Factors influencing childhood anaemia in Bangladesh: a two level logistic regression analysis

Household environment associated with anaemia among children aged 6-59 months in Ethiopia: a multilevel analysis of Ethiopia demographic and health survey (2005-2016)

BACKGROUND

Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia.

METHODS

In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6-59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05.

RESULTS

The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7-49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1-49.1) in 2005, 42.8% (95%CI: 41.8-43.8) in 2011, and increased to 57.4% (95%CI: 56.3-58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05-1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12-1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13-1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child's age (6-35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05-1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01-1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02-1.19), children from poor households (AOR: 1.18: 95%CI: 1.06-1.31), and rural residence (AOR: 1.23, 95%CI: 1.06-1.42).

CONCLUSION

In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies.

The Effect of Iron-Fortified Lentils on Blood and Cognitive Status among Adolescent Girls in Bangladesh

BACKGROUND

Iron deficiency is highly prevalent in South Asia, especially among women and children in Bangladesh. Declines in cognitive performance are among the many functional consequences of iron deficiency.

OBJECTIVE

We tested the hypothesis that, over the course of a 4-month iron fortification trial, cognitive performance would improve, and that improvement would be related to improvements in iron status.

METHODS

Participants included 359 adolescent girls attending Bangladesh Rural Advancement Committee (BRAC) clubs as a subsample of a larger double-blind, cluster-randomized community trial in which participants were assigned to one of three conditions: a condition in which no lentils were supplied (NL, n = 118, but which had the usual intake of lentils), a control (non-fortified) lentil condition (CL, n = 124), and an iron-fortified lentil condition (FL, n = 117). In the FL and CL conditions, approximately 200 g of cooked lentils were served five days per week for a total of 85 feeding days. In addition to biomarkers of iron status, five cognitive tasks were measured at baseline (BL) and endline (EL): simple reaction time task (SRT), go/no-go task (GNG), attentional network task (ANT), the Sternberg memory search Task (SMS), and a cued recognition task (CRT).

RESULTS

Cognitive performance at EL was significantly better for those in the FL relative to the CL and NL conditions, with this being true for at least one variable in each task, except for the GNG. In addition, there were consistent improvements in cognitive performance for those participants whose iron status improved. Although there were overall declines in iron status from BL to EL, the declines were smallest for those in the FL condition, and iron status was significantly better for those in FL condition at EL, relative to those in the CL and NL conditions.

CONCLUSIONS

the provision of iron-fortified lentils provided a protective effect on iron status in the context of declines in iron status and supported higher levels of cognitive performance for adolescent girls at-risk of developing iron deficiency.

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.

Magnitude and predictors of anemia among preschool children (36-59 months) in Atingo town, Jimma, Ethiopia

Introduction

Anemia is a serious public health concern that affects more than 25% of the world's population. It is still widespread and at its most severe in Ethiopia. This study pointed to identify the magnitude and predictors of anemia in preschool children in Atinago.

Method

A structured interview and anthropometric metrics had been used in a cross-sectional study to collect data from 309 preschool children using a systematic sampling strategy from May 10 to June 25, 2022. Frequencies, percentages, means, and a bar chart were created as descriptive statistics. Factors that were significant at the 25% level in univariate analysis were run through multiple logistic models. Odds ratios with respective 95% confidence intervals were developed to determine the relevant predictors.

Result

The majority (51.7%) of preschool children in Atinago town had anemia. The finding reveals that poor dietary diversity (adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.02-3.07), children from families with food insecurity (AOR = 2.28, 95% CI = 1.31-3.9), child-mothers used iron folate for less than 3 months during pregnancy (AOR = 1.93, 95% CI = 1.07-3.48), households with more than five children (AOR = 1.880, 95% CI = 1.12-3.18), and stunted children (AOR = 1.78, 95% CI = 1.05-3.01) were highly susceptible to anemia.

Conclusion

The findings indicate that anemia was a serious issue among preschool children in Atinago. Therefore, stakeholders should provide community-based nutrition training on consuming diverse diets, dietary improvements in the home, consuming iron-rich meals, and the like; encourage mothers to participate in early ANC follow-up; and strengthen activities aimed at identifying households with food insecurity status.

