diseases surveys is an opportunity to use public health resources more efficiently.

Global profile of anemia during pregnancy versus country income overview: 19 years estimative (2000-2019)

Anemia is a worldwide public health problem that is worst in low- and middle-income countries (LMICs), reaching 60% of prevalence. The etiology of anemia is diverse and multifactorial, with iron deficiency being the most prevalent, and often found in pregnant women. Iron is indispensable for the production of red blood cells and approximately 80% of the available heme iron is used for hemoglobin synthesis in mature erythroblasts. Iron deficiency affects oxygen transport, compromising energy and muscle metabolism and can occur with depletion of iron storage, defective erythropoiesis, and low hemoglobin levels. We analyzed anemia prevalence in pregnant women from 2000 to 2019 worldwide correlating them with current (2022) country income, with especial attention to LMICs using WHO dataset. Our analysis indicates that pregnant women from LMICs had a higher probability (40%) of anemia during pregnancy especially those from Africa and South Asia. Africa and the Americas showed a higher decrease in the prevalence of anemia from 2000 to 2019. The Americas and Europe have a lower prevalence, concentrated in 57% of most upper-middle- and high-income countries. Black women are also more prone to develop anemia during pregnancy, especially if they are from LMICs. However, the prevalence of anemia appears to decrease with an increase in educational level. In conclusion, anemia prevalence fluctuated from 5.2 to 65.7% worldwide in 2019, validating it as a public health problem.

Prevalence and Risk Factors of Anaemia among Orang Asli Children in Malaysia: A Scoping Review

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.

A Case-Control Study of the Factors Associated with Anemia in Chinese Children Aged 3-7 years Old

Background

Anemia in children is still an important public problem in China and can have a profound impact on the physical and mental health of children. The purpose of this study was to explore the risk factors for anemia among Chinese children aged 3-7 years old and to provide some basis for the prevention and control of anemia.

Methods

A matched case-control study was conducted and 1104 children (552 cases and 552 controls) were recruited in this study. Cases were children who were diagnosed with anemia by the doctor of physical examination and checked by one deputy chief physician of pediatrics, and controls were healthy children without anemia. Data were collected using a self-designed structured questionnaire. Univariable and multivariable analyses were used to identify independent determinants of anemia. P values less than 0.05 were used to declare statistical significance.

Results

In the multivariable analyses, maternal anemia before or during pregnancy and lactation (OR = 2.14, 95% CI: 1.10∼4.15; OR = 2.86, 95% CI: 1.66∼4.94; OR = 2.51, 95% CI: 1.13∼5.60), gestational weeks (OR = 0.72, 95% CI: 0.53∼0.96), having G6PD deficiency or thalassemia (OR = 8.12, 95% CI: 2.00∼33.04; OR = 36.25, 95% CI: 10.40∼126.43), having cold and cough in previous two weeks (OR = 1.56, 95% CI: 1.04∼2.34), family income (OR = 0.80, 95% CI: 0.65∼0.97), and being a picky eater (OR = 1.80, 95% CI: 1.20∼2.71) were determinants of anemia in children aged 3-7 years old.

Conclusions

Some of the identified factors are modifiable and could be targeted to reduce childhood anemia. More emphasis should be given by the concerned bodies to intervene in the anemia problem by improving the maternal health education, screening for disease-related anemia, requesting medical services in a timely manner, improving the economic status of households, promoting dietary habits, and improving sanitation and hygiene practices.

Prevalence of anemia among Indigenous children in Latin America: a systematic review

OBJECTIVE

To describe the prevalence pattern of anemia among Indigenous children in Latin America.

METHODS

PRISMA guidelines were followed. Records were identified from the databases PubMed, Google Scholar, and Lilacs by two independent researchers between May and June 2021. Studies were included if the following criteria were met: a) studied Indigenous people b) was about children (from 0 to 12 years old); c) reported a prevalence estimate of anemia; d) had been conducted in any of the countries of Latin America; e) was published either in English, Portuguese, or Spanish; f) is a peer-reviewed article; and g) was published at any date.

RESULTS

Out of 2,401 unique records retrieved, 42 articles met the inclusion criteria. A total of 39 different Indigenous communities were analyzed in the articles, and in 21 of them (54.0%) child anemia was a severe public health problem (prevalence ≥ 40%). Those communities were the Aymara (Bolivia); Aruak, Guaraní, Kamaiurá, Karapotó, Karibe, Kaxinanuá, Ma-cro-Jê, Suruí, Terena, Xavante (Brazil); Cabécar (Costa Rica), Achuar, Aguaruna, Awajún, Urarina, Yomybato (Peru); Piaroa and Yucpa (Venezuela); and Quechua (Peru and Bolivia). Children below two years had the highest prevalence of anemia (between 16.2% and 86.1%). Among Indigenous people, risk factors for anemia include nutrition, poor living conditions, access to health services, racism, and discrimination. Bolivia and Guatemala are scarcely studied, despite having the highest proportion of Indigenous communities in Latin America.

CONCLUSIONS

Anemia constitutes a poorly documented public health problem among Indigenous children in 21 Indigenous communities in Bolivia, Brazil, Colombia, Costa Rica, Ecuador, Guatemala, Mexico, and Peru. In all Indigenous communities included in this study child anemia was an issue, especially in younger children.

Predictors of iron deficiency anaemia among children aged 6-59 months in Tanzania: Evidence from the 2015-16 TDHS-MIS cross-sectional household survey

Iron deficiency anaemia remains a public health problem, particularly in children aged 6-59 months. This study assessed factors associated with iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months in Tanzania. Data for this cross-sectional study were extracted from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS). The study covered 8014 children aged 6-59 months and their mothers. Iron deficiency anaemia was defined (haemoglobin < 11g/dL). Univariable and multivariable logistic regression analyses that adjust for clustering and sampling weights were conducted to describe the associations between anaemia and potential confounding variables. The prevalence of iron deficiency anaemia among children aged 6-23 months, 24-59 months and 6-59 months were 76%, 49% and 59%, respectively. Factors associated with increased odds of iron deficiency anaemia among children aged 6-23 months included a mother being employed, being a male child, child perceived to small size at birth by mothers, a mother being anaemic and children belonging to the poorest socio-economic quintile. In addition, being a mother with no schooling, children not being dewormed, a mother being anaemic, delivering a baby at home, child fever and stunting, were factors associated with increased odds of iron deficiency anaemia among children aged 24-59 months. Factors associated with increased odds of iron deficiency anaemia among children aged 6-59 months were: a mother being employed, being a mother with no schooling, being a male child, belonging to the 6-59 months age bracket, a mother having a BMI of between 19 and 25 kg/m2, a mother being anaemic, having a baby at home, children belonging to bigger households, child fever and stunting. Interventions to minimise the burden of iron deficiency anaemia in children should target employed and/or anaemic mothers, poor and rich households, as well as male children.

Anaemia and associated factors among children aged 6-23 months in agrarian community of Bale zone: a cross-sectional study

Anaemia remains among the most prevalent nutritional problems among children in developing countries. In Ethiopia, more than half of children <5 years of age are anaemic. In the early stages of life, it leads to poor cognitive performance, delay psychomotor development and decreases working capacity in later life. The present study aimed to assess the prevalence and associated factors of anaemia among children aged 6-23 months in the Bale zone. A community-based cross-sectional study was conducted from 1 to 30 June 2021. Multistage stratified sampling and simple random sampling techniques were employed to select 770 samples. An interviewer-administered questionnaire was used to collect data on socio-demographic, child health and feeding practices. Haemoglobin levels were estimated using a portable Hemosmart machine. Children with haemoglobin values below 11 g/dl were considered anaemic. Binary logistic regression analysis was performed to identify factors associated with anaemia. Statistical significance was set at P < 0⋅05. The prevalence of anaemia was 47⋅9 % (95 % CI (44⋅4, 51⋅5)). The multivariate analysis showed that child age (6-11 months) (AOR 1⋅47; 95 % CI (1⋅06, 2⋅03)), household food insecurity (AOR 1⋅44; 95 % CI (1⋅01, 2⋅04)), having diarrhoea and cough in the past 2 weeks (AOR 1⋅70; 95 % CI (1⋅18, 2⋅44)) and (AOR 1⋅97; 95 % CI (1⋅28, 3⋅04), respectively), not consuming the recommended dietary diversity (AOR 2⋅72; 95 % CI (1⋅96, 3⋅77)) and stunting (AOR 1⋅88; 95 % CI (1⋅31, 2⋅70)) were significantly associated with anaemia. Anaemia in children aged 6-23 months was a severe public health problem in the study area. Integrated nutritional interventions combined with iron fortification and supplementation is recommended.

