Prevalence of Anaemia and Associated Risk Factors among Children in North-western Uganda: A Cross Sectional Study

Anaemia and associated factors among children aged 6-59 months during the post-ebola period in Sierra Leone: a national cross-sectional survey- 2019

BACKGROUND

Anaemia is a global public health problem associated with early childhood adverse effects on mental, physical, and social development. Sierra Leone had made progress in reducing the prevalence of anaemia pre-Ebola period however this was affected by the Ebola epidemic which further strained an already struggling health system. Therefore, this study aimed to assess the prevalence and factors associated with anaemia during post-Ebola period among children aged 6-59 months in Sierra Leone.

METHODS

We analyzed data from the 2019 Sierra Leone demographic and health survey (SLDHS), a nationally representative cross-sectional study. We used data collected using a stratified two-stage cluster sampling design that resulted in the random selection of a representative sample of 13,872 households. A total sample of 3,459 children aged 6-59 months were included in the study. Multivariable logistic regression was used to calculate the adjusted odds ratios and corresponding 95% confidence intervals.

RESULTS

The prevalence of anaemia was 68.9%, that of mild anaemia was 35.8%, moderate anaemia was 30.3% and for severe anaemia was 2.8%. Children aged 6-36 months were 1.83 times more likely to have anaemia compared to those above 36 months, while boys 1.33 times more likely to be anaemic compared to girls. Children born in poor households, to mothers who had anaemia and had a history of fever had 65%, 85% and 38% increase in likelihood of childhood anaemia respectively. In addition, children living in rural areas and stunted were 1.55 and 1.38 times more likely to be anaemic respectively compared to those living in urban areas and not stunted. Children born to younger mothers (15-24 years) were 1.45 times more likely to be anaemic compared to older mother (35-49 years.

CONCLUSION

The current study demonstrated the predominant existence of anaemia among children aged 6-59 months in Sierra Leone. Owing to the adverse effects of anaemia on the development of children in the future, there is an urgent need for effective and efficient remedial public health interventions to prevent further complications.

Level of minimum acceptable diet and its associated factors among children aged 12-23 months in Ugandan districts

Uganda has made notable progress in improving child nutrition indicators, albeit not fast enough to meet global targets. Navigating the landscape of child nutrition in Uganda demands attention, particularly in light of the necessity for a minimum acceptable diet (MAD) for children aged 12-23 months. While the focus on local nutritional planning is crucial, the absence of routine-specific nutritional status data creates a significant information gap. To bridge this void, this study used datasets from the 2021 Lot Quality Assurance Sampling (LQAS) survey. Data were analysed using multilevel mixed-effects logistic regression (clustering districts based on regional boundaries) at a 5% statistical significance level using STATA version 17. Of the 7,111 children surveyed, 3,256 (49.20%) received the minimum meal frequency, 695 (9.80%) received the minimum dietary diversity, and only 380 (5.34%) received the MAD. There was a notable variation in the proportion of children that received the MAD across regions and districts. Children living in urban areas, children whose mothers had a higher education, and children whose mothers had a diverse diet were more likely to receive the MAD. Children were less likely to receive the MAD if they lived in a household that did not receive a health worker visit within the year. These findings suggest a need to prioritize initiatives aimed at increasing dietary diversity among children in Uganda. This could be done through a variety of approaches, such as leveraging the use of home gardens to boost nutrition through diverse crop cultivation, demonstration gardens, and offering nutrition counselling through village health teams.

Sex of household head and other household determinants of childhood anaemia among households in Ghana: regression analysis of the 2019 Malaria Indicator Survey

BACKGROUND

Childhood anaemia is still a major public health concern. Although the prevalence of anaemia among children under age five is reducing in Ghana, the severity level is still worsening. This study sought to examine and compare household factors affecting the anaemia status of children under age five living in male- and female-headed households in Ghana.

METHODS

The study used a weighted sample of 5,799 household heads from the 2019 Ghana Malaria Indicator Survey (GMIS). A binary logistic regression analysis was used to examine the effect of sex of household heads and other household factors on the anaemia status of children under the age of five in male- and female-headed households in Ghana. All analyses were conducted at the 95% confidence level.

RESULTS

The results showed that a higher proportion (83.0%) of children under age five are not anaemic in households in Ghana. However, the probability of a child being anaemic is higher in male-headed households (aOR = 1.28; C.I:1.08-1.51), in the poorest (aOR = 2.41; CI: 1.59-3.65), poorer (aOR = 2.04; C.I:1.41-2.94) and middle (aOR = 1.78; C.I:1.29-2.46) household wealth category. Higher likelihood of anaemia was found among children in households that used charcoal (aOR = 1.51; C.I:1.15-1.99) and fuelwood (aOR = 1.44; C.I:1.02-2.02) for cooking. Similarly, there is a high probability of childhood anaemia in households with 5-10 members (aOR = 4.49; C.I: 3.78-5.34), 11 or more members (aOR = 7.21; C.I: 4.60-11.31) and household residing in northern part of Ghana (aOR = 1.40; C.I:1.07-1.83). The lower odds of being anaemic were recorded among children whose household heads were aged 40 years and older, household using other cooking fuels (aOR = 0.49; C.I: 0.21-0.78) and household with no bednets (aOR = 0.57; C.I: 0.44-0.74).

CONCLUSIONS

The GMIS data suggest that anaemia and its severity are higher among children living in MHH than among those living in FHH. The results indicate that poverty, a higher number of household members, relatively younger male household heads and the type of cooking fuel used were factors accounting for the differences in childhood anaemia in MHH and FHH. Equal attention should be given to MHH and FHH in terms of programmes and interventions aimed towards preventing and reducing childhood anaemia in Ghana.