Temporal evolution of anemia in children aged six to 59 months in the state of Pernambuco, Brazil, 1997 to 2016

OBJECTIVE

To analyze the temporal evolution of anemia in children aged six to 59 months in Pernambuco, based on population surveys from 1997, 2006, and 2016 and the factors associated with the situation in 2016.

METHODS

The field studies took place in the participants' households, in the Recife Metropolitan Area, as well as in the urban and rural inland. The trend study of anemia in children used data from the State Health and Nutrition Survey (Pesquisa Estadual de Saúde e Nutrição - PESN) II (40.9%) and III (32.8%). Data from PESN IV were collected using questionnaires administered to families to verify socioeconomic and individual conditions, as well as anthropometric - weight and height - and biochemical - hemoglobin - records. We adopted the test for trend in proportion for the time trend study and Poisson regression for hypothesis tests for the associated factors. Statistically significance was set at a p-value<0.05.

RESULTS

In 2016, the prevalence of anemia was 24.2%, indicating a significant reduction in disease incidence. In children aged 6-23 months, this number decreased from PENS II and III to PENS IV - 63 and 55.6 to 37.7% (p<0.001), respectively. In 2016, the statistically significant variables for anemia in children were maternal hemoglobin, child's age, current or recent case of diarrhea, and weight-for-age index.

CONCLUSION

Between 1997 and 2016, anemia rates decreased, showing an epidemiological trend that can contribute to continuously improve the health of children under five years of age in Pernambuco.

Prevalence of childhood anemia: Potential sociodemographic and dietary factors in Nigeria

BACKGROUND

Childhood anemia is a global public health issue. In this study, we assessed the potential sociodemographic and dietary factors associated with the prevalence of anemia among children aged 6-59 months in Nigeria.

METHODS

In this cross-sectional study, we collected dietary information and demographic data on 6,338 children with anemia from the Nigerian Demographic and Health Surveys (2018). The association between the occurrence of anemia and the demographic and dietary factors was determined by conducting Chi-squared tests. Additionally, bivariate and multivariate order logit models were constructed and reported as odds ratios.

RESULTS

The results of the multivariate analysis showed that the risk of anemia was reduced by 13% and 44% in children aged 13-36 months (OR = 0.87; 95% CI = 0.77-0.98; p = 0.019) and 37-59 months (OR = 0.56; 95% CI = 0.49-0.63; p < 0.001), respectively, compared to the risk of anemia in children aged 6-12 months. Anemia was 28% less likely in children of non-anemic mothers (OR = 0.72; 95% CI = 0.66-0.80; p < 0.001) than children of anemic mothers. Children fed pumpkin, carrot, squash, and sweet potato showed a lower occurrence of anemia by 17% (OR = 0.83; 95% CI = 0.70-0.99; p = 0.036) compared to those who were not fed these vegetables. Chances of anemia increased by 14% in children who were fed white potatoes, white yams, manioc, cassava, and other root-based foods (OR = 1.14; 95% CI = 1.01-1.29; p = 0.036).

CONCLUSION

This study highlighted the impact of a plant-based diet on the high prevalence of childhood anemia in Nigeria. Therefore, reformation of dietary habits, the inclusion of nutritional supplements, and food-fortification programs with reductions in maternal anemia are recommended.

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.

An Observational Study of Paediatric Preoperative Transfusion Practice in a Resource-Limited Setting

Background

Paediatric anaemia is highly prevalent in low–middle-income countries and can negatively impact postoperative outcomes. Currently, there are no guidelines for the management of paediatric preoperative anaemia. To ensure optimal care in resource-limited settings: balancing the risks of anaemia and using resources such as blood transfusion, we first need to understand current practices. To address this, a joint UK–Bangladesh team conducted an observational study at a paediatric surgical centre in Bangladesh.

Methods

A total of 464 patients ≤16 years who underwent elective and emergency surgery were categorised into major (351/464), moderate (92/464) and minor (21/464) surgery groups according to anticipated blood loss. Preoperative anaemia testing and transfusion was assessed retrospectively through patient notes.

Results

Median age was 4 years and 73% were male. 32.5% (151/464) patients had preoperative blood testing for anaemia. 17.5% (81/464) children were transfused preoperatively. Of those children transfused, 40.7% (33/81) underwent transfusion solely based on visible signs of anaemia on clinical examination. Seventy-five percentage (36/48) of children who underwent transfusion after blood testing had haemoglobin ≥80 g/L. Major surgery category had the highest proportion of children who were transfused and tested for anaemia.