Wildmeat consumption and child health in Amazonia

Consuming wildmeat may protect against iron-deficiency anemia, a serious public health problem globally. Contributing to debates on the linkages between wildmeat and the health of forest-proximate people, we investigate whether wildmeat consumption is associated with hemoglobin concentration in rural and urban children (< 5 years old) in central Brazilian Amazonia. Because dietary practices mediate the potential nutritional benefits of wildmeat, we also examined whether its introduction into children's diets is influenced by rural/urban location or household socio-economic characteristics. Sampling 610 children, we found that wildmeat consumption is associated with higher hemoglobin concentration among the rural children most vulnerable to poverty, but not in the least vulnerable rural, or urban children. Rural caregivers share wildmeat with children earlier-in-life than urban caregivers, potentially because of cultural differences, lower access to domesticated meat, and higher wildmeat consumption by rural households (four times the urban average). If wildmeat becomes unavailable through stricter regulations or over-harvesting, we predict a ~ 10% increased prevalence of anemia among extremely poor rural children. This modest protective effect indicates that ensuring wildmeat access is, alone, insufficient to control anemia. Sustainable wildlife management could enhance the nutritional benefits of wildlife for vulnerable Amazonians, but reducing multidimensional poverty and improving access to quality healthcare are paramount.

Prevalence and Triggering Factors of Childhood Anemia: An Application of Ordinal Logistic Regression Model

INTRODUCTION

Anemia is indeed a significant risk factor for children's health as it affects growth retardation and has severe short and prolonged effects that follow in morbidity and death. Notwithstanding such ways to tackle anemia, the prevalence remains high in India and poses a severe public health concern.

OBJECTIVES

The primary focus of this study was to find the prevalence and to determine the factors associated with the anemia of children under five years of age in India. Problem Statement. The increasing prevalence of childhood anemia and the life-threatening consequences for millions of children in India are a major concern. Knowing the relevant associated factors with childhood anemia is essential to reduce the frequency and severity level. Study design. For analysis purposes, this study utilized a cross-sectional study design. Methodology. Using the Indian Demographic and Health Survey 2015-16 data, we used chi-squared and gamma tests to find the association. Then, we utilized multinomial logistic regression and ordinal logistic regression to find the better model and the influencing factors of anemia in India.

RESULTS

In our study, we have found that children with highly educated mothers were 36.7% less likely (OR = 0.633, P ≤ 0.001, 95% CI: 0.608, 0.658) to be higher anemic than the children with not educated mother. Children with moderate and severe anemic mothers were 163.3% (OR = 2.633, P ≤ 0.001, 95% CI: 2.565, 7.704) more likely to be higher anemic than the children with not anemic mother. Not stunting children were 21.9% (OR = 0.781, P ≤ 0.001, 95% CI: 0 .764, 0.797) less likely to be higher anemic than the stunting children. Children aged 36-59 months were 73.9% (OR = 0.361, P ≤ 0.001, 95% CI: 0.353, 0.369) less likely to be higher anemic than the children aged 6-24 months. Again, the ACI value revealed that ordinal logistic regression was a better-fitted model for these data.

CONCLUSION

and contribution. The variables such as stunting, underweight, wasting, child age, size of the child, and source of drinking water were the most critical indicators for child anemia in India. In summary, our study result indicated the major socioeconomic and demographic factors associated with childhood anemia in India, which can help the policymaker to take quick decision to reduce the severity level.

Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis

OBJECTIVE

To estimate the prevalence of anaemia in Brazilian children up to 83·9 months old.

DESIGN

Systematic review and meta-analysis, using databases PubMed, Scopus, SciELO, Lilacs, Google Scholar, Periódicos Capes, Arca, Biblioteca Virtual em Saúde, Microsoft Academic Search and Cochrane Library using search terms: anaemia, prevalence, child and Brazil. PROSPERO Registration number: CRD42020208818.

SETTING

Cross-sectional, cohort, case-control and intervention studies published between 2007 and 2020 were searched, excluding those who assessed children with an illness or chronic condition. The main outcome was anaemia prevalence. Random effects models based on the inverse variance method were used to estimate pooled prevalence measures. Sensitivity analyses removed studies with high contribution to overall heterogeneity.

PARTICIPANTS

From 6790 first screened, 134 eligible studies were included, totalling 46 978 children aged zero to 83·9 months analysed, with adequate regions representativeness.

RESULTS

Pooled prevalence of anaemia was 33 % (95 % CI 30, 35). Sensitivity analyses showed that withdrawal of studies that contributed to high heterogeneity did not influence national average prevalence.

CONCLUSIONS

Childhood anaemia is still a serious public health problem in Brazil, exposing 33 % of Brazilian children to the anaemia repercussions. The main limitation of the study is the estimation of national prevalence based on local surveys, but a large number of studies were included, with representation in all regions of the country, giving strength to the results. In Brazil, more public policies are needed to promote supplementation, fortification and access to healthy eating to reduce the high level of anaemia among children.

Prevalence and Determinants of Anemia among Children in Zanzibar, Tanzania: Analysis of Cross-Sectional Population Representative Surveys

The aim of this study was to assess the prevalence of anemia and its determinants among children aged 6–59 months in Zanzibar, Tanzania, from 2005 to 2015. We used secondary data from the Tanzania Demographic and Health Surveys from three different periods: 2005, 2010, and 2015. A sample of 3502 child-mother pairs from three survey datasets was used to analyze the overall prevalence of anemia and reveal its determinants. Hierarchical logistic regression was used to demonstrate the prevalence odds ratio of factors, both from the mothers and children, for anemia prevalence. The study indicated a significant decrease in anemia prevalence from 76.1% in 2005 to 65.4% in 2015 (p < 0.001). Hierarchical logistic regression between variables and anemia showed a significant association (p = 0.02) with households that improperly disposed of stool, children with minimum dietary diversity (p = 0.041), children in low age quartiles (p = < 0.001), and underweight children (p = 0.025). Maternal, household characteristics, and child factors were associated with childhood anemia in Zanzibar, Tanzania. Despite the significant decrease of anemia in Zanzibar, the overall prevalence rate is still a significant public health concern. Designing and strengthening comprehensive interventions to address anemia in the general population and different categories should be given special consideration.

An Assessment of Health Outcomes and Methylmercury Exposure in Munduruku Indigenous Women of Childbearing Age and Their Children under 2 Years Old

In line with the 1000-day initiative and the Sustainable Development Goals (SDG) 2 and 3, we present a cross-sectional analysis of maternal health, infant nutrition, and methylmercury exposure within hard-to-reach indigenous communities in the state of Pará, Brazilian Amazon. We collected data from all women of childbearing age (i.e., 12-49) and their infants under two years old in three Munduruku communities (Sawré Muybu, Sawré Aboy, and Poxo Muybu) along the Tapajos River. We explored health outcomes through interviews, vaccine coverage and clinical assessment, and determined baseline hair methylmercury (H-Hg) levels. Hemoglobin, infant growth (Anthropometric Z scores) and neurodevelopment tests results were collected. We found that 62% of women of childbearing age exceeded the reference limit of 6.0 μg/g H-Hg (median = 7.115, IQR = 4.678), with the worst affected community (Sawré Aboy) registering an average H-Hg concentration of 12.67 μg/g. Half of infants aged under 24 months presented with anemia. Three of 16 (18.8%) infants presented H-Hg levels above 6.0 µg/g (median: 3.88; IQR = 3.05). Four of the 16 infants were found to be stunted and 38% of women overweight, evidencing possible nutritional transition. No infant presented with appropriate vaccination coverage for their age. These communities presented with an estimated Infant Mortality Rate (IMR) of 86.7/1000 live births. The highest H-Hg level (19.6 µg/g) was recorded in an 11-month-old girl who was found to have gross motor delay and anemia. This already vulnerable indigenous Munduruku community presents with undernutrition and a high prevalence of chronic methylmercury exposure in women of childbearing age. This dual public health crisis in the context of wider health inequalities has the potential to compromise the development, health and survival of the developing fetus and infant in the first two critical years of life. We encourage culturally sensitive intervention and further research to focus efforts.