Prevalence and factors associated with anaemia in children aged 6-24 months living a high malaria transmission setting in Burundi

BACKGROUND

In very young children, anaemia has been linked to increased morbidity, mortality and poor cognitive development. Although Burundi has a high burden of anaemia, which may be worsened by the high burden of malaria, little is known about the extent of the problem in very young children who are most at risk of severe disease. We estimated the prevalence, and assessed the factors associated with anaemia in children aged 6-24 months using baseline data collected as part of an on-going study evaluating the effect of Micronutrient supplementation on anaemia and cognition among children in high malaria transmission settings in Burundi.

METHODS

Between February and March 2020, surveys were conducted in 498 households within the catchment area of Mukenke Health Center. One child aged 6-24 months was selected per household to participate in the survey. Following written informed consent, we administered a questionnaire to the child's primary caregiver to capture information on child's demographics, nutritional status, food intake, health (status, and morbidity and treatment-seeking practices), as well as the household markers of wealth. A physical exam was conducted, and a blood sample was collected to: 1) assess for presence of plasmodium infection using a rapid diagnosis test; 2) estimate the haemoglobin levels using a portable haemocue machine. A stool sample was also collected to examine for the presence of helminth infections.

RESULTS

The prevalence of anaemia was 74.3% (95% confidence interval [CI] 61.5%-84.0%), with most of the anaemic study participants classified as having moderate anaemia (59.2%). A total of 62 (12.5%) participants had positive malaria rapid diagnosis tests. Factors significantly associated with higher odds of developing anaemia included not receiving deworming medication (adjusted Odd ratio [aOR] = 3.54, 95% CI 1.79-6.99, p<0.001), the child's home location (Mukenke II: aOR = 2.22, 95% CI 1.89-2.62, p<0.001; Mukenke: aOR = 2.76, 95% CI 2.46-3.10, p<0.001 and Budahunga: aOR = 3.12, 95% CI 2. 94-3.31, p<0.001) and the child's age group (Children aged 6-11 months: aOR = 2.27, 95% CI 1.32-3.91, p<0.001). Education level was inversely associated with less odds of anaemia: child's primary care giver with a secondary (aOR = 0.67; 95% CI: 0.47-0.95, p = 0,024) and tertiary education level (aOR = 0.48; 95% CI: 0.38-0.61, p<0.001).

CONCLUSION

Anaemia is highly prevalent among young children in high malaria transmission setting. Anaemia is more prevalent among children who not dewormed and those with malaria. To prevent the long-term adverse outcomes of the anaemia in children, policy makers should focus on improving uptake of the deworming and malaria prevention programs, promote preventive interventions and improve the education of women especially in families with very young children.

Prevalence of, and factors associated with anaemia in children aged 1-3 years in Aceh, Indonesia: A cross-sectional study

Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In Indonesia, there was a 10% increase in the national prevalence of child anaemia between 2013 and 2018. Aim: This study aims to assess the prevalence of, and factors associated with anaemia among children aged one to three years in eight districts in Aceh Province, Indonesia. Methods: A cross-sectional study was conducted on a sample of 1148 mother-child dyads aged one to three years between November and December 2018. The sampling process involved a three-stage cluster sampling design using the probability proportionate to size methodology. Anaemia status was determined using haemoglobin level (Hb < 11.0 g/dL). Data were analysed using multivariable logistic regression to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) for associated factors. Results: The overall prevalence of anaemia was 76.1% (869/1142). 44.7% (510/1142) and 28.6% (327/1142) had moderate and mild anaemia, respectively. Child aged 12-24 months (aOR: 2.00, 95% CI: 1.26-3.17), not receiving routine immunisation (aOR: 2.62, 95% CI: 1.34-5.10), and maternal anaemia (aOR: 2.15, 95% CI: 1.59-2.90) were significantly associated with anaemia. Conclusion: The prevalence of anaemia among the children in this study was high, and was associated with child age, immunisation status, and maternal anaemia. These findings provide further insight into anaemia as a public health issue at a sub-national level in Indonesia and for development of targeted programmes to address associated risk factors of child anaemia.

Spatial Variations and Determinants of Anemia among Under-five Children in Nepal, DHS (2006-2016)

Anemia among under-five children is the major health problem in Nepal. The lack of nutritional supplementation and lack of healthcare facilities are influential factors of anemia. Thus, the main objective of this study is to explore spatial variations and determinants of anemia among under-five children in Nepal. Nepal Demographic and Health Survey (NDHS) data from 2006 to 2016 were used in this study, which includes: household and individual-level data of 8555 under-five children, whose anemia was measured. In addition, a total of 260 (2006), 281 (2011), and 383 DHS clusters (2016) were taken in consideration for spatial analysis. The overall prevalence of anemia was 48.9%, 46.4%, and 52.2% in 2006, 2011, and 2016 respectively. The spatial analysis revealed a nonrandom spatial distribution, where statistically significant hotspots and coldspots were detected in different parts of the country. The results also identified mother’s age, mother’s educational level, socioeconomic status of household, number of under-5 children, household size, birth weight, underweight, stunting, diarrhea, and fever as associated factors of anemia among under-5 children. These findings may provide assistance to concerned health officials in adopting anemia-related programs and policies to address the anemia problems that plague Nepalese children under the age of five.