Conclusion

A liberal transfusion approach is evident here. Discussion with local clinicians revealed that this was due to limitations in obtaining timely blood results and reduction in laboratory costs incurred by families when clinical suspicion of anaemia was high. Further research is needed to analyse the potential of using bedside haemoglobin testers in conjunction with patient blood management strategies to limit blood transfusions and its associated risks.

Maternal health status and household food security on determining childhood anemia in Bangladesh -a nationwide cross-sectional study

BACKGROUND

The aim of this study was to examine the effect of household food security on childhood anemia in Bangladesh while controlling for socioeconomic and demographic factors.

METHODS

We used nationally representative Bangladesh Demographic Health Survey (BDHS) 2011 data for this study, the only existing survey including anemia information and household food security. The sample included 2171 children aged 6-59 months and their mothers. Differences between socioeconomic and demographic variables were analyzed using Chi-square test. Univariate and multivariate logistic regression analyses were performed to estimate the effects of different socioeconomic and demographic factors on childhood anemia. We also performed mediation analysis to examine the direct and indirect effect of household food security on childhood anemia.

RESULTS

In Bangladesh, 53% male (95% CI: 50-56) and 51% female (95% CI: 47-54) children aged 6-59 months were anemic in 2011. The food insecure households have 1.20 times odds (95% CI: 0.97-1.48) of having anemic children comparing to food secure households in the unadjusted model. On the other hand, anemic mothers have 2 times odds (95% CI: 1.67-2.44) of having anemic children comparing to non-anemic mothers. However, household food security is no longer significantly associated with childhood anemia in the adjusted model while mothers' anemia remained a significant factor (OR 1.87: 95% CI: 1.53-2.29). Age of children is the highest associated factor, and the odds are 4.89 (95% CI: 3.21-7.45) for 6-12 months old children comparing to 49-59 months in the adjusted model. Stunting and household wealth are also a significant factor for childhood anemia. Although food security has no significant direct effect on childhood anemia, maternal anemia and childhood stunting mediated that relationship.

CONCLUSIONS

Future public health policies need to focus on improving mothers' health with focusing on household food security to eliminate childhood anemia.

Socio-economic inequality in anaemia among men in India: a study based on cross-sectional data

BACKGROUND

Undernutrition is a serious matter of public health concern in India. Existing studies, policies and programs focus on women and children thereby ignoring men in policymaking. This study examines the socio-economic inequality in anaemia levels among men in India and tries to decompose the factors behind it.

METHODS

The fourth round of National Family Health Survey is used to fulfill the study objectives. The outcome variable of the study is men having anaemia or not. The study uses bivariate and multivariate techniques to identify the factors associated with the outcome variable. Further, concentration index and concentration curve are calculated to measure the socio-economic inequality in anaemia among men in India.

RESULTS

The results indicate that majority of the socio-economic related inequality is explained by wealth quintile followed by geographical regions of India, body mass index and educational attainment. The results also emphasize that older men belong to the high-risk groups. Moreover, the likelihood of anaemia is 40% more likely among men who belonged to East region and 25%, 13% and 7 % less likely among those who belonged to Northeast, West and South region compared to those who belonged in the North region of the country.

CONCLUSION

Existing policies on anaemia should include men to achieve an anaemia free India. Individual education and awareness should be encouraged to improve nutritional status.

Cesarean delivery and early childhood diseases in Bangladesh: An analysis of Demographic and Health Survey (BDHS) and Multiple Indicator Cluster Survey (MICS)

Introduction

The rate of cesarean delivery (C-section) has been increasing worldwide, including Bangladesh, and it has a negative impact on the mother and child's health. Our aim was to examine the association between C-section and childhood diseases and to identify the key factors associated with childhood diseases.

Methods

We used four nationally representative data sets from multiple indicator cluster survey (MICS, 2012 and 2019) and Bangladesh Demographic and Health Survey (BDHS, 2011and 2014) and analyzed 25,270 mother-child pairs. We used the frequency of common childhood diseases (fever, short or rapid breaths, cough, blood in stools, and diarrhea) as our outcome variable and C-section as exposure variable. We included mother’s age, place of residence, division, mother’s education, wealth index, child age, child sex, and child size at birth as confounding variables. Negative binomial regression model was used to analyze the data.