Prevalence of Intestinal Parasite Infection and its Association with Anemia among Children Aged 6 to 59 Months in Sidama National Regional State, Southern Ethiopia

BACKGROUND

Previous studies conducted in Ethiopia revealed anemia as a severe public health problem among under-5 children but failed to associate with parasite infection. This study was aimed at assessing the prevalence of intestinal parasite infection (IP) and its association with anemia among children aged 6 to 59 months in Yirgalem General Hospital, Southern Ethiopia.

METHOD

Institution based cross-sectional study was conducted in 2020 on 367 children aged 6 to 59 months. Trained data collectors administered the questionnaire. Blood was collected and analyzed for hemoglobin using the HemoCue 301. The stool samples were collected and analyzed. Association between IP and anemia was measured using multivariable analysis. The outputs are presented using an adjusted odds ratio (AOR) with 95% confidence intervals.

RESULTS

The prevalence of anemia was 48.8% (95% CI: 43.7, 53.9). Anemia was of mild, moderate, and severe type in 24.5%, 21.5%, and 2.8% of the children respectively. The prevalence of IP was 43.3% (95% CI: 38.2, 48.3). The odds of anemia were higher among children infected with IP (AOR = 3.19, 95% CI: 1.97, 5.17), large family size (AOR = 2.13, 95% CI: 1.26, 3.59), low-income level (AOR = 2.05, 95% CI: 1.25, 3.35), and MUAC < 11 cm (AOR = 3.27, 95% CI: 1.85, 5.81).

CONCLUSIONS

The prevalence of IP was high. Anemia has severe public health significance. IP infection, income level, family size, and MUAC level were associated with anemia in children. Strengthening existing programs to prevent childhood anemia, and IP recommended.

Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis

BACKGROUND

Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa.

METHODS

This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia.

RESULTS

The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia.

CONCLUSION

Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.

Prevalence of iron-deficiency anaemia in Brazilian children under 5 years of age: a systematic review and meta-analysis

Fe-deficiency anaemia is considered an important public health problem both in wealthier countries and in those of medium and low income, especially in children under 5 years of age. The shortage of studies with national representativity in medium-income countries, such as Brazil, prevents the knowledge of the current situation and its associated factors. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of Fe-deficiency anaemia in Brazilian children under 5 years of age and determined the factors involved in the variability of the estimates of prevalence. We collected fifty-seven studies from the databases MEDLINE, LILACS and Web of Science, along with the reference lists of included articles. We contacted authors for unpublished data. We did not restrict publication timespan and language. This systematic review and meta-analysis was reported according to the guidelines by PRISMA. The pooled prevalence of anaemia in Brazil was 40·2 (95 % CI 36·0, 44·8) %. The age range of the child and the period of data collection were associated with the anaemia prevalence. The pooled prevalence of anaemia was higher in children under 24 months of age (53·5 v. 30·7 %; P < 0·001) and in studies with data collected before 2004 (51·8 v. 32·6 %; P = 0·001). The efforts made by the Brazilian government were successful in the reduction of anaemia in children under 5 years of age in Brazil in the evaluated period. However, prevalence remains beyond acceptable levels for this population group.

Baixo peso ao nascer, prematuridade e restrição de crescimento intra-uterino: resultados dos dados de base da primeira coorte de nascimentos indígenas no Brasil (coorte de nascimentos Guarani)

ABSTRATO

FUNDO: O baixo peso ao nascer (BPN) continua sendo um importante problema de saúde global, associado a uma série de resultados adversos de saúde ao longo da vida. As evidências sugerem que o BPN é um determinante relevante de morbidade e mortalidade em grupos indígenas, que geralmente têm acesso limitado às políticas públicas de saúde e nutrição. O conhecimento da prevalência de BPN e de suas causas subjacentes pode contribuir com etapas essenciais para a prevenção de seus efeitos sobre a saúde. O estudo teve como objetivo estimar as prevalências de BPN, prematuridade e restrição de crescimento intra-uterino (RCIU) e investigar seus determinantes na primeira coorte de nascimentos indígenas no Brasil. MéTODOS: Este estudo transversal utilizou dados de linha de base coletados da primeira coorte de nascimentos indígenas no Brasil, a Coorte de Nascimentos Guarani. O Brasil é um dos países com maior diversidade étnica do mundo, com 305 povos indígenas e 274 línguas nativas. Os Guarani são uma das cinco maiores etnias, com aldeias localizadas principalmente na região sul. Todos os nascimentos únicos de 1º de junho de 2014 a 31 de maio de 2016 foram selecionados em 63 aldeias indígenas Guarani nas regiões Sul e Sudeste. Foi realizada regressão logística múltipla hierárquica.

RESULTADOS

As taxas de prevalência de BPN, prematuridade e RCIU foram 15,5, 15,6 e 5,7%, respectivamente. As chances de BPN foram menores em recém-nascidos de mães que vivem em casas de tijolo e argamassa (OR: 0,25; IC 95%: 0,07-0,84) e foram maiores em filhos de mães ≤20 anos de idade (OR: 2,4; IC 95%: 1,29-4,44) e com anemia crônica antes da gravidez (OR: 6,41; IC 95%: 1,70-24,16). A prematuridade foi estatisticamente associada ao tipo de fonte de energia para cozinhar (fogão a lenha - OR: 3,87; IC 95%: 1,71-8,78 e fogueiras - OR: 2,57; IC 95%: 1,31-5,01). RCIU foi associado à primiparidade (OR: 4,66; IC 95%: 1,68-12,95) e anemia materna crônica antes da gravidez (OR: 7,21; IC 95%: 1,29-40,38). CONCLUSõES: Idade materna, estado nutricional e paridade, condições de moradia e exposição à poluição interna foram associados com resultados perinatais na população indígena Guarani. Esses resultados indicam a necessidade de investir no acesso e melhoria da assistência pré-natal; também no fortalecimento do Subsistema de Saúde Indígena, e em ações intersetoriais para o desenvolvimento de políticas habitacionais e de saneamento e melhorias ambientais ajustadas às necessidades e conhecimentos dos povos indígenas.

["Measuring hunger": psychometric scales of food insecurity and indigenous peoples in Brazil]

The Brazilian Food Insecurity Scale (EBIA) was validated for the Brazilian context in 2004. Since then, the scale has evaluated and measured the experience of food insecurity in rural and urban households, initially in the Brazilian National Household Sample Survey and later in the Brazilian National Survey of Demographic and Health. However, indigenous peoples have not been examined specifically in these surveys, despite recognition of their food and nutritional vulnerability. In this scenario, we analyze and discuss the application of the EBIA among indigenous peoples in Brazil, based on a set of fundamental questions for understanding and measuring their experience with food insecurity and "hunger". We conduct a sociopolitical and ethnographic analysis of a set of official documents and significant articles on the use of psychometric scales of food insecurity among Brazilian indigenous peoples, compared to international studies on the validation and application of scales in other sociocultural contexts. The initiatives with adaptation and application of the EBIA to indigenous peoples in Brazil indicate that understanding and measuring food insecurity in these peoples poses a major challenge. Particularly complex is the proposal to guarantee comparability of different contexts while taking into account the multiple local singularities. We propose that ethnographic studies should serve as specific components of future initiatives on this topic and that they should cover aspects such as the seasonality of indigenous peoples' food production, different processes of food monetization, and the dynamics of their food systems.

