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Guja H, Belgiu M, Baye K, Stein A. Prevalence and determinants of stunting and anaemia in children aged 6-23 months: A multilevel analysis from rural Ethiopia. MATERNAL & CHILD NUTRITION 2024:e13736. [PMID: 39377551 DOI: 10.1111/mcn.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/26/2024] [Accepted: 09/08/2024] [Indexed: 10/09/2024]
Abstract
Low- and middle-income countries shoulder the greatest burden of stunting and anaemia in children. This calls for prompt and effective intervention measures, while the contributing factors are not fully understood. This study evaluates determinants spanning from individual-, household- and community levels including agroecology and antinutrients as unique sets of predictors. Primary data were collected from 660 rural households representing the midland (ML), highland, and upper highland (UHL) agroecological zones from northern Ethiopia. The study relates several predictors to stunting and anaemia in children aged 6-23 months. We found 49.1% and 49.7% of children were stunted and anaemic, respectively. Children living in the ML are approximately twice more likely to be stunted adjusted odds ratio (AOR: 1.869; 95% CI: 1.147-3.043) than in the UHL. The risk of stunting increases by 16.3% and 41.9% for every unit increase in phytate-to-zinc and phytate-to-iron molar ratios, respectively. A 10% increase in mean aggregated crop yield was observed to reduce the likelihood of stunting occurrence by 13.6%. Households lacking non-farm income-generating opportunities, travel longer time to access the marketplace and poor health service utilisation were associated with increased risk of stunting. Low diversity of child's diet, age of the child (18-23 months) and mothers at a younger age are significantly associated with stunting. Risk of anaemia in children is high amongst households with unimproved water, sanitation, and hygiene practices, younger age (6-11 months) and mostly occurs amongst boys. Children in the ML had a 55% reduced risk of being anaemic (AOR: 0.446; 95% CI: 0.273-0.728) as compared to the UHL. Therefore, the influence of these factors should be considered to tailor strategies for reducing undernutrition in children of 6-23 months in rural Ethiopia. Interventions should go beyond the administrative boundaries into targeting agroecological variation.
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Affiliation(s)
- Habtamu Guja
- Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
- Center for Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mariana Belgiu
- Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
| | - Kaleab Baye
- Center for Food Science and Nutrition, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Stein
- Faculty of Geo-information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
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Hu J, Song Z, Zhao L, Gonzalez SC, Wang E, Hou X. The temporal trends of prevalence and years lived with disability of anaemia in China, Japan, and South Korea, from 1990 to 2021: Results from the Global Burden of Disease Study 2021. J Glob Health 2024; 14:04073. [PMID: 38779874 PMCID: PMC11112532 DOI: 10.7189/jogh.14.04073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Studies have shown that the disease burden of anaemia varies globally, yet they have not yet determined its exact extent in East Asian countries specifically. We thus aimed to investigate the prevalence and years lived with disability (YLDs) due to anaemia from 1990 to 2021 in China, Japan, and South Korea. Methods We extracted the prevalence and YLDs with their age-standardised rates (ASRs) in China, Japan, and South Korea from the Global Burden of Disease Study 2021, stratified by sex, age, and causes. We then examined the temporal trend of anaemia burden from 1990 to 2021 using joinpoint analysis and the association of anaemia burden with the Human Development Index and Universal Health Index through Spearman's correlation analysis. Results In 2021, anaemia affected 136 million people in China (95% uncertainty interval (UI) = 131, 141), with ASRs of prevalence of 8.9% (95% UI = 8.6, 9.3), and accounted for 3.0 million YLDs (95% UI = 2.0, 4.4). It affected 13.6 million people in Japan (95% UI = 11.8, 16.0), with ASRs of prevalence of 7.4% (95% UI = 6.1, 9.0), and caused 181 thousand YLDs (95% UI = 108, 282). It also affected 2.7 million individuals in South Korea (95% UI = 2.4, 3.0), with ASRs of prevalence of 5.2% (95% UI = 4.6, 5.7), and led to 34 thousand YLDs (95% UI = 22, 55). We observed a significant gender discrepancy in the anaemia burden in these three countries, with the prevalence and YLD rates in women being almost twice as high as those in men. Moreover, the peak age of the anaemia burden shifted toward higher age groups in all three countries, particularly in Japan. Chronic kidney disease was responsible for a growing share of anaemia cases and YLDs, especially in adults aged more than 60 years in Japan and South Korea. Haemoglobinopathies were another noticeable cause of anaemia in China, though dietary iron deficiency remained the leading cause. Both socioeconomic development and essential health service coverage showed negative associations with the anaemia burden in the three countries in the past three decades, though with differential patterns. Conclusions Anaemia remains a major public health issue in China, Japan, and South Korea; targeted surveillance and interventions are recommended for high-risk populations and cause-specific anaemia.