Household Food Insecurity, Level of Nutritional Adequacy, and Nutritional Status of Toddlers in the Coastal Area of Central Tapanuli Regency

BACKGROUND: The food security and livestock service office of North Sumatra Province (2020) noted that almost a third of the area or 35% of the subdistricts in Central Tapanuli Regency are food-insecure areas. AIM: This study aims to determine the level of family food insecurity, the level of nutritional adequacy, and the nutritional status of children under 5 in the coastal area of Central Tapanuli Regency. METHODS: This research is part of a dissertation study entitled Positive Deviance in Household Food Insecure in Improving the Nutritional Status of Toddlers in the Coastal Area of Central Tapanuli Regency. The steps in this research are to identify the level of household food insecurity, level of nutritional adequacy, and nutritional status of children under 5. The research was conducted by interviewing respondents (mothers of toddlers) and taking anthropometric measurements of 59 children under 5 purposively in the coastal area of Central Tapanuli Regency. RESULTS: Most of the occupations of the head of the family are fishers (78.0%) and the household food insecurity status as much as 81.4% is food insecure. The nutritional status of children under 5 in the less category is 50.8%, the nutritional status of stunting is 35.6%, and wasting is 10.2%. There is a significant relationship between family food insecurity and the level of adequacy of nutrients: Energy (p = 0.000; odds ratio [OR] = 38.000) and protein (p = 0.002; OR = 10.929). There is a significant relationship between household food insecurity and nutritional status of weight for age (p = 0.0039; OR = 6.300). CONCLUSION: Household food insecurity is related to the level of nutritional adequacy (energy and protein) and nutritional status of weight for age.

A simulation study for evaluating the performance of clustering measures in multilevel logistic regression

BACKGROUND

Multilevel logistic regression models are widely used in health sciences research to account for clustering in multilevel data when estimating effects on subject binary outcomes of individual-level and cluster-level covariates. Several measures for quantifying between-cluster heterogeneity have been proposed. This study compared the performance of between-cluster variance based heterogeneity measures (the Intra-class Correlation Coefficient (ICC) and the Median Odds Ratio (MOR)), and cluster-level covariate based heterogeneity measures (the 80% Interval Odds Ratio (IOR-80) and the Sorting Out Index (SOI)).

METHODS

We used several simulation datasets of a two-level logistic regression model to assess the performance of the four clustering measures for a multilevel logistic regression model. We also empirically compared the four measures of cluster variation with an analysis of childhood anemia to investigate the importance of unexplained heterogeneity between communities and community geographic type (rural vs urban) effect in Malawi.

RESULTS

Our findings showed that the estimates of SOI and ICC were generally unbiased with at least 10 clusters and a cluster size of at least 20. On the other hand, estimates of MOR and IOR-80 were less accurate with 50 or fewer clusters regardless of the cluster size. The performance of the four clustering measures improved with increased clusters and cluster size at all cluster variances. In the analysis of childhood anemia, the estimate of the between-community variance was 0.455, and the effect of community geographic type (rural vs urban) had an odds ratio (OR)=1.21 (95% CI: 0.97, 1.52). The resulting estimates of ICC, MOR, IOR-80 and SOI were 0.122 (indicative of low homogeneity of childhood anemia in the same community); 1.898 (indicative of large unexplained heterogeneity); 0.345-3.978 and 56.7% (implying that the between community heterogeneity was more significant in explaining the variations in childhood anemia than the estimated effect of community geographic type (rural vs urban)), respectively.

CONCLUSION

At least 300 clusters with sizes of at least 50 would be adequate to estimate the strength of clustering in multilevel logistic regression with negligible bias. We recommend using the SOI to assess unexplained heterogeneity between clusters when the interest also involves the effect of cluster-level covariates, otherwise, the usual intra-cluster correlation coefficient would suffice in multilevel logistic regression analyses.

Prevalence and associated risk factors of asymptomatic malaria and anaemia among school-aged children in Dara Mallo and Uba Debretsehay districts: results from baseline cluster randomized trial

Background

Despite the growing evidence that malaria and anaemia are two interlinked health problems of school-aged children (SAC) in developing countries, there is scarce information about malaria among SAC in Ethiopia. Moreover, anaemia-related studies were more concentrated in easily accessible areas. This study aimed to assess the prevalence of malaria and anaemia and corresponding risk factors among SAC in Dara Mallo and Uba Debretshay districts, in hard to reach areas, so as to inform appropriate integrated interventions for both diseases.

Methods

This study was part of baseline data collected for a cluster-randomized trial registered in Pan African Clinical Trials Registry (PACTR202001837195738). Data were collected from 2167 SAC and their households through face-to-face interview; malaria was diagnosed by using rapid diagnostic test (RDT); haemoglobin concentration was determined using hemoCue hb 301 and adjusted for altitude to determine anaemic status; helminth infections were determined by using kato-katz, and anthropometric measurements were made to determine nutritional status of children. Generalized mixed effects logistic regression model was used to assess the association between predictor variables and malaria and anaemia using school as a random variable.

Results

The overall prevalence of malaria was 1.62% (95% CI 1.15–2.27%) (35/2167). Of the 35 children positive for malaria, 20 (57.14%), 3 (8.57%) and 12 (34.29%) were due to Plasmodium falciparum, Plasmodium vivax and mixed infections of P. falciparum and P. vivax, respectively. Malaria was significantly lower among children from literate household head (Adjusted OR  =  0.38; 95% CI 0.15–0.95) and residence house located at an altitude range above 1100 masl (AOR  =  0.40; 95% CI 0.17–0.94). The prevalence of anaemia was 22.00% (95% CI 20.3–23.8%) (477/2167) and was significantly reduced by eating legumes, nuts or seed group of food in their 24-h dietary diversity recall (AOR  =  0.64; 95% CI 0.41–0.99).

Conclusions

The prevalence of malaria was low and unevenly distributed per school while the overall prevalence of anaemia was moderate. It is important to implement integrated interventions targeting both malaria and anaemia, with special emphasis given to children from illiterate households and living at an altitude below 1100 masl. The micronutrient content of locally grown legumes should be further investigated to recommend specific interventions to overcome anaemia.

Differences in factors associated with anemia in Haitian children from urban and rural areas

BACKGROUND

In Haiti, differences in the prevalence of anemia between urban and rural areas have been observed.

OBJECTIVE

To identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti.

METHODS

This cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5-13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect.

RESULTS

In rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, ([Formula: see text] = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32-3.18)], age [AOR = 0.89; 95%CI (0.85-0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67-0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed.