Sanitation conditions of indigenous and nonindigenous households in Brazil according the 2000 and 2010 national censuses

This study compares the availability of basic sanitation infrastructure in indigenous and nonindigenous household located in urban and rural areas using data from the 2000 and 2010 Brazilian National Censuses. The analyses were based on descriptive statistics and modelling with multiple logistic regression. While there was an increase in the availability of basic sanitation in Brazilian households over the decade, indigenous households continued to have worse conditions in 2010. Sewage was the sanitation service with the lowest coverage in both censuses, and indigenous households had a lower rate of sewage services than nonindigenous households did. Logistic regression results confirmed the findings of the descriptive analyses, attesting to the fact that sanitation conditions are worse in indigenous households. In some areas, such as the urban North and Southeast and rural areas of the Central-West region, the gap in basic sanitation infrastructure between indigenous and nonindigenous households increased from 2000 to 2010. This study not only indicates the less-adequate sanitation conditions in indigenous households in Brazil but also attests to the persistence of major inequalities associated with race or color in the country.

Community-level epidemiology of intestinal helminth infections and anemia in Harbu Town, northeastern Ethiopia

Anemia and intestinal helminth infections are overlapping health problems in developing countries. This study examined the determinants of intestinal helminth infection and anemia in a human population in Harbu Town, northeastern Ethiopia. A total of 484 individuals provided stool and blood samples as well as information about their sociodemographic characteristics and living practices in a community-based cross-sectional survey conducted between May and June, 2013. Stool specimens were examined for intestinal helminth infections using the Kato-Katz method. While a HemoCue machine was used to measure blood hemoglobin levels, a CareStart^TM malaria Pf/Pv combo test was used to test the blood specimens for Plasmodium infection. Out of 484 individuals examined, 15.5% were anemic and 32.0% were infected with intestinal helminths. Plasmodium infection was not detected in any of the study participants. Schistosoma mansoni infection was most common (26.7%) followed by Hymenolepis nana (4.1%). The prevalence of S. mansoni and H. nana infection was greater among school-age children than in pre-school-age children and adults. The prevalence of helminth infection decreased with an increase in monthly income (P = 0.048) and varied among different occupations (P = 0.023). The odds of anemia increased with an increase in the age of individuals (adjusted odds ratio = 1.03, 95% CI = 1.01, 1.06). Hookworm infection was associated with anemia (P = 0.029). In conclusion, intestinal helminth infections and anemia were public health problems among the community of Harbu Town. Increasing age and hookworm infection may increase susceptibility to anemia. Controlling helminth infection may help to reduce the burden of anemia in Harbu Town, Ethiopia.

Cultural Values and the Coliform Bacterial Load of "Masato," an Amazon Indigenous Beverage

Access to safe drinking water is limited in many isolated areas, such as the Amazon where Indigenous peoples frequently reside. Identifying safe forms of drinking water accepted by the communities could have positive health benefits for Indigenous peoples. Many Amazon Indigenous peoples traditionally prepare and consume a fermented beverage called masato, which is frequently the only form of water consumption. Despite its widespread consumption and evidence of the health benefits of fermentation, masato remains poorly investigated. We partnered with a Shawi Indigenous community in the Peruvian Amazon to conduct participatory photography to research masato preparation, and to characterize key cultural features and to assess the presence of total and fecal coliform bacteria by using a membrane filter technique. Pictures show that masato preparation is a key part of cultural practices and that there are clear gender roles in the preparation process. We found that 100% of communal water sources (26/26) were contaminated with coliform bacteria; by contrast, fewer, 18% of masato samples (2/11), were positive for coliform. This exploratory study suggests that fermented beverages like masato merit further investigation as they represent an Indigenous method to improve water quality in Amazonian communities where water safety cannot be assured.

Magnitude, Severity, and Associated Factors of Anemia among Under-Five Children Attending Hawassa University Teaching and Referral Hospital, Hawassa, Southern Ethiopia, 2016

Background

Anemia is a widespread public health problem associated with increased risk of morbidity and mortality. Infants, under-5-year-old children, and pregnant women have greater susceptibility to anemia. The magnitude and associated risk factors for anemia vary in different settings. The study aimed to assess the magnitude, severity, and associated factors of anemia at Hawassa University Teaching and Referral hospital, Hawassa, southern Ethiopia.

Methods

In a hospital-based cross-sectional study, a total of 422 under-five children were included. Sociodemographic data and other predisposing factors were collected by structured questionnaire. Venous blood samples were collected and analyzed for hemoglobin determination using a Cell-Dyn 1800 automated analyzer. Stool samples were collected and processed using direct wet mount and formol-ether concentration method to detect intestinal parasites. Data were entered and analyzed using SPSS version 20 statistical packages. Binary and multiple logistic regressions were computed to assess factors associated with anemia. p value less than 0.05 was taken as statistically significant.

Result

The overall prevalence of anemia was found to be 41.7%. The mean hemoglobin level was 10.59 g/dl. Anemia was of mild, moderate, and severe type in 6.6%, 19%, and 16.1% of the children, respectively. Children in the age group 6-23 months (AOR = 2.04 (95% CI: 1.13, 3.69)), and mothers having no formal education (AOR = 1.73 (95% CI: 0.99, 3.02)) were identified as associated factors for anemia.

Conclusion

The prevalence of anemia among the study subjects was 41.7% indicative of the fact that anemia is an important public health problem. It was associated with the child's age, residence, mother's education level, and intestinal parasite (Ascaris lumbricoides). It clearly indicates that there should be well integrated public health interventions to improve the health status that needs to be prioritized to prevent anemia among children under five years of age.

Food Profiles of Indigenous Households in Brazil: Results of the First National Survey of Indigenous Peoples' Health and Nutrition

The objective of the present study was to characterize the food profiles in Indigenous households participating in the First National Survey of Indigenous People's Health and Nutrition in Brazil. Multiple correspondence analysis was used to estimate distances between regions and foods from three sources (local Indigenous production, purchased, and external donation), in addition to "not consumed." The combined distribution of the first two dimensions revealed three distinct profiles of food acquisition. Observed proximities between geopolitical regions and distinct modes of food acquisition speak to regional contrasts in food sovereignty among the Indigenous population that are closely linked to historical occupation and economic expansion in the country. Considering the concept of food sovereignty as involving rights to dietary autonomy, healthy diets, and resource management, our data suggest Brazil's North region is the closest of the four regions analyzed to these goals. Food sovereignty in the Northeast and South/Southeast regions is reduced due to greater monetarization and proximity to market economy resources. The advance of agribusiness in the Amazon has been a hallmark of the Brazilian government's current environmental policy, directly threatening the survival of Indigenous peoples living in that region.

Prevalence of anaemia in Brazilian children in different epidemiological scenarios: an updated meta-analysis

OBJECTIVE

To update the estimation of the prevalence of anaemia in Brazilian children according to four different epidemiological scenarios.

DESIGN

A new systematic review was conducted with a meta-analysis of the results published between 2007 and May 2019. Literature search was carried out in the PubMed and LILACS databases using keywords anaemia, child and Brazil. A total of thirty-seven articles (17 741 children) were selected and categorised according to the origin of their respective samples: childcare centres (Childcare; n 13 studies/2697 individuals), health services (Services; n 4/755), populations with social inequities (Inequities, n 7/6798) and population-based studies (Populations; n 13/7491). Assuming a prevalence of 20·9 % as reference (Health National Survey; n 3455), the combined prevalence ratios (PR) were calculated. A random-effects model was used.

PARTICIPANTS

Brazilian children 6-60 months of age.

