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Schildroth S, Kordas K, White RF, Friedman A, Placidi D, Smith D, Lucchini RG, Wright RO, Horton M, Claus Henn B. An Industry-Relevant Metal Mixture, Iron Status, and Reported Attention-Related Behaviors in Italian Adolescents. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:27008. [PMID: 38363634 PMCID: PMC10871126 DOI: 10.1289/ehp12988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 12/01/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Exposure to environmental metals has been consistently associated with attention and behavioral deficits in children, and these associations may be modified by coexposure to other metals or iron (Fe) status. However, few studies have investigated Fe status as a modifier of a metal mixture, particularly with respect to attention-related behaviors. METHODS We used cross-sectional data from the Public Health Impact of Metals Exposure study, which included 707 adolescents (10-14 years of age) from Brescia, Italy. Manganese, chromium, and copper were quantified in hair samples, and lead was quantified in whole blood, using inductively coupled plasma mass spectrometry. Concentrations of Fe status markers (ferritin, hemoglobin, transferrin) were measured using immunoassays or luminescence assays. Attention-related behaviors were assessed using the Conners Rating Scales Self-Report Scale-Long Form, Parent Rating Scales Revised-Short Form, and Teacher Rating Scales Revised-Short Form. We employed Bayesian kernel machine regression to examine associations of the metal mixture with these outcomes and evaluate Fe status as a modifier. RESULTS Higher concentrations of the metals and ferritin were jointly associated with worse self-reported attention-related behaviors: metals and ferritin set to their 90th percentiles were associated with 3.0% [β = 0.03 ; 95% credible interval (CrI): - 0.01 , 0.06], 4.1% (β = 0.04 ; 95% CrI: 0.00, 0.08), and 4.1% (β = 0.04 ; 95% CrI: 0.00, 0.08) higher T -scores for self-reported attention deficit/hyperactivity disorder (ADHD) index, inattention, and hyperactivity, respectively, compared with when metals and ferritin were set to their 50th percentiles. These associations were driven by hair manganese, which exhibited nonlinear associations with all self-reported scales. There was no evidence that Fe status modified the neurotoxicity of the metal mixture. The metal mixture was not materially associated with any parent-reported or teacher-reported scale. CONCLUSIONS The overall metal mixture, driven by manganese, was adversely associated with self-reported attention-related behavior. These findings suggest that exposure to multiple environmental metals impacts adolescent neurodevelopment, which has significant public health implications. https://doi.org/10.1289/EHP12988.
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Affiliation(s)
- Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - Roberta F. White
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Neurology, Boston University, Boston, Massachusetts, USA
| | - Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Donatella Placidi
- Department of Occupational Health, University of Brescia, Brescia, Italy
| | - Donald Smith
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, California, USA
| | - Roberto G. Lucchini
- Department of Occupational Health, University of Brescia, Brescia, Italy
- Department of Environmental Health Sciences, Florida International University, Miami, Florida, USA
| | - Robert O. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Schildroth S, Valeri L, Kordas K, Shi B, Friedman A, Smith D, Placidi D, Wright RO, Lucchini RG, White RF, Horton M, Claus Henn B. Assessing the mediating role of iron status on associations between an industry-relevant metal mixture and verbal learning and memory in Italian adolescents. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 906:167435. [PMID: 37774885 PMCID: PMC10918745 DOI: 10.1016/j.scitotenv.2023.167435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Metals, including lead (Pb), manganese (Mn), chromium (Cr) and copper (Cu), have been associated with neurodevelopment; iron (Fe) plays a role in the metabolism and neurotoxicity of metals, suggesting Fe may mediate metal-neurodevelopment associations. However, no study to date has examined Fe as a mediator of the association between metal mixtures and neurodevelopment. OBJECTIVE We assessed Fe status as a mediator of a mixture of Pb, Mn, Cr and Cu in relation to verbal learning and memory in a cohort of Italian adolescents. METHODS We used cross-sectional data from 383 adolescents (10-14 years) in the Public Health Impact of Metals Exposure Study. Metals were quantified in blood (Pb) or hair (Mn, Cr, Cu) using ICP-MS, and three markers of Fe status (blood hemoglobin, serum ferritin and transferrin) were quantified using luminescence assays or immunoassays. Verbal learning and memory were assessed using the California Verbal Learning Test for Children (CVLT-C). We used Bayesian Kernel Machine Regression Causal Mediation Analysis to estimate four mediation effects: the natural direct effect (NDE), natural indirect effect (NIE), controlled direct effect (CDE) and total effect (TE). Beta (β) coefficients and 95 % credible intervals (CIs) were estimated for all effects. RESULTS The metal mixture was jointly associated with a greater number of words recalled on the CVLT-C, but these associations were not mediated by Fe status. For example, when ferritin was considered as the mediator, the NIE for long delay free recall was null (β = 0.00; 95 % CI = -0.22, 0.23). Conversely, the NDE (β = 0.23; 95 % CI = 0.01, 0.44) indicated a beneficial association of the mixture with recall that operated independently of Fe status. CONCLUSION An industry-relevant metal mixture was associated with learning and memory, but there was no evidence of mediation by Fe status. Further studies in populations with Fe deficiency and greater variation in metal exposure are warranted.