CONCLUSIONS

In this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.

Time to detection of anemia and its predictors among children living with HIV at Debre Tabor and University of Gondar Compressive Specialized Hospitals, 2020: a multicentre retrospective follow-up study

BACKGROUND

Even though antiretroviral therapy access for HIV infected children increased dramatically, anemia have been continued as a challenge regardless of a cluster of differentiation (CD4) count and viral load. Hence, this study aimed to assess the time to detection of anemia and its predictors among children living with HIV at Debre Tabor and university of Gondar compressive specialized hospital, 2020.

METHODS

A retrospective follow-up study was conducted from January 2010 to December 2018. A total of 372 children under the age of 15 who had received ART were included in the study. Data were collected from children's medical charts and ART registration logbook using a standard checklist. Besides, the data were entered into Epi data 4.2.2 and then exported to Stata 14.0 for further analysis. The Cox regression model, the variables having P-value ≤.05 with 95% CIs in multivariable analysis were declared as statistically significant for anemia.

RESULT

The mean (±SD) of follow-up periods were 56.6 ± 1.7 SD months. The overall median survival time free from anemia was 137 months, and the incidence rate of anemia was 6.9 per 100 PYO (95% CI: 5.3, 7.8). Moreover, WHO clinical staging of III/IV [AHR: 4.2, 95% CI: 1.80, 11.1], low CD4 count below threshold [AHR: 1.9, 95% CI: 1.09, 3.37], cotrimoxazole preventive therapy non-users, and poor level of adherence [(AHR: 2.4, 95% CI: 1.20, 4.85] were the main predictors of the time to detection of anemia.

CONCLUSION

The incidence rate of anemia in our retrospective cohort was high. The risk of anemia is present in children living with HIV infection but the risk for anemia is increased based on (WHO clinical staging III and IV, CD4 count below the threshold level, CPT non-users, and poor level of adherence). Since many of these risk factors are present routinely, even within one single patient, our clinical monitoring for anemia quarterly was fully justified as was our routine switch from standard therapies such as AZT to another regimen upon lab confirmation of anemia. Additional methods to improve cotrimoxazole preventative therapy and level of adherence are also needed.

Neurodevelopmental performance among pre-schoolers treated for severe anaemia at Lira Regional Referral Hospital, Uganda

BACKGROUND

Severe anaemia is a common clinical problem among young children in sub-Saharan Africa. However, the effect of severe anaemia on neurodevelopment of these children is not well described. Therefore, we assessed the neurodevelopmental performance of preschool children diagnosed with severe anaemia in Northern Uganda.

METHODS

We conducted a prospective cohort study among children < 5 years of age 14 days post discharge after an episode of severe anaemia (Hb < 5.0 g/dl; n = 171; mean Hb = 3.9g/dl) at Lira Regional Referral Hospital, Uganda. Neurodevelopmental outcomes (cognitive, language and motor) were assessed using Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III). Age-adjusted z-scores for each domain were calculated using scores from healthy community control children (n = 88) recruited from the same environment for each age category. Multiple linear regression was used to compare z-scores in the cognitive, language and motor scales between the two groups after adjusting for weight-for-age z-score, socioeconomic status, mother's education, and father's employment on all the scales.

RESULTS

The prevalence of neurodevelopmental impairment was 2.3% (95% CI: 0.8-6.1) for cognition, 1.7% (95%: 0.6-5.3) for language and 3.5% (95% CI: 1.6-7.6) for motor scales and 4.6% (95% CI: 2.3-9.1) for deficits in ≥1 area of neurodevelopment. Significant differences were observed between the two groups with the SA group performing worse on cognition [adjusted mean score, (Standard error, SE), P-value] [-0.20, (0.01) vs. 0.00, (0.01), P = 0.02]; language [-0.25, (0.01) vs. 0.00, (0.01), P< 0.001]; and motor [-0.17, (0.01) vs. 0.00, (0.01), P = 0.05] scales.

CONCLUSION

In children < 5 years of age, severe anaemia was associated with neurocognitive (cognition, language and motor) deficits in the immediate period post treatment. Further research is needed to identify risk factors and determine the long-term effects of poor neurodevelopment in young children with severe anaemia.

Magnitude of Anemia and Associated Factors among HIV-Infected Children Receiving Antiretroviral Therapy in Pastoral Community, Ethiopia: A Retrospective Cross-Sectional Study

Background

The two major comrbidities (anemia and poor nutrition) are common manifestations of HIV-infected children, which threaten their lives. In Ethiopia, there is limited information on the magnitude and factors associated with anemia among HIV-infected children. Thus, this study was aimed to determine the magnitude and factors associated with anemia among HIV-infected children receiving antiretroviral therapy in the Afar region, Ethiopia.

Methods

A cross-sectional retrospective record review was conducted on a sample size of 102 HIV-infected children aged 6 months to < 15 years in selected ART sites of the Afar region from May 1 to 25, 2018. Patient cards from 2009 to 2017 with the required information were considered. A paired sample t-test was used to assess whether there is a significant difference in the hemoglobin level before and after the HAART regimen. Multivariable logistic regression was used to determine predictors of anemia. Statistical significance was determined atp value < 0.05.

Result

At baseline, 53.9% of study participants were anemic, from which 8.7%, 36.3%, and 9.8% were mild, moderate, and severe, respectively. There was a statistically significant improvement of hemoglobin level following the one-year course of ART treatment from 10.67 ± 1.82 to 11.5 ± 1.5 (p value ≤ 0.001): an improvement of 0.83 ± 1.74. Children who were moderately and severely stunted were more than five (AOR = 5.16, 95% CI (1.71, 15.56)) and more than twelve (AOR = 12.45, 95% CI (2.62, 59.21)) times more likely to be anemic than children who were not stunted, respectively. Children whose mothers had not attended ANC follow-up were more than three (AOR = 3.68, 95% CI (1.38, 9.81)) times more likely to be anemic than children whose mothers attended ANC. Children who were in clinical stages 3 and 4 were more than five (AOR = 5.07, 95% CI (1.79, 14.37)) times more likely to be anemic than children who were in clinical stage 1 and 2.