RESULTS

The prevalence of anaemia, by scenario, was: Childcare 24·8 % (PR 1·06; 95 % CI 0·81, 1·40); Services 39·9 % (PR 1·76, 95 % CI 1·33, 2·35); Inequities 51·6 % (PR 2·02, 95 % CI 1·87, 2·18); and Populations 35·8 % (PR 1·42, 95 % CI 1·23, 1·64). Therefore, the values were all higher than the national prevalence; the Inequities had the highest prevalence, and only Childcare did not reach statistical significance. Concerning the previous meta-analysis, there was a reduction in anaemia prevalence in all scenarios: -52·3, -33·7, -22·4 and -10·7 %, respectively.

CONCLUSIONS

Compared to the situation revealed in the previous meta-analysis, anaemia, although observed to a lesser extent, remains an important public health problem in the different scenarios analysed, especially for children living in Inequities. Access to Childcare mitigates the risk for this condition.

Socioeconomic factors associated with anemia among children aged 6-59 months in Namibia

Anemia remains a public health concern, and its prevalence varies between countries as well as between age, sex and levels of poverty. This study aims at examining the association between socio-demographic factors and anemia among children aged 6–59 months in Namibia. Data was extracted from the 2013 Namibian Demographic Health Survey. The association between anemia and other factors was examined with logistic regression. Results are reported in odds ratio (OR), with 95% confidence intervals (CI). In total, 1,383 children aged 6–59 months had complete data and included in the analyses. Our study shows that there is a statistically significantly increased risk of anemia among children from poorer households compared with the richest quintile. Also, there was a statistically significance supporting anemia being more common among boys than girls. There was also a statistically significant negative effect related to age. Our study shows that young children, boys and children in poorer households have an increased risk of anemia. Considering the adverse impact of anemia on child development, policies must prioritize factors exacerbating anemia risk.

Is Anemia in Low Income Pregnant Women Related to Their Infants' Having Anemia? A Cohort Study of Pregnant Women-Infant Pairs in the United States

OBJECTIVE

Given evidence that anemia in the first year of life is associated with long-term cognitive, motor, and behavioral deficits, reducing infant anemia is important. The primary objective of this research is to examine whether anemia in low income pregnant women in the United States is associated with anemia in the women's infants.

METHODS

This cohort study linked Centers for Disease Control and Prevention surveillance data on pregnant women with incomes below 185% of the federal poverty level from 2010 and 2011 with data on 6-11 month olds from 2011, resulting in a sample of 21,246 uniquely matched mother-infant pairs. We examined bivariate and multivariate relationship between anemia severity in pregnant women and in their infants.

RESULTS

Seventeen percent of women had anemia (13.1% mild and 3.9% moderate to severe) and 20.1% infants had anemia (16.4% mild and 3.7% moderate to severe). For both women and infants, blacks had substantially higher anemia rates than whites. In bivariate analysis and multivariate analyses maternal anemia showed a dose-response relationship to infant anemia. In predicted probabilities from the multivariate models, 27.2% of infants born to pregnant women with moderate to severe anemia had anemia, compared to 23.3% for infants whose mothers had mild anemia, and 18.3% for infants whose mothers did not have anemia.

CONCLUSION

This study provides strong evidence of a relationship between maternal and infant anemia in the United States among people with low incomes. Efforts to reduce anemia during pregnancy may be an important strategy for minimizing childhood anemia.

Determinants of stunting among children aged 0-59 months in Nepal: findings from Nepal Demographic and health Survey, 2006, 2011, and 2016

Background

Stunting is one of the most commonly used indicators of child nutrition and health status. Despite significant efforts by the government and external development partners to improve maternal and child health and nutrition, stunting is consistently high in Nepal. This paper assesses the potential determinants of stunting among children aged 0–59 months using the last three successive Nepal Demographic and Health Surveys (NDHS).

Methods

We used three nationally representative cross-sectional household surveys, known as the NDHS- 2006, 2011 and 2016. Logistic regression was used to identify the potential determinants of stunting. The sub sample for this study includes n = 5083 in 2006, n = 2485 in 2011, and n = 2421 in 2016.

Results

Rates of stunting decreased from nearly 50% in 2006 to about 36% in 2016. The prevalence of stunting was higher among children from larger families (51.0% in 2006, 41.1% in 2011, 38.7% in 2016), poor wealth quintile households (61.2% in 2006, 56.0% in 2011, 49.2% in 2016), and severely food insecure households (49.0% in 2011, 46.5% in 2016). For child stunting, the common determinants in all three surveys included: being from the highest equity quintile (OR: 0.58 in 2006, 0.26 in 2011, 0.28 in 2016), being older (OR: 2.24 in 2006, 2.58 in 2011, 1.58 in 2016), being below average size at time of birth (OR: 1.64 in 2006, 1.55 in 2011, 1.60 in 2016), and being affected by anemia (OR: 1.32 in 2006, 1.59 in 2011, 1.40 in 2016).

Conclusions

This study found that household wealth status, age of child, size of child at time of birth, and child anemia comprised the common determinants of stunting in all three surveys in Nepal. Study findings underscore the need for effective implementation of evidence-based nutrition interventions in health and non-health sectors to reduce the high rates of child stunting in Nepal.

Electronic supplementary material

The online version of this article (10.1186/s40795-019-0300-0) contains supplementary material, which is available to authorized users.

Determinants of Anemia among Children Aged 6–59 Months in Ethiopia: Further Analysis of the 2016 Ethiopian Demographic Health Survey

Background. Anemia among children is a global public health problem. The burden is high in developing countries including Ethiopia. Although there are some studies about anemia among children, there is a dearth of information about factors associated with anemia in Ethiopia. Therefore, this analysis was performed to identify factors associated with anemia among children aged 6–59 months in Ethiopia. Methods. We used the 2016 Ethiopian Demography and Health Survey (EDHS) data. EDHS was a community-based, cross-sectional study conducted from January 18, 2016 to June 27, 2016. The 2016 EDHS selected the participants using a two-stage stratified cluster sampling technique. A total of 8,462 children aged 6–59 months were included for this analysis. Both descriptive and logistic regression analyses were performed using Stata version14. A P value less than 0.05 at 95% confidence interval was set to test the statistical significance. Results. The analysis indicated that about 58% (95% CI: 55.1, 60.1) of children aged 6–59 months were anemic. Of those, 29.4% and 3.1% had moderate and severe anemia, respectively. The analysis revealed that stunted (AOR = 0.135, 95% CI: 1.13, 1.62) and underweight (AOR = 1.27, 95% CI: 1.04, 1.55) children had higher odds of being anemic. Besides, children aged 6–23 months (AOR = 1.39, 95% CI: 1.06, 1.82), 24–42 months of age (AOR = 1.26, 95% CI: 1.05, 1.51), and those with fever (AOR = 1.34, 95% CI: 1.07, 1.67) had higher odds of being anemic. Similarly, children from anemic mothers (AOR = 1.86, 95% CI: 1.58, 2.18) and poor households (AOR = 1.35, 95% CI: 1.09, 1.67) were at a higher risk of anemia. Children from households with large family sizes (AOR = 1.29, 95% CI: 1.03, 1.60), young mothers (15–24 years of age (AOR = 1.39, 95% CI: 1.06, 1.82) and 25–34 years of age (AOR = 1.26, 95% CI: 1.05, 1.51)), and developing regions (AOR = 1.44, 95% CI: 1.03, 2.02) also had higher odds of developing anemia. Conclusion. The overall prevalence of anemia among children aged 6–59 months in Ethiopia was high. Malnourished children (stunting and underweight); children with fever; children from anemic, uneducated, and young mothers; and children from large and poor families had higher odds to develop anemia. Therefore, preventing childhood illnesses and maternal anemia should be strengthened to reduce anemia among children.

The Xavante Longitudinal Health Study in Brazil: Objectives, design, and key results

OBJECTIVE

The Xavante Longitudinal Health Study was developed to permit granular tracking of contemporary health challenges faced by indigenous communities in Brazil, taking into consideration ongoing historical processes that may be associated with increases in child undernutrition, adult obesity, and cardiovascular disease risks.