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Affiliation(s)
- Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Linda Valeri
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - Baoyi Shi
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Donald Smith
- Department of Microbiology and Environmental Toxicology, University of California Santa Cruz, Santa Cruz, CA, USA
| | - Donatella Placidi
- Department of Occupational Health, University of Brescia, Brescia, Italy
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roberto G Lucchini
- Department of Occupational Health, University of Brescia, Brescia, Italy; Department of Environmental Health Sciences, Florida International University, Miami, FL, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA; Department of Neurology, Boston University, Boston, MA, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
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Rahman MJ, Rahman MM, Kakehashi M, Matsuyama R, Sarker MHR, Ali M, Promitee SK, Prihanto JB, Ahmed A, Shimpuku Y. Impact of eHealth education to reduce anemia among school-going adolescent girls in rural Bangladesh: Study protocol of a randomized controlled trial. J Family Med Prim Care 2023; 12:2569-2575. [PMID: 38186809 PMCID: PMC10771192 DOI: 10.4103/jfmpc.jfmpc_1010_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/10/2023] [Accepted: 09/08/2023] [Indexed: 01/09/2024] Open
Abstract
Adolescent girls are highly vulnerable to developing anemia due to reproductive immaturity, poor personal hygiene, and lack of nutritional intake and health education in rural Bangladesh. Digital health technology is a promising tool to overcome barriers and provide appropriate health guidelines. We aim to evaluate eHealth education's impact and changes in adolescent girls' knowledge, attitude, and practice regarding anemia. A 1:1 parallel randomized control trial was conducted among school-going adolescent girls in rural Bangladesh. A total of 138 anemic (mild and moderate) participants were enrolled. We randomized schools to reduce the health education bias through a simple coin toss technique, then allocated participants to the intervention group (n = 69) and control group (n = 69) by stratified random sampling technique. The intervention group received two online counseling sessions and 8-month eHealth education through mobile phone calls and short message service regarding anemia. The control group received the usual care. The primary endpoint changes the anemic level through changing knowledge, healthy lifestyle behavior, and an iron-rich food dietary plan. Per-protocol analysis will utilize to compare the control and intervention groups using SPSS software. Descriptive statistics (frequencies, percentages, mean, SD) will be employed, and continuous variables will be compared using the t-test/Mann-Whitney test. Two-way analysis of variance will assess outcome variables at baseline, 4 months, and 8 months. The 8-month intervention is designed from May 2022 to February 2023. Participants' age range of 10-14 years was 60.9% in the intervention group and 56.5% in the control group. Among the participants, 89.9% and 88.4% were mild anemic; 11.11 (SD ± 0.80) and 11.06 (SD ± 0.96) were mean hemoglobin in the intervention and control groups, respectively. eHealth education is expected to be an effective way to increase knowledge and healthy behavioral change, which can reduce the anemia burden among adolescent girls.