Conclusion

The magnitude of anemia among HIV-infected children was found to be high, which is 53.9%. Nutritional status (stunting), WHO clinical stage, and history of ANC follow-up were the predictors significantly associated with childhood anemia. Thus, interventions for HIV-infected children should consider those factors.

Contribution of Amaranthus cruentus and Solanum macrocarpon Leaves Flour to Nutrient Intake and Effect on Nutritional Status of Rural School Children in Volta Region, Ghana

BACKGROUND

Plant-based foods are staple diets and main micronutrient sources of most rural Ghanaian households. The objective of this study was to determine the effect of Amaranthus cruentus and Solanum macrocarpon leafy vegetable flour on micronutrient intake and nutritional status of rural Ghanaian school children.

METHOD

This study was a randomized controlled trial that consisted of baseline data collection and a three-month nutrition intervention feeding program. Two groups of 53 children, age 4-9 years, involved in the Ghana School Feeding Program took part in the study. An experimental group consumed Amaranthus cruentus and Solanum macrocarpon leaves flour (ACSMLVF) stews and soup. The control group consumed stews and soup without ACSMLVF. Haemoglobin and serum vitamin A concentrations were determined. Dietary and anthropometric data were collected and analysed. Participants were screened for malaria parasitaemia and hookworm.

RESULTS

Anaemia was present in 41.5% and 37.3%, respectively, of the intervention and control groups at baseline. It was present in 28.3% and 53.3%, respectively, at the end of the study. This was significantly different (p=0.024). There was a low vitamin A concentration in 66.0% and 64.7% at baseline and 20.8% and 23.4% at the end of the study in the intervention and control groups, respectively. The mean iron, zinc, and provitamin A (beta-carotene) intakes of the intervention group were 14.2 ± 7.1 mg, 5.7 ± 2.1 mg, and 214.5 ± 22.6 μg, respectively, at baseline. Those of the control were 13.7 ± 6.1 mg, 5.4 ± 2.1 mg, and 210.6 ± 20.1 μg, respectively. At the end of the study, the mean intake of iron, zinc, and beta-carotene for the intervention group was 24.1 ± 10.9 mg, 13.8 ± 8.2 mg, and 694.2 ± 33.1 μg, respectively. The intake of these micronutrients for the control at the end of the study was 14.8 ± 6.2 mg, 5.9 ± 2.3 mg, and 418.4 ± 34.7 μg, respectively.

CONCLUSION

Consumption of ACSMLVF stews and soup increased iron, zinc, and beta-carotene intakes. Anaemia prevalence was lower in the intervention group at the end of the study.

Intestinal parasitosis, anaemia and risk factors among pre-school children in Tigray region, northern Ethiopia

BACKGROUND

Intestinal parasitic infections (IPIs) and anaemia are major health problems. This study assessed the prevalence of intestinal parasitic infections, anaemia and associated factors among pre-school children in rural areas of the Tigray region, northern Ethiopia.

METHODS

A community based cross-sectional study was conducted among 610 pre-school children in rural communities of Northern Ethiopia from June 2017 to August 2017. Stool specimens were examined for the presence of trophozoites, cysts, oocysts, and ova using direct, formal-ethyl acetate concentration, Kato-Katz, and Ziehl-Neelsen techniques. Haemoglobin was measured using a HemoCue spectrometer.

RESULTS

Among the 610 participating pre-school children in the study, the prevalence of IPIs and anaemia were 58% (95% conference interval (CI): 54.1-61.9%) and 21.6% (95% CI: 18.5-25.1%), respectively. Single, double, and triple parasitic infections were seen in 249 (41, 95% CI: 37-45%), 83 (14, 95% CI: 11-17%), and 22 (3.6, 95% CI: 2.4-5.4%) children, respectively. Of the seven intestinal parasitic organisms recorded from the participants, Entamoeba histolytica/dispar was the most prevalent 220 (36.1%) followed by Giardia lamblia 128 (20.1%), and Hymenolepis nana 102 (16.7%). Mixed infections were common among G. lamblia, E. histolytica/dispar and Cryptosporidium spp. oocyst. Intestinal parasitic infection prevalence increased from 47% in children aged 6-11 months to 66% in those aged 48-59 months; the prevalence ratio (PR) associated with a one-year increase in age was 1.08 (95% CI: 1.02-1.14, p = 0.009). Age-adjusted prevalence was higher in children who had been dewormed (PR = 1.2; 95% CI: 1.00-1.4, p = 0.045), and lower in households having two or more children aged under five (PR = 0.76, 95% CI: 0.61-0.95, p = 0.015). Anaemia rose from 28% in children aged 6-11 months to 43% in those aged 12-23 months, then fell continuously with age, reaching 7% in those aged 48-59 months. Age adjusted, anaemia was more prevalent in households using proper disposal of solid waste (PR = 1.5, 95% CI: 0.1-2.10, p = 0.009) while eating raw meat (PR = 0.49, 95% CI: 0.45-0.54, p = 0.000), any maternal education (PR = 0.64 95% CI: 0.52-0.79, p = 0.000), and household water treatment (PR = 0.75, 95% CI: 0.56-1.0, p = 0.044) were associated with lower prevalence of anaemia.

CONCLUSIONS

More than half of the children were infected with intestinal parasites, while anaemia prevalence was concentrated in the 12-23 month age group. This study has identified a number of potentially modifiable risk factors to address the significant prevalence of IPIs and anaemia in these children. Improvements in sanitation, clean water, hand hygiene, maternal education could address both short and long-term consequences of these conditions in this vulnerable population.