METHODS

This was an open-cohort study with six semiannual data collection waves from 2009 to 2012. The study was undertaken in two Xavante villages, Pimentel Barbosa and Etênhiritipá, State of Mato Grosso, Central Brazil. No sampling technique was used. Data collection placed emphasis on growth and nutrition of children under five and nutrition status, blood pressure, and blood glucose levels of adolescents and adults.

RESULTS

Baseline data collection began in July/August 2009 with a population census (656 individuals). Between the first and final waves, the study population increased by 17%. At baseline, stunting and wasting was elevated for most age groups <10 years. Overweight, obesity, and increased risk of metabolic complications were expressive among individuals >17 years, disproportionately affecting females. Anemia was elevated in most age groups, especially among females. Mean systolic and diastolic blood pressure was moderate. The overall prevalence of high blood pressure was relatively low.

CONCLUSIONS

Our findings reveal marked health disparities relative to the Brazilian national population and a complex dietary health epidemiology involving the double burden of malnutrition, rapidly changing nutritional indicators, and elevated metabolic disease risk. The topically broad multidisciplinary focus permitted construction of the richest longitudinal data set of socio-epidemiological information for an indigenous population in Brazil.

[Basic sanitation and inequalities in color/race in urban households with under-five children, with a focus on the indigenous population]

This study aimed to analyze the presence of basic sanitation services in households with children under five years of age located in urban areas of Brazil, with a focus on indigenous children. This cross-sectional study was based on data from the 2010 Population Census. We calculated the rates of households with running water (public system), sewage disposal (public system or septic tanks), and garbage collection (directly or via public dumpsters). Multiple logistic regression (MLR) models were used to estimate associations between color/race and presence of sanitation services, based on odds ratios (OR). The study considered Brazil's urban metropolitan areas and stratified the results by major geographic region. Significance was set at 5%. The lowest frequencies were for sewage disposal, and all the rates were lower for indigenous people. MLR analyses included 29 comparisons (48.3%) in which households with indigenous children (compared to other color/race categories) were at a disadvantage, especially in the South of Brazil, where all comparisons were negative for indigenous households. Similar results appeared in metropolitan areas. The results thus suggest inequalities basic sanitation services based on color/race, where indigenous people are generally at a disadvantage, especially in the South of Brazil. Given the relationship between sanitation and health, as already demonstrated in the literature, these results can partly explain the low health levels in indigenous children in Brazil.

[Ethnic and racial inequalities in hospital admissions due to avoidable causes in under-five Brazilian children, 2009-2014]

There has been a global increase in hospital admissions for primary care-sensitive conditions (PCSCs) as an indicator of effectiveness in primary health care. This article analyzes ethnic and racial inequalities in cause-related hospitalizations in under-five children in Brazil as a whole and the country's five major geographic regions, with an emphasis on PCSCs and acute respiratory infections (ARIs). Using data from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS), 2009-2014, the authors calculated proportions, rates, and rate ratios for PCSCs, adjusted by sex and age after multiple imputation of missing data on color/race. The principal causes of hospitalization were respiratory tract infections (37.4%) and infectious and parasitic diseases (19.3%), and indigenous children were proportionally the most affected. Crude PCSC rates (per 1,000) were highest in indigenous children (97.3; 95%CI: 95.3-99.2), followed by brown or mixed-raced children (40.0; 95%CI: 39.8-40.1), while the lowest rates were in Asiandescendant children (14.8; 95%CI: 14.1-15.5). The highest adjusted rate ratios for PCSCs were seen among indigenous children compared to white children - 5.7 (95%CI: 3.9-8.4) for Brazil as a whole, reaching 5.9 (95%CI: 5.0-7.1) and 18.5 (95%CI: 16.5-20.7) in the North and Central, respectively, compared to white children. ARIs remained as important causes of pediatric hospitalizations in Brazil. Alarming ethnic and racial inequalities were observed in PCSCs, with indigenous children at a disadvantage. Improvements are needed in living conditions, sanitation, and subsistence, as well as guaranteed timely access to high-quality primary health care in the more vulnerable population groups, especially the indigenous peoples of the North and Central, in order to mitigate the health inequalities and meet the guidelines of the SUS and the Brazilian Constitution.

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.

Does education offset the effect of maternal disadvantage on childhood anaemia in Tanzania? Evidence from a nationally representative cross-sectional study

BACKGROUND

Despite being preventable, anaemia is a major public health problem that affects a sizable number of children under-five years globally and in Tanzania. This study examined the maternal factors associated with the risk of anaemia among under-five children in Tanzania. We also assessed whether higher maternal education could reduce the risks of anaemia among children of women with poor socio-economic status.

METHODS

Data was drawn from the 2015-16 Tanzania demographic and health survey and malaria indicator survey for 7916 children under five years. Adjusted odds ratios were estimated by fitting a proportional odds model to examine the maternal risk factors of anaemia. Stratified analysis was done to examine how the relationship differed across maternal educational levels.

RESULTS

The findings revealed that maternal disadvantage evident in young motherhood [AOR:1.43, 95%CI:1.16-1.75], no formal education [AOR:1.53, 95%CI:1.25-1.89], unemployment [AOR:1.31, 95%CI:1.15-1.49], poorest household wealth [AOR:1.50, 95%CI:1.17-1.91], and non-access to health insurance [AOR:1.26, 95%CI: 1.03-1.53] were risk factors of anaemia among children in the sample. Sub-group analysis by maternal education showed that the risks were not evident when the mother has secondary or higher education. However, having an unmarried mother was associated with about four-times higher risk of anaemia if the mother is uneducated [AOR:4.04, 95%CI:1.98-8.24] compared with if the mother is currently in union.

CONCLUSION

Findings from this study show that a secondary or higher maternal education may help reduce the socio-economic risk factors of anaemia among children under-5 years in Tanzania.

Anemia in Bolivian children: a comparative analysis among three regions of different altitudes

Here, we analyzed four population-based demographic and health surveys conducted in Bolivia between 1998 and 2016 to understand trends in anemia in children from 6 to 59 months of age by selected sociodemographic characteristics and three categories of altitude: low, medium, and high. Over the 18-year period, the prevalence of anemia was virtually unchanged while that in children living at high altitude increased. Anemia in children living at all three altitude categories is more than 40% and a severe public health problem according to the World Health Organization. We did not identify a single consistent risk factor for anemia in children living at high altitude compared with those living at medium or low altitude. The most consistent characteristic associated with childhood anemia across the three altitude categories was diarrhea in the last 2 weeks. Low length/height for age, an adolescent or anemic mother, a mother with no or little education, and a mother who speaks Quechua or Aymara were also risk factors. We conclude that it is necessary to review anemia policies and programs and prioritize children who are at greatest risk of developing anemia, particularly those living at high altitude. As iron deficiency appears to explain only a small part of childhood anemia, there is also a need to better understand its other causes and develop appropriate interventions.

Prevalence and risk factors of anemia in children aged from 6 to 59 months in Togo: analysis from Togo demographic and health survey data, 2013-2014

BACKGROUND

Anemia in children continues to be a major public health challenge in developing countries and particularly in Sub-Saharan Africa. Anemia has serious consequences on the growth and development of the children in the early stages of life. This study aimed to determine the prevalence and associated factors of anemia among children from 6 to 59 months in Togo.

METHODS

Data from the Togo Demographic and Health Survey 2013-2014 were used for this study. This nationally representative survey provided data on a wide range of indicators such as mother and child health, nutrition and other characteristics. Anemia status was determined using hemoglobin level (Hb < 11.0 g/dl), and the weighted prevalence of childhood anemia along with 95% confidence intervals were provided. Data were analyzed using logistic regression models to estimate odds ratios (OR) and their 95% confidence intervals (95% CI) for associated factors.