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Affiliation(s)
- Md Jiaur Rahman
- Global Health Nursing, Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Md Moshiur Rahman
- Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masayuki Kakehashi
- Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ryota Matsuyama
- Veterinary Medicine, Rakuno Gakuen University, Hokkaido, Japan
| | | | - Mohammad Ali
- Department of Medicine, Comilla Medical College, Cumilla, Bangladesh
| | - Sumaita Kabir Promitee
- Nutrition and Clinical Service Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Chandpur, Bangladesh
| | - Junaidi Budi Prihanto
- Physical Education, Health and Recreation, Sport Science Faculty, Universitas Negeri Surabaya, Indonesia
| | - Ashir Ahmed
- Department of Advanced Information Technology, Graduate School of Information Science and Electrical Engineering, Kyushu University, Fukuoka, Japan
| | - Yoko Shimpuku
- Global Health Nursing, Department of Health Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Odo DB, Yang IA, Dey S, Hammer MS, van Donkelaar A, Martin RV, Dong GH, Yang BY, Hystad P, Knibbs LD. A cross-sectional analysis of ambient fine particulate matter (PM 2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries. ENVIRONMENTAL RESEARCH 2023; 227:115734. [PMID: 36963710 DOI: 10.1016/j.envres.2023.115734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM2.5 exposure was 33.0 (±21.6) μg/m3. The adjusted model showed that a 10 μg/m3 increase in annual PM2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.
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Affiliation(s)
- Daniel B Odo
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; College of Health Sciences, Arsi University, Asela, Ethiopia.
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia; UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, New Delhi, India; Arun Duggal Centre of Excellence for Research in Climate Change and Air Pollution, Indian Institute of Technology Delhi, New Delhi, India
| | - Melanie S Hammer
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Randall V Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, United States
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, USA
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW, 2050, Australia
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Schildroth S, Friedman A, White RF, Kordas K, Placidi D, Bauer JA, Webster TF, Coull BA, Cagna G, Wright RO, Smith D, Lucchini RG, Horton M, Claus Henn B. Associations of an industry-relevant metal mixture with verbal learning and memory in Italian adolescents: The modifying role of iron status. ENVIRONMENTAL RESEARCH 2023; 224:115457. [PMID: 36773645 PMCID: PMC10117691 DOI: 10.1016/j.envres.2023.115457] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Biomarker concentrations of metals are associated with neurodevelopment, and these associations may be modified by nutritional status (e.g., iron deficiency). No prior study on associations of metal mixtures with neurodevelopment has assessed effect modification by iron status. OBJECTIVES We aimed to quantify associations of an industry-relevant metal mixture with verbal learning and memory among adolescents, and to investigate the modifying role of iron status on those associations. METHODS We used cross-sectional data from 383 Italian adolescents (10-14 years) living in proximity to ferroalloy industry. Verbal learning and memory was assessed using the California Verbal Learning Test for Children (CVLT-C), and metals were quantified in hair (manganese, copper, chromium) or blood (lead) using inductively coupled plasma mass spectrometry. Serum ferritin, a proxy for iron status, was measured using immunoassays. Covariate-adjusted associations of the metal mixture with CVLT subtests were estimated using Bayesian Kernel Machine Regression, and modification of the mixture associations by ferritin was examined. RESULTS Compared to the 50th percentile of the metal mixture, the 90th percentile was associated with a 0.12 standard deviation [SD] (95% CI = -0.27, 0.50), 0.16 SD (95% CI = -0.11, 0.44), and 0.11 SD (95% CI = -0.20, 0.43) increase in the number of words recalled for trial 5, long delay free, and long delay cued recall, respectively. For an increase from its 25th to 75th percentiles, copper was beneficially associated the recall trials when other metals were fixed at their 50th percentiles (for example, trial 5 recall: β = 0.31, 95% CI = 0.14, 0.48). The association between copper and trial 5 recall was stronger at the 75th percentile of ferritin, compared to the 25th or 50th percentiles. CONCLUSIONS In this metal mixture, copper was beneficially associated with neurodevelopment, which was more apparent at higher ferritin concentrations. These findings suggest that metal associations with neurodevelopment may depend on iron status, which has important public health implications.