Under-five anemia and its associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia: systematic review and meta-analysis

BACKGROUND

Anemia is the most common hematologic disorder of children in the globe. There are fragmented and inconclusive study findings on under-five anemia in Ethiopia. Understanding the distribution of anemia is an important step for program planners and policymakers. Therefore, this systematic review was aimed to assess the pooled prevalence of anemia and associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia.

METHODS

We searched through African journals of online, Google Scholar, CINHAL, PubMed, Web of Science, Cochrane library, and Scopus. Reviewers used standardized format to extract the data. The data was exported to Stata version 11 software for analysis after extracted by Microsoft excel. The DerSimonian-Laird random-effect model was used to assess the pooled prevalence of under-five anemia. Variation between studies (heterogeneity) was assessed by I2 statistic test. Publication bias was assessed by the Egger test.

RESULT

From 561 studies, 16 articles were included in this review. The pooled prevalence of under-five anemia in Ethiopia was 44.83%. In subgroup analysis, the higher pooled prevalence of anemia was observed from children's age less than 2 years old (50.36%) (95% CI 39.53, 61.18). Poor dietary diversity OR = 1.71 (1.10, 2.68), stunting OR = 2.59 (2.04, 3.28), food insecurity OR = 2.87 (1.25, 6.61), and not dewormed OR = 2.34 (1.77, 3.09) were predictors of under-five anemia.

CONCLUSION

The magnitude of under-five anemia in this study was extremely high. Therefore, increased coverage of supplementation and fortification programs, periodic deworming, feeding diversified food, supplement food for those who are stunted, and securing food in the households may all alleviate under-five anemia.

Prevalence and factors associated with anemia among children under five years of age in Rombo district, Kilimanjaro region, Northern Tanzania

Background:  Anemia is a severe public health problem affecting more than half of children under five years of age in low-, middle- and high-income countries. The study aimed to determine the prevalence and factors associated with anemia among children under five years of age in northern Tanzania. Methods: This community-based cross-sectional study was conducted in Rombo district, Kilimanjaro region, northern Tanzania, in April 2016. Multistage sampling technique was used to select a total of 602 consenting mothers and their children aged 6-59 months and interviewed using a questionnaire. Data were analyzed using Stata version 15.1. We used generalized linear models (binomial family and logit link function) with a robust variance estimator to determine factors associated with anemia. Results: Prevalence of anemia was 37.9%, and it was significantly higher among children aged 6-23 months (48.3%) compared to those aged 24-59 months (28.5%). There were no significant differences in anemia prevalence by sex of the child. Adjusted for other factors, children aged 6-23 months had over two times higher odds of being anemic (OR=2.47, 95% CI 1.73, 3.53, p<0.001) compared to those aged 24-59 months. No significant association was found between maternal and nutritional characteristics with anemia among children in this study. Conclusion: Prevalence of anemia was lower than the national and regional estimates, and it still constitutes a significant public health problem, especially among children aged 6-23 months. The study recommends iron supplementation, food fortification, dietary diversification, and management of childhood illnesses interventions for mothers and children under two years.

Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys

BACKGROUND

Anemia is a public health problem in many developing countries. It affects a sizable proportion of women of reproductive age. Anemia increases the risk of morbidity and mortality from infectious diseases, and can lead to poor fetal outcomes, and low productivity. This study examined the trends and determinants of anemia among women of reproductive age in Uganda.

METHODS

This study analyzed data from the Uganda Demographic and Health Surveys conducted in 2006, 2011, and 2016. The study was based on 10,956 weighted cases of women age 15-49. Bivariate analysis and multiple logistic regression analysis examined the association between the outcome variable and the determinants. Potential determinants of anemia in women were selected based on literature.

RESULTS

The results of the analysis show that anemia decreased in Uganda between 2006 and 2016, but with an increase between 2011 and 2016. The overall prevalence of anemia among women was 50, 23, and 32% respectively in 2006, 2011, and 2016. Women who were pregnant at the time of the survey had higher odds of being anemic across the surveys (OR 2.00, 95% CI 1.49-2.67; OR 1.47, 95% CI 1.02-2.10; OR 1.33, 95% CI 1.07-1.65). Women in households with nonimproved sources of drinking water also had higher odds for anemia (OR 1.32, 95% CI 1.09-1.61) in 2016. Wealth index, region and age were also significantly associated with anemia in women.

CONCLUSION

In order to reduce anemia in women, there is need to target pregnant women during antenatal and postpartum visits, and ensure that nutrition education during such visits is supported. There is also need to ensure sustainable household access to safe water. This should be combined with interventions aimed at enhancing household wealth.

Zinc deficiency associated with anaemia among young children in rural Guatemala

One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross‐sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models. Associations between anaemia and maternal, child and household variables, and biomarkers (soluble transferrin receptor, ferritin, zinc, folate, vitamin B12, C‐reactive protein, and α1‐acid glycoprotein) were explored. Rates of anaemia were 56% among infants/toddlers and 12.1% among preschoolers. In children with anaemia, rates of iron deficiency (low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L) and zinc deficiency (serum zinc <65 μg/dl) were 81.1% and 53.7%, respectively. Folate deficiency (either plasma folate <3 ng/ml or erythrocyte folate <100 ng/ml) was 3.3%. Vitamin B12 deficiency (plasma vitamin B12 <148 pmol/L) was 7.5%. For infants and toddlers (<24 months), the odds ratio of anaemia was lower when higher number of adults lived in the household (OR = 0.69; 95% CI [0.53, 0.90]), and higher when children were zinc deficient (OR = 3.40; 95% CI [1.54, 7.47]). For preschoolers (36–60 months), the odds ratio of anaemia was lower for every additional month of age (OR = 0.90; 95% CI [0.81, 1.00]). Findings suggest that micronutrient deficiencies coexist in Guatemalan rural children, and zinc deficiency is associated with anaemia in children <24 months, highlighting the need of continued multidisciplinary interventions with multiple micronutrients. Further research examining how household composition, feeding practices, and accessibility to micronutrient supplements and to animal source foods is needed to incorporate strategies to improve the nutritional status of Guatemalan children.