RESULTS

Two thousand eight hundred ninety children aged 6-59 months were included in this analysis. The weighted prevalence of anemia was 70.9% [95% CI = 68.8-73.1] with 2.6% [95% CI = 2.0-3.3] of severe anemia among these children. In the multivariate analysis, the adjusted odds ratio (aOR) for anemia was 0.33 [95% CI = 0.26-0.42] in children aged from 24 to 42 months and 0.22 [95% CI = 0.17-0.29] in children aged from 43 to 59 months. Children's malaria status was strongly associated to childhood anemia with an aOR of 3.03 [95% CI = 2.49-3.68]. The secondary level of education and more for the mother was associated to childhood anemia with an aOR of 0.67 [95% CI = 0.52-0.86]. The aOR for children whose mother had anemia was 1.62 [95% CI = 1.30-2.02].

CONCLUSION

This study has highlighted the high prevalence of childhood anemia in Togo and revealed that younger children and maternal anemia were positively associated to childhood anemia whereas age of children and high level of maternal education were negatively associated to childhood anemia.

Prevalence of Anemia in Children from Latin America and the Caribbean and Effectiveness of Nutritional Interventions: Systematic Review and Meta⁻Analysis

Anemia affects 1.62 billion people worldwide. Latin America and the Caribbean (LAC) comprise several developing countries where children are a population at risk. This systematic review and meta-analysis aimed to estimate the prevalence of anemia in this population. Electronic databases, reference lists, and websites of health ministries were searched until December 2018. Stratified analyses were performed using RevMan5.3 to estimate the overall prevalence of anemia in preschool and school-age children. The effectiveness of nutritional interventions was also evaluated. We included 61 studies from the 917 reviewed, which included 128,311 preschool- and 38,028 school-age children from 21 LAC countries. The number of anemic children was 32.93% and 17.49%, respectively, demonstrating a significant difference according to age (p < 0.01). No difference was observed by gender and only school-age children from low/very low socioeconomic status (SES) (25.75%) were more prone to anemia than those from middle SES (7.90%). It was not a concern in the Southern Cone but constituted a serious public health problem in the Latin Caribbean. Nutritional interventions reduced the prevalence from 45% to 25% (p < 0.01). Anemia is still a public health problem for children in LAC countries. National surveys should include school-age children. Further nutritional interventions are required to control anemia.

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.

Male and undernourished children were at high risk of anemia in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Anemia is one of the global public health problems affecting more than one-third of the world population. It has been strongly associated with limited psychomotor development; and poor growth and performance in cognitive, social, and emotional function in children. Despite published data revealed that anemia is a public health problem among children in Ethiopia, there is no a pooled national estimate on the prevalence and associated risk factors of anemia.

METHODS

Published articles until December 31, 2017, were searched using comprehensive search strings through PubMed/Medline, EMBASE, SCOPUS, HINARI, Web of Science, Google Scholar and Google. Reference probing of published articles and hand searching were employed for grey literature. Two groups of review authors independently appraised the studies for eligibility and extracted the data. The quality of articles was assessed using Joana Brigg's institute critical appraisal checklist for prevalence and analytical studies. The pooled estimates were determined using random effect model. Heterogeneity between the included studies was assessed using the I2 statistics. Subgroup analysis was employed in the evidence of heterogeneity. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression test statistic.

RESULTS

Of the total 871 articles retrieved, 34 articles which involved 61,748 children were eligible for meta-analysis. The overall pooled prevalence of anemia using random effect model was 31.14% (95% CI: 24.62, 37.66%). In subgroup analysis, the pooled prevalence of anemia was higher among preschool-aged children (44.17%; 95% CI: 37.19, 51.15%) than school-aged children (22.19%; 95% CI: 17.54, 26.83%). Furthermore, the odds of anemia was higher among children who were male (OR = 1.11; 95% CI: 1.03, 1.19), stunted (OR = 1.95; 95% CI: 1.52, 2.51), and wasted (OR = 2.05; 95% CI: 1.36, 3.10).

CONCLUSION

The pooled prevalence of anemia among children was high, indicating that it had been continuing to be a public health problem. Therefore, there is a need to design a comprehensive prevention and control strategies to reduce its burden.

Prevalence and temporal trend (2005-2015) of anaemia among children in Northeast Brazil

OBJECTIVE

Anaemia is the main nutritional deficiency in Brazil, and a prevention and control programme (National Program for Iron Supplementation) has been developed since 2005. Studies on the temporal evolution of anaemia prevalence contribute to assessment of the effectiveness of the actions undertaken. The present study aimed to identify the prevalence and temporal trend of anaemia in children.

DESIGN

Study based on two cross-sectional household surveys carried out in 2005 and 2015. Anaemia was defined as Hb<11 g/dl (HemoCue®). Trend analysis was performed using the prevalence ratio (PR), calculated by Poisson regression with a robust adjustment of the variance. Differences were significant when P<0·05 in both crude analyses and those adjusted for possible confounding factors (e.g. socio-economic, demographic and health variables).

SETTING

Alagoas, Brazil.

SUBJECTS

In total, 666 and 782 children in the first and second Alagoas State Health and Nutrition Survey, respectively (probabilistic samples).

RESULTS

In 2005 and 2015, anaemia prevalence was 45·1 and 27·4 %, respectively (-39·1 %; PR=0·61; 95 % CI 0·52, 0·70). In both surveys, children aged ≤24 months were more affected (P24 months (67·2 v. 40·7 %; 27·0 v. 19·3 %, respectively).

CONCLUSIONS

The prevalence of anaemia reduced significantly in the evaluated period. Thus, it may no longer be a severe public health problem but can instead be considered a problem of moderate magnitude. It remains, however, above the level considered acceptable according to WHO criteria. These results justify the implementation of prevention and control actions.

Structured Additive Quantile Regression for Assessing the Determinants of Childhood Anemia in Rwanda

Childhood anemia is among the most significant health problems faced by public health departments in developing countries. This study aims at assessing the determinants and possible spatial effects associated with childhood anemia in Rwanda. The 2014/2015 Rwanda Demographic and Health Survey (RDHS) data was used. The analysis was done using the structured spatial additive quantile regression model. The findings of this study revealed that the child’s age; the duration of breastfeeding; gender of the child; the nutritional status of the child (whether underweight and/or wasting); whether the child had a fever; had a cough in the two weeks prior to the survey or not; whether the child received vitamin A supplementation in the six weeks before the survey or not; the household wealth index; literacy of the mother; mother’s anemia status; mother’s age at the birth are all significant factors associated with childhood anemia in Rwanda. Furthermore, significant structured spatial location effects on childhood anemia was found.

Condições de saneamento e desigualdades de cor/raça no Brasil urbano: uma análise com foco na população indígena com base no Censo Demográfico de 2010

RESUMO: Objetivo: Os objetivos deste estudo foram analisar e descrever a presença da infraestrutura de saneamento básico nas áreas urbanas do Brasil, contrastando os perfis dos domicílios indígenas com os de não indígenas. Métodos: Trata-se de um estudo transversal com base nos microdados do Censo 2010. As análises foram baseadas em estatísticas descritivas (prevalências) e na construção de modelos de regressão logística múltipla (ajustados por covariáveis socioeconômicas e demográficas). Estimaram-se as razões de chance para a associação entre as variáveis explicativas (covariáveis) e de desfecho (abastecimento de água, esgotamento sanitário, coleta de lixo e saneamento adequado). O nível de significância estatística estabelecido foi de 5%. Resultados: Entre os serviços analisados, o esgotamento sanitário mostrou-se o mais precário. Em relação à cor ou raça, os domicílios com responsáveis indígenas apresentaram as menores frequências de presença de infraestrutura sanitária no Brasil Urbano. Os resultados das regressões ajustadas mostraram que, em geral, os domicílios indígenas se encontram em desvantagem quando comparados aos de outras categorias de cor ou raça, especialmente quanto à presença do serviço de coleta de lixo. Essas desigualdades foram de maior magnitude nas regiões Sul e Centro-Oeste. Conclusão: As análises deste estudo não somente confirmam o perfil de precárias condições de infraestrutura de saneamento básico dos domicílios indígenas em área urbana, como também evidenciam a persistência de iniquidades associadas à cor ou raça no país.