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Affiliation(s)
- Samantha Schildroth
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA.
| | - Alexa Friedman
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA
| | - Roberta F White
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA; Department of Neurology, Boston University, Boston MA, USA
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, USA
| | - Donatella Placidi
- Department of Occupational Health, University of Brescia, Brescia, Italy
| | - Julia A Bauer
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Thomas F Webster
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston MA, USA
| | - Giuseppa Cagna
- Department of Occupational Health, University of Brescia, Brescia, Italy
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Donald Smith
- Department of Microbiology and Environmental Toxicology, University of California Santa Cruz, Santa Cruz CA, USA
| | - Roberto G Lucchini
- Department of Occupational Health, University of Brescia, Brescia, Italy; Department of Environmental Health Sciences, Florida International University, Miami FL, USA
| | - Megan Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Birgit Claus Henn
- Department of Environmental Health, Boston University School of Public Health, Boston MA, USA
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Tian J, Zhu Y, Liu S, Wang L, Qi Q, Deng Q, Andegiorgish AK, Elhoumed M, Cheng Y, Shen C, Zeng L, Zhu Z. Associations between life-course household wealth mobility and adolescent physical growth, cognitive development and emotional and behavioral problems: A birth cohort in rural western China. Front Public Health 2023; 11:1061251. [PMID: 36817901 PMCID: PMC9934056 DOI: 10.3389/fpubh.2023.1061251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Background Parental household wealth has been shown to be associated with offspring health conditions, while inconsistent associations were reported among generally healthy population especially in low- and middle- income countries (LMICs). Whether the household wealth upward mobility in LMICs would confer benefits to child health remains unknown. Methods We conducted a prospective birth cohort of children born to mothers who participated in a randomized trial of antenatal micronutrient supplementation in rural western China. Household wealth were repeatedly assessed at pregnancy, mid-childhood and early adolescence using principal component analysis for household assets and dwelling characteristics. We used conditional gains and group-based trajectory modeling to assess the quantitative changes between two single-time points and relative mobility of household wealth over life-course, respectively. We performed generalized linear regressions to examine the associations of household wealth mobility indicators with adolescent height- (HAZ) and body mass index-for-age and sex z score (BAZ), scores of full-scale intelligent quotient (FSIQ) and emotional and behavioral problems. Results A total of 1,188 adolescents were followed, among them 59.9% were male with a mean (SD) age of 11.7 (0.9) years old. Per SD conditional increase of household wealth z score from pregnancy to mid-childhood was associated with 0.11 (95% CI 0.04, 0.17) SD higher HAZ and 1.41 (95% CI 0.68, 2.13) points higher FSIQ at early adolescence. Adolescents from the household wealth Upward trajectory had a 0.25 (95% CI 0.03, 0.47) SD higher HAZ and 4.98 (95% CI 2.59, 7.38) points higher FSIQ than those in the Consistently low subgroup. Conclusion Household wealth upward mobility particularly during early life has benefits on adolescent HAZ and cognitive development, which argues for government policies to implement social welfare programs to mitigate or reduce the consequences of early-life deprivations. Given the importance of household wealth in child health, it is recommended that socioeconomic circumstances should be routinely documented in the healthcare record in LMICs.
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Affiliation(s)
- Jiaxin Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yingze Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Shuang Liu
- Sichuan Center for Disease Control and Prevention, Institute of Tuberculosis Control and Prevention, Chengdu, China
| | - Liang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Qiwei Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yue Cheng
- Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Shaanxi, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China,Key Laboratory of Environment and Genes Related to Diseases, Xi'an Jiaotong University, Ministry of Education, Xi'an, Shaanxi, China,Lingxia Zeng ✉
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China,*Correspondence: Zhonghai Zhu ✉
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A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries. Anemia 2023; 2023:6406286. [PMID: 36636253 PMCID: PMC9831712 DOI: 10.1155/2023/6406286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Identifying the root causes of iron deficiency anaemia is a prerequisite for effective management and prevention in adolescents. This systematic review assessed risk factors of iron deficiency anaemia among adolescents living in developing countries. Method Electronic databases such as PubMed, Cochrane Library, Science Direct, Google Scholar, and SCOPUS were comprehensively searched for studies published between 1990 and 2020 that involved risk factors of iron deficiency anaemia among adolescents living in developing countries. The quality of the included studies was assessed using the American Dietetic Association Quality Criteria Checklist. Results A total of 2,252 publications were reviewed, and only fifteen cross-sectional studies were eligible for inclusion, eight of which focused on female adolescents and seven on both genders. Direct risk factors contributing to anaemia among adolescents included food intake practices (n = 10 studies), female adolescents (n = 8 studies), menstruation (n = 5 studies), and parasitic infection (n = 6 studies). Indirect risk factors found to be associated with anaemia among adolescents included low educational status (n = 4 studies) and low socioeconomic status (n = 3 studies). All fifteen studies were of good quality. Conclusion Food intake practices, female adolescents, menstruation, parasitic infection, and low educational status were the leading risk factors of iron deficiency anaemia among adolescents. Further research should concentrate on assessing the effectiveness and efficacy of existing interventions aimed at preventing iron deficiency among vulnerable groups in developing countries.