Under nutrition, maternal anemia and household food insecurity are risk factors of anemia among preschool aged children in Menz Gera Midir district, Eastern Amhara, Ethiopia: a community based cross-sectional study

BACKGROUND

In Ethiopian, the prevalence of anemia among preschool aged children widely varied across regions. Since anemia adversely affects the cognitive and physical development of the children, it is important to determine its burden for implementing appropriate measurements. Therefore, this study was aimed at determining the anemia prevalence and associated factors among preschool aged children.

METHOD

A community based cross-sectional study was conducted on a total of 432 preschool children in Menz Gera Midir district from January to May, 2017. A multi stage sampling procedure was applied to select the target groups. Hemocue analyzer for Haemoglobin determination; anthropometric measurements for assessment nutritional status, structured questionnaires for socio-demographic and economic variables were used for data collection. The morphological appearance of red blood cell was assessed microscopically to determine type of anemia. Descriptive statistics were employed to summarize the data and binary logistic regression was used for inferential statistics. A p value less than 0.05 was considered as statistically significant.

RESULT

The overall prevalence of anemia was 123 (28.5%); of which 38 (30.9%) and 85 (69.1%) were moderate and mild, respectively. Morphologically about 50.4, 37.4 and 12.2% were microcytic hypochromic, normocytic normochromic and macrocytic anemias, respectively. Child age 6-11 months (COR: 5.67, 95% CI: 2.2, 14.86), child age 12-23 months (COR: 5.8, 95% CI: 2.3, 14.7), wasting (COR: 3.5, 95% CI: 1.2, 9.8), stunting (COR: 3.8, 95% CI: 1.92, 7.77), underweight (COR: 2.12, 95% CI: 1.07, 4.38), MUAC measurement below 13 cm (COR: 5.6, 95% CI: 2.83, 11.15), household headed by female (COR: 3.24, 95% CI: 1.1, 9.63), maternal anemia (COR: 4, 95% CI: 2.2, 7.23) and household food insecurity (COR: 2.12, 95% CI: 1.09, 4.12) were significantly associated with anemia.

CONCLUSION

The prevalence of anemia among the children was found to be high and associated with child age group, child nutritional status, house hold headed by female, maternal anemia and household food insecurity. Further studies on nutritional anemia, community based nutritional education, iron supplementation to children at risk should be promoted.

Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011

BACKGROUND

Bangladesh is one of the most anemia prone countries in South Asia. Children of age under five years and women of reproductive age are particularly vulnerable in this region. Although several studies have investigated the risk factors of anemia, only few have explored its association with malnutrition, despite its high prevalence in the same group. The objective of this paper is to investigate the association of malnutrition with anemia by conducting separate analyses for under-five children and women of reproductive age using data from the nationally representative 2011 Bangladesh Demographic and Health Survey.

METHODS

Two binary outcome variables are considered separately: presence of anemia in children under five years of age (Hb<11.0 g/dl) and presence of anemia in women of childbearing age (Hb<12.0 g/dl). The exposures of interest corresponding to these two outcomes are stunting (low height-for-age) and low BMI (<18.5 kg/m2), respectively. Preliminary analysis involves estimating the association between exposure and outcome while controlling for a single confounder by computing adjusted odds ratios (adjOR) using the Cochran-Mantel-Haenszel approach in stratified analysis. Later, associations between the exposures and outcomes are estimated separately for under-five children and women of reproductive age by fitting multivariable regression models that adjust simultaneously for several confounders.

RESULTS

The prevalence of anemia is found to be higher among both the stunted children and women with low BMI compared to their healthy counterparts (Children: 56% vs 48%; women: 50% vs 43%). Furthermore, stunted children and women with low BMI have significantly increased odds of developing anemia, as reflected by the adjusted ORs of 1.76 (95% CI:1.10-2.83) and 1.81 (95% CI: 1.11-3.48), respectively. The association of stunting with anemia in children was modified by their age and socio-economic condition, where risk of being anemic decreases with increasing age but with a lower rate for stunted children from richest family. In addition, stunted children of anemic mothers are at greater risk of being anemic compared to non-stunted children of anemic or non-anemic mothers. Again the association between BMI and anemia in women is modified by the level of education, with risk of anemia being lowest among women with low BMI and higher education.

CONCLUSION

Evidence-based policies targeting the vulnerable groups are required to combat anemia and nutritional deficiencies simultaneously under the same program.

Risk Factors of Anaemia among Children under Five Years in the Hohoe Municipality, Ghana: A Case Control Study

Background

Anaemia is one of the major causes of death among children under five years in Ghana. We examined the risk factors of anaemia among children under five years in the Hohoe Municipality, Ghana.

Methods

This facility-based matched case control study recruited 210 children (70 cases and 140 controls) aged 6 to 59 months. Stratified and simple random sampling techniques were used to select mothers attending Child Welfare Clinic (CWC) for the screening of their children. Data were collected using a semistructured questionnaire. Finger prick blood was collected to estimate the haemoglobin (Hb) level and thick film was prepared to determine malaria parasitaemia. Axillary temperature was measured using an +electronic thermometer and anthropometric measurements were done using a weighing scale and inelastic tape measure. Continuous variables were presented as means and standard deviations and categorical variables as frequencies and proportions. Conditional logistic regression was used to determine the strength of association between the dependent and the independent variables. Statistical significance was considered at p value of <0.05.