Anemia e níveis de hemoglobina em crianças indígenas Xavante, Brasil Central

RESUMO: Objetivo: Avaliar a prevalência de anemia, os níveis médios de hemoglobina e os principais fatores nutricionais, demográficos e socioeconômicos associados em crianças Xavante, em Mato Grosso, Brasil. Métodos: Realizou-se inquérito em duas comunidades indígenas Xavante na Terra Indígena Pimentel Barbosa visando avaliar todas as crianças com menos de dez anos. Foram coletados dados de concentração de hemoglobina, antropometria e aspectos socioeconômicos/demográficos por meio de avaliação clínica e questionário estruturado. Utilizaram-se os pontos de corte recomendados pela Organização Mundial da Saúde (OMS) para a classificação de anemia. Análises de regressão linear com hemoglobina como desfecho e regressão de Poisson com variância robusta com presença ou não de anemia como desfechos foram realizadas (intervalo de confiança de 95% -IC95%). Resultados: Os menores valores médios de hemoglobina ocorreram nas crianças com menos de dois anos, sem diferença significativa entre os sexos. A anemia atingiu 50,8% das crianças, prevalecendo aquelas com menos de dois anos 2 anos (77,8%). A idade associou-se inversamente à ocorrência de anemia (razão de prevalência - RP - ajustada = 0,60; IC95% 0,38 - 0,95) e os valores médios de hemoglobina aumentaram significativamente conforme o incremento da idade. Os maiores valores de escores z de estatura-para-idade reduziam em 1,8 vez a chance de ter anemia (RP ajustada = 0,59; IC95% 0,34 - 1,00). A presença de outra criança com anemia no domicílio aumentou em 52,9% a probabilidade de ocorrência de anemia (RP ajustada = 1,89; IC95% 1,16 - 3,09). Conclusão: Elevados níveis de anemia nas crianças Xavante sinalizam a disparidade entre esses indígenas e a população brasileira geral. Os resultados sugerem que a anemia é determinada por relações complexas e variáveis entre fatores socioeconômicos, sociodemográficos e biológicos.

Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: a cross- sectional study

Background

Anaemia is one of the major causes of death among children under five years in Africa, with a prevalence of 64.6% among pre-school children. In 2014, we conducted a cross-sectional study in Namutumba district in East-central Uganda to determine the prevalence and factors associated with anaemia among children aged 6 to 59 months.

Methods

We conducted a household survey in 376 randomly selected households. One child aged 6 to 59 months was randomly sampled from each selected household. A structured questionnaire administered to an adult caregiver was used to collect household data. Blood was collected by finger or heel prick to estimate the haemoglobin level using a portable haemocue analyser. Anthropometric data including age, weight and height was collected for each child. A modified poisson regression model was used to determine the correlates of anaemia, prevalence ratios and their 95% confidence intervals (CI).

Results

The prevalence of anaemia was high (58.8%) and was highest among children aged 12 to 23 months (68.5%) and males (61.3%). About 27.7% children were stunted. Children aged 6–11 and 12–23 months were more likely to be anaemic (APR = 1.12; 95% CI: 1.05–1.19 and APR = 1.12; 95% CI: 1.00–1.24 respectively), Resident of Magada and Namutumba (urban areas) were less likely to be anaemic (APR = 0.89; 95% CI: 0.87–0.91and APR = 0.86; 95% CI: 0. 85–0.88 respectively). Children of caretakers of a big family size (seven or more children) and with any formal education were less likely to be anaemic (APR = 0.94; 95% CI: 0.89–0.99 and APR = 0.93; 95% CI: 0.87–0.99). Stunting (HAZ scores) was a predictor of anaemia (APR = 1.07; 95% CI: 1.02–1.12).

Conclusion

Anaemia is highly prevalent among children and there is need to invest in measures to prevent anaemia, especially among children in the rural areas.

Malaria, Moderate to Severe Anaemia, and Malarial Anaemia in Children at Presentation to Hospital in the Mount Cameroon Area: A Cross-Sectional Study

Background. Malaria remains a major killer of children in Sub-Saharan Africa, while anaemia is a public health problem with significant morbidity and mortality. Examining the factors associated with moderate to severe anaemia (MdSA) and malarial anaemia as well as the haematological characteristics is essential. Methodology. Children (1–14 years) at presentation at the Regional Hospital Annex-Buea were examined clinically and blood samples were collected for malaria parasite detection and full blood count evaluation. Results. Plasmodium falciparum, anaemia, and malarial anaemia occurred in 33.8%, 62.0%, and 23.6% of the 216 children, respectively. Anaemia prevalence was significantly higher in malaria parasite positive children and those with fever than their respective counterparts. MdSA and moderate to severe malarial anaemia (MdSMA) were detected in 38.0% and 15.3% of the participants, respectively. The prevalence of MdSA was significantly higher in children whose household head had no formal education, resided in the lowland, or was febrile, while MdSMA was significantly higher in febrile children only. Children with MdSMA had significantly lower mean white blood cell, lymphocyte, and platelet counts while the mean granulocyte count was significantly higher. Conclusion. Being febrile was the only predictor of both MdSA and MdSMA. More haematological insult occurred in children with MdSMA compared to MdSA.

Anemia and undernutrition among children aged 6-23 months in two agroecological zones of rural Ethiopia

BACKGROUND

Child malnutrition during the first 1,000 days, commencing at conception, can have lifetime consequences. This study assesses the prevalence of anemia and undernutrition among children aged 6-23 months in midland and lowland agroecological zones of rural Ethiopia.

METHODS

Cross-sectional data examining sociodemographic, anthropometry, hemoglobin levels, and meal frequency indicators were collected from 216 children aged 6-23 months and their mothers randomly selected from eight rural kebele (villages).

RESULTS

Of 216 children, 53.7% were anemic, and 39.8%, 26.9%, and 11.6% were stunted, underweight, and wasted, respectively. The prevalence of anemia was higher in the lowland agroecological zone (59.5%) than the midland (47.6%). Among those children who were stunted, underweight, and wasted, 63.5%, 66.7%, and 68.0% were anemic, respectively. Child anemia was significantly associated with the child not achieving minimum meal frequency, sickness during the last 2 weeks before the survey, stunting and low body mass index, and with maternal hemoglobin and handwashing behavior. The prevalence of stunting was higher in the lowland agroecological zone (42.3%) than the midland (36.2%). The predictors of stunting were age and sex of the child, not achieving MMF, maternal body mass index, and age. As maternal height increases, the length for age of the children increases (P=0.003).

CONCLUSION

The overall prevalence of anemia and undernutrition among children aged 6-23 months in these study areas is very high. The prevalence was higher in the lowland agro-ecological zone. Health information strategies focusing on both maternal and children nutrition could be sensible approaches to minimize stunting and anemia.

[Obesity and overweight in adult Xukuru of Ororubá Indians, Pernambuco State, Brazil: magnitude and associated socioeconomic and demographic factors]

This cross-sectional study focused on the epidemiology of overweight and obesity and the association with demographic and socioeconomic variables in a sample of 794 Xukuru of Ororubá adults 19-59 years of age, from an indigenous reserve in Pesqueira County, Pernambuco State, Brazil. Descriptive analyses and multivariate logistic regression were carried out, using cut-off points of BMI > 24.99kg/m2 for overweight and > 29.99kg/m2 for obesity. Prevalence rates of overweight and obesity were higher in women (52.2% and 21%, respectively) than in men (44.1% and 7.5%, respectively). Female sex and age (> 30 years) were associated with both outcomes in the multivariate regression. For obesity, the following variable showed statistically significant associations: socioeconomic status and the interaction between male gender and per capita income. As in other indigenous populations in Brazil, the study's findings suggest that the Xukuru are experiencing a rapid nutritional transition.