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Shankar H, Singh MP, Hussain SSA, Phookan S, Singh K, Mishra N. Epidemiology of malaria and anemia in high and low malaria-endemic North-Eastern districts of India. Front Public Health 2022; 10:940898. [PMID: 35968433 PMCID: PMC9366887 DOI: 10.3389/fpubh.2022.940898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Anemia and malaria are the two major public health problems that lead to substantial morbidity and mortality. Malaria infection destroys erythrocytes, resulting in low hemoglobin (Hb) levels known as anemia. Here we report the determinants of anemia in high and low malaria-endemic areas that would help understand which parasite densities, age, and gender-associated low Hb levels. Therefore, a cross-sectional mass survey (n = 8,233) was conducted to screen anemia and malaria in high and low malaria-endemic districts (HMED and LMED) of North-East India. Axillary body temperature was measured using a digital thermometer. The prevalence of anemia was found to be 55.3% (4,547/8,233), of which 45.1% had mild (2,049/4,547), 52.1% moderate (2,367/4,547) and 2.9% had severe anemia (131/4,547). Among anemic, 70.8% (3,219/4,547) resided in LMED and the rest in HMED. The median age of the anemic population was 12 years (IQR: 7–30). Overall, malaria positivity was 8.9% (734/8,233), of which HMED shared 79.6% (584/734) and LMED 20.4% (150/734) malaria burden. The village-wise malaria frequency was concordant to asymptomatic malaria (10–20%), which showed that apparently all of the malaria cases were asymptomatic in HMED. LMED population had significantly lower Hb than HMED [standardized beta (β) = −0.067, p < 0.0001] and low-density Plasmodium infections had higher Hb levels than high-density infections (β = 0.113; p = 0.031). Women of reproductive age had higher odds for malaria (OR: 1.42; 95% CI: 1.00–2.05; p = 0.04). Females (β = −0.193; p < 0.0001) and febrile individuals (β = −0.029; p = 0.008) have shown lower Hb levels, but malaria positivity did not show any effect on Hb. Young children and women of reproductive age are prone to anemia and malaria. Although there was no relation between malaria with the occurrence of anemia, we found low-density Plasmodium infections, female gender, and LMED were potential determinants of Hb.