Results

The prevalence of anaemia was high (53.8%), while children whose mothers received iron supplementation during pregnancy were 7.64 times more likely to be anaemic compared with those who did not [AOR=7.64 (95% CI:1.41-41.20.93); p=0.018]. Children with poor dietary diversity were 9.15 times more likely to have anaemia [AOR=9.15 (95% CI: 3.13-26.82); p< 0.001]; and children whose mothers were farmers and traders were 83% [AOR = 0.17 (95% CI: 0.05-0.60); p=0.006] and 79% [AOR=0.21 (95% CI: 0.06-0.74); p=0.014], respectively, less likely to have anaemia.

Conclusion

The biologic, intermediate, and underlying factors that were significantly associated with anaemia comprised maternal iron supplementation, poor dietary diversity, farmers, and traders. Given that iron supplementation during pregnancy did not protect children against anaemia, we recommend the child's nutritional dietary diversity is encouraged.

Prevalence and clinical outcomes of Plasmodium falciparum and intestinal parasitic infections among children in Kiryandongo refugee camp, mid-Western Uganda: a cross sectional study

BACKGROUND

The prevalence of Plasmodium falciparum and Intestinal Parasitic Infections (IPIs) - with the corresponding pathogenesis among children remain uncertain. This study aimed at determining the prevalence and the outcomes (including anaemia) of the respective infections and co-infections. Anaemia is a condition in which the number of red blood cells transporting oxygen to the various body parts is not sufficient to meet the needs of the body.

METHODS

This was a cross sectional study conducted among 476-refugee camp school children. Kato-Katz technique was used to screen stool samples for intestinal parasites. Microscopy was used for malaria testing while the portable Haemoglobin (Hb) calorimeter was used to measure haemoglobin concentration.

RESULTS

The overall prevalence of the mixed infections was 63.03%. Plasmodium falciparum was most prevalent of the single infections 262(55.04%) followed by Taenia spp. 14 (2.9%), Schistosoma mansoni 12(2.5%), Giardia lamblia 7 (2.9%), Trichuris trichiura 2(0.4%), Hookworm 2(0.4%) and Strongyloides stercoralis 1(0.2%). The odds of developing simple or uncomplicated malaria infection or anaemia was 14 times higher in individuals with dual co-infection with Plasmodium falciparum + Taenia sp. compared to single parasitic infection (Odds = 14.13, P = 0.019). Co-infection with Plasmodium falciparum + Taenia spp, was a strong predictor of Malaria and anaemia.

CONCLUSION

This study shows that Plasmodium falciparum and Taenia spp. co-infections is a stronger predictor of malaria and anaemia. The prevalence of malaria and anaemia remains higher than the other regions in Uganda outside restricted settlements. The findings of this study underline the need for pragmatic intervention programmes to reduce burden of the co-infections in the study area and similar settlements.

Assessment of the diagnostic performance of TrueHb® point-of-care hemometer compared with Sysmex i3 analyzer among patients at International Hospital Kampala, Uganda

Aim/Objective: To assess the diagnostic performance of TrueHb® point-of-care (POC) hemometer compared with Sysmex i3 analyzer at International Hospital Kampala, Uganda. Materials and methods: We analyzed ethylenediaminetetraacetic acid blood samples to estimate hemoglobin (Hb) levels using parallel testing with TrueHb® hemometer and Sysmex i3 analyzer. Data were analyzed to ascertain the diagnostic performance of the test assays using the Bland and Altman method. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The study enrolled 402 patients; of these, 156 (38.8%) were males. The average Hb levels were 8.7±1.8 and 13.3±2.6 g/dL for the anemic and nonanemic patients, respectively. One hundred and fifty-five participants were anemic, giving anemia prevalence of 38.56% (95% CI: 35.17-40.38). The mean difference of the TrueHb® and Sysmex i3 assays was 2.2219 (SD 1.07915), and the two devices did not show a difference in their measurements (t=-2.407, p-value 0.017, 95% CI: -0.095-0.010). Further, they showed a significant level of agreement (t=41.281; 95% CI: 2.1161-2.3277) and intraclass correlation coefficients (ICC=0.793). The sensitivity, specificity, positive and negative predictive values were 100.00%, 51.01%, 55.16% and 100.00%, respectively. The average performance turnaround time (TAT) for the TrueHb® hemometer was 2.46 mins (95% CI: 2.37-2.55). Conclusion: TrueHb® POC hemometer is an accurate POC for Hb estimation with a good performance agreement with the Sysmex i3 analyzer. This, coupled with its utility aspects, makes it a good diagnostic tool in a high anemia burden and low-resource setting.

Soil-transmitted helminth infections, anemia and undernutrition among schoolchildren in Yirgacheffee, South Ethiopia

Objective

Current data on soil-transmitted helminth infections, anemia and malnutrition that are largely neglected is vital to the control and management of them in a specific setting. This study was, therefore, aimed at determining the status of the three health concerns in one of the high-risk groups, schoolchildren, in South Ethiopia.

Results

Among the 443 sampled schoolchildren, 54% were infected with soil-transmitted helminths (STHs) and 15.4% of them had anaemia, while the prevalence rate of undernutrition was 28.9%. Species-wise, prevalence of STH infections was 21.7, 16.7, 7.2 and 8.4% for Ascaris lumbricoides, the hookworms, Trichuris trichiura and mixed infections, respectively. Untreated drinking water, high frequency of sucking fingernails and open defecation were significantly associated with risk of getting STH infections. Child positivity for STH infection didn’t show any significant association with undernutrition of the children. Anaemia was significantly correlated with hookworm (adjusted odds ratio (AOR) = 2.96, 95% confidence interval (CI) = 2.15, 4.86), A. lumbricoides (AOR = 1.93, 95% CI = 1.13, 3.01) and polyparasitism (AOR = 1.54, 95% CI = 1.04, 2.64). In addition, children with heavy intensities of hookworm infections and those undernourished were more likely to suffer from anaemia with P = 0.001 and P = 0.007, respectively.