Results

In the BDHS data, the prevalence of C-section increased from 17.95% in 2011 to 23.33% in 2014. Also, in MICS, the prevalence almost doubled over an eight-year period (17.74% in 2012 to 35.41% in 2019). We did not observe any significant effect of C-section on childhood diseases in both surveys. Only in 2014 BDHS, we found that C-section increases the risk of childhood disease by 5% [Risk Ratio (RR): 1.05, 95% CI: 0.95, 1.17, p = 0.33]. However, the risk of childhood disease differed significantly in all survey years by division, child's age, and child’s size at birth after adjusting for important confounding variables. For example, children living in Chittagong division had a higher risk [(2011 BDHS RR: 1.22, 95% CI: 1.08, 1.38) and (2019 MICS RR: 1.21, 95% CI: 1.08, 1.35)] of having disease compared to Dhaka division. Maternal age, education, and wealth status showed significant differences with the outcome in some survey years.

Conclusion

Our study shows that C-section in Bangladesh continued to increase over time, and we did not find significant association between C-section and early childhood diseases. High C-section rate has a greater impact on maternal and child health as well as the burden on the health care system. We recommend raising public awareness of the negative impact of unnecessary C-section in Bangladesh.

Low educational level of head of household, as a proxy for poverty, is associated with severe anaemia among children with sickle cell disease living in a low-resource setting: evidence from the SPRING trial

Severe anaemia, defined as haemoglobin level < 6·0 g/dl, is an independent risk factor for death in individuals with sickle cell disease living in resource-limited settings. We conducted a cross-sectional study of 941 children with sickle cell anaemia, who had been defined as phenotype HbSS or HbSβ⁰ thalassaemia, aged five to 12 years, and were screened for enrollment into a large primary stroke prevention trial in Nigeria (SPRING; NCT02560935). The main aim of the study was to determine the prevalence and risk factors for severe anaemia. We found severe anaemia to be present in 3·9% (37 of 941) of the SPRING study participants. Severe anaemia was significantly associated with the lower educational level of the head of the household (P = 0·003), as a proxy for poverty, and a greater number of children per room in the household (P = 0·004). Body mass index was not associated with severe anaemia. The etiology of severe anaemia in children living with sickle cell anaemia in Nigeria is likely to be multifactorial with an interplay between an individual's disease severity and other socio-economic factors related to poverty.

Association between social capital and mental health among older people living with HIV: the Sichuan Older HIV-Infected Cohort Study (SOHICS)

BACKGROUND

Mental health problems are common among older people living with HIV and associated with poorer health outcomes. Social capital is an important determinant of mental health problems but under-studied in this population. This study investigated the association between social capital and mental health problems among older people living with HIV in China.

METHODS

The study was based on the baseline data of a cohort study investigating mental health among older people living with HIV in Sichuan, China during November 2018 to February 2019. Participants were people living with HIV aged ≥50 years living in Sichuan province. Stratified multi-stage cluster sampling was used to recruit participants from 30 communities/towns; 529 out of 556 participants being approached completed the face-to-face interview. Social capital was measured by two validated health-related social capital scales: the Individual and Family scale and the Community and Society scale. Presence of probable depression (CES-D-10 score ≥ 10) and probable anxiety (GAD-7 score ≥ 5) were used as dependent variables. Two-level logistic regression models were applied to examine the association between social capital and probable depression/anxiety.

RESULTS

The prevalence of probable depression and probable anxiety was 25.9% (137/529) and 36.3% (192/529), respectively. After adjusting for significant covariates, the individual/family level of social capital was inversely associated with both probable depression (odds ratios (OR): 0.89, 95% CI: 0.84-0.93, p < 0.001) and probable anxiety (OR: 0.90, 95% CI: 0.86-0.95, p < 0.001). The community/society level social capital was associated with probable depression (OR: 0.91, 95% CI: 0.84-0.99, p < 0.001) but not probable anxiety (p > 0.05).

CONCLUSIONS

Interventions building up social capital should be considered to improve mental health of older people living with HIV. Some useful strategies include cognitive processing therapy, improving community networking and engagement, and promoting social bonding with neighborhood.

Correction to: Factors influencing childhood anaemia in Bangladesh: a two level logistic regression analysis

Following publication of the original article [1], the authors reported that name that appeared in published online version is incorrect.