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Affiliation(s)
- Hari Shankar
- ICMR-National Institute of Malaria Research, New Delhi, India
- Indian Council of Medical Research, New Delhi, India
| | | | | | - Sobhan Phookan
- ICMR-National Institute of Malaria Research Field Unit, Guwahati, India
| | - Kuldeep Singh
- ICMR-National Institute of Malaria Research Field Unit, Guwahati, India
| | - Neelima Mishra
- ICMR-National Institute of Malaria Research, New Delhi, India
- *Correspondence: Neelima Mishra
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9
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Atalell KA, Tamir TT, Alemu TG, Techane MA. Spatial distributions and determinants of anaemia among adolescent girls in Ethiopia: a secondary analysis of EDHS 2016 - a cross-sectional study. BMJ Open 2022; 12:e059405. [PMID: 35618330 PMCID: PMC9137342 DOI: 10.1136/bmjopen-2021-059405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the spatial distributions and determinants of anaemia among adolescent girls in Ethiopia. Exploring the spatial epidemiology of anaemia and identifying the risk factors would inform policymakers to come up with evidence-based prevention strategies for anaemia, especially in adolescent girls, who are the most affected segment of the population. METHODS Secondary analysis of the Ethiopian Demographic and Health Survey 2016 was conducted. A total of 3172 adolescents were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and the geospatial pattern and prediction of anaemia were mapped using ArcGIS V.10.8. A multilevel logistic regression model was fitted to identify factors associated with anaemia among adolescent girls. Adjusted OR with 95% CI was calculated and variables having a p value less than 0.05 were statistically significant factors of anaemia. RESULT The overall prevalence of anaemia among adolescent girls in Ethiopia was 23.8 (22.4 to 25.3), with significant spatial variations across the country. The SaTScan analysis identified a primary cluster in the eastern, northeastern and southeastern parts of Ethiopia (loglikelihood ratio=39, p<0.001). High anaemia prevalence was observed in eastern parts of the country. In the multivariable multilevel logistic regression analysis, no formal education (adjusted OR (AOR)=1.49, 95% CI 1.05 to 2.12), Afar (AOR=3.36, 95% CI 1.87 to 6.05), Somali (AOR=4.63, 95% CI 2.61 to 8.23), Harari (AOR=1.90, 95% CI 1.32 to 4.10), Dire Dawa (AOR=2.32, 95% CI 1.32 to 4.10) and high cluster altitude (AOR=1.37, 95% CI 1.03 to 1.82) were significantly associated with anaemia. CONCLUSION The national distributions of anaemia varied substantially across Ethiopia. Educational status, region and cluster altitude were significantly associated with anaemia in the multivariable logistic regression model. Thus, targeted public health interventions for adolescent girls should be implemented in the hotspot areas.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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10
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Safiri S, Kolahi AA, Noori M, Nejadghaderi SA, Karamzad N, Bragazzi NL, Sullman MJM, Abdollahi M, Collins GS, Kaufman JS, Grieger JA. Burden of anemia and its underlying causes in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. J Hematol Oncol 2021; 14:185. [PMID: 34736513 PMCID: PMC8567696 DOI: 10.1186/s13045-021-01202-2] [Citation(s) in RCA: 136] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023] Open
Abstract
Background Anemia is a common disease which affects around 40% of children and 30% of reproductive age women and can have major health consequences. The present study reports the global, regional and national burden of anemia and its underlying causes between 1990 and 2019, by age, sex and socio-demographic index (SDI). Methods Publicly available data on the point prevalence and years lived with disability (YLDs) were retrieved from the global burden of disease (GBD) 2019 study for 204 countries and territories between 1990 and 2019. The point prevalence, YLD counts and rates per 100,000 population were presented, along with their corresponding 95% uncertainty intervals. Results In 2019, the global age-standardized point prevalence and YLD rates for anemia were 23,176.2 (22,943.5–23,418.6) and 672.4 (447.2–981.5) per 100,000 population, respectively. Moreover, the global age-standardized point prevalence and YLD rate decreased by 13.4% (12.1–14.5%) and 18.8% (16.9–20.8%), respectively, over the period 1990–2019. The highest national point prevalences of anemia were found in Zambia [49327.1 (95% UI: 46,838.5–51,700.1)], Mali [46890.1 (95% UI: 44,301.1–49,389.8)], and Burkina Faso [46117.2 (95% UI: 43,640.7–48,319.2)]. In 2019, the global point prevalence of anemia was highest in the 15–19 and 95+ age groups in females and males, respectively. Also, the burden of anemia was lower in regions with higher socio-economic development. Globally, most of the prevalent cases were attributable to dietary iron deficiency, as well as hemoglobinopathies and hemolytic anemias. Conclusions Anemia remains a major health problem, especially among females in less developed countries. The implementation of preventive programs with a focus on improving access to iron supplements, early diagnosis and the treatment of hemoglobinopathies should be taken into consideration. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-021-01202-2.
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Affiliation(s)
- Saeid Safiri
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. .,Social Determinants of Health Research Center, Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nahid Karamzad
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, School of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.,Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Morteza Abdollahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Gary S Collins
- Centre for Statistics in Medicine, NDORMS, Botnar Research Centre, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jessica A Grieger
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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