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Affiliation(s)
- Jie Hu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Molecular Precision Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zongbin Song
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liang Zhao
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Sarel Chavarria Gonzalez
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinran Hou
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Alamneh TS, Melesse AW, Gelaye KA. Determinants of anemia severity levels among children aged 6-59 months in Ethiopia: Multilevel Bayesian statistical approach. Sci Rep 2023; 13:4147. [PMID: 36914676 PMCID: PMC10011377 DOI: 10.1038/s41598-022-20381-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/13/2022] [Indexed: 03/16/2023] Open
Abstract
Anemia is a widespread public health problem that affects all stages of life particularly preschool children and pregnant mothers. Anemia among children had significant impact on their growth, development, school performance and mortality. Different strategies like deworming of young children, vitamin A supplementation for children aged 6-59 months, and ferrous sulphate supplementation and provision of insecticide treated bed net for pregnant women were designed to control and prevent anemia. Also, previous studies on anemia factors were conducted but they were not considering the ordered nature of anemia. Therefore, this study aimed to identify the factors of anemia severity levels among children aged 6-59 months in Ethiopia by using ordinal analysis based on Bayesian hierarchical statistical approach. A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 8483 weighted children were included. Due to the ordered nature of the anemia and nested nature of DHS data, ordinal logistic regression model based on hierarchical Bayesian statistical approach was employed to identify the determinants of anemia severity levels. In this study, moderate anemia level was found to be the commonest type which accounts around 29.4%. Female children, poorer, middle, and richest wealth index, primary maternal education and having ANC visit had lower risk of having higher order of anemia. Moderate maternal anemia and stunted children had higher chance of having higher order of anemia. Children age had significant different effect on mild and moderate anemia. Meanwhile, multiple birth/s and deworming had effect on moderate anemia. In addition, normal birth weight had also significant and different effect on mild and severe anemia and history of feverlike illness on mild anemia. The prevalence of anemia among children aged 6-59 months anemia was found to be a severe public health problem. Children age, sex, maternal education, child stunting, history of fever, multiple birth, birth weight, provision of deworming and maternal anemia was found to be the most important factors for child anemia severity levels. Therefore, intervention efforts to control and prevent anemia in Ethiopia requires targeting of these hindering factors.
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Affiliation(s)
- Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alemakef Wagnew Melesse
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Du Y, Durstenfeld A, Dill SE, Wang Q, Zhou H, Xue H, Kache S, Medina A, Rozelle S. Prevalence of Anemia and Associated Factors among Infants under Six Months in Rural China. Public Health Nutr 2022; 26:1-27. [PMID: 35920295 PMCID: PMC9989709 DOI: 10.1017/s1368980022001616] [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: 05/31/2021] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine haemoglobin level and anaemia status among infants under six months of age in rural China. DESIGN A cross-sectional survey collected data among infants under six months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). SETTING 80 townships were selected in Sichuan, China from November to December 2019. PARTICIPANTS 942 infants under six months, while haemoglobin level were tested for 577 infants. RESULTS The overall mean (±SD) haemoglobin level was 106.03 (± 12.04) g/L. About 62.6% (95%CI: 58.5, 66.6) of sample infants were anemic using the WHO threshold, and 20.5% (95%CI: 17.3, 24.1) were anemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower haemoglobin levels were significantly associated with lower birth weight (<4 months: b = 4.14, 95% CI: 0.19, 8.08; 4-5 months: b = 6.60, 95% CI: 2.94, 10.27) and delivery by cesarean section (<4 months: b = -4.64, 95%CI: -7.79, -1.49; 4-5 months: b = -4.58, 95%CI: -7.45, -1.71). CONCLUSION A large share of infants under six months in rural western China are anemic. Infants with low-birth-weight and cesarean-delivered should be prioritized for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between cesarean-section and anaemia to promote health and development in infancy.
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Affiliation(s)
- Yefan Du
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Anne Durstenfeld
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stanford University, Palo Alto, CA, USA
| | - Sarah-Eve Dill
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Qingzhi Wang
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Huan Zhou
- Department of Health Behavior and Social Science, West China School of Public Health and West China Fourth Hospital, Sichuan University, No. 16 Section 3 South Renmin Road, Chengdu, Sichuan610041, People’s Republic of China
| | - Hao Xue
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Saraswati Kache
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Alexis Medina
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
| | - Scott Rozelle
- Rural Education Action Program, Freeman Spogli Institute for International Studies, Stanford University, Palo Alto, CA, USA
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Aliyo A, Jibril A. Assessment of anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia: Hospital-based cross-sectional study. PLoS One 2022; 17:e0270853. [PMID: 35789228 PMCID: PMC9255756 DOI: 10.1371/journal.pone.0270853] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Anemia adversely affects children’s mental, physical and social development, particularly in Africa. In the early stages of life, it leads to severe negative consequences on the cognitive, growth and development of children. Objective This study aimed to assess anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia, from October to November 2020. Method A hospital-based quantitative cross-sectional study was conducted at Bule Hora General Hospital, Southern Ethiopia. A convenience sampling technique was used to include 375 under-five children enrolled in the study. The pretested structure questionnaire was used to collect socioeconomic and demographic characteristics of study individuals after taking appropriate written informed consent. Then, a venous blood sample was collected from each child and analyzed for hemoglobin determination using a Midray BC 3000 Plus machine. Binary logistic regression models were used to identify associated factors of anemia. A p-value ≤ 0.05 was considered statistically significant. Result The overall prevalence of anemia among under-five children was 13.2% (50) [95% CI = 5.2–21.2%]. Among anemic children under-five years of age, 12% (6) had mild anemia, 32% (16) had moderate anemia and 56% (28) had severe anemia. In this study, anemia was significantly associated with a history of intestinal protozoan infection [AOR = 2.55, 95% CI = 1.28–10.42], malaria infection [AOR = 5.01, 95% CI = 0.18–11.44] and soil-transmitted helminths infection [AOR = 6.39, 95% CI = 1.75–29.08]. Conclusion The prevalence of anemia among under-five children was found to be low in the study area; however, the majority of anemic children were in a severe stage. It could be managed by preventing malaria infection, intestinal protozoa and soil-transmitted helminthic infection.
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Affiliation(s)
- Alqeer Aliyo
- Department of Medical Laboratory Science, Bule Hora University, Bule Hora, Ethiopia
- * E-mail:
| | - Abdurezak Jibril
- Department of Nursing, Bule Hora University, Bule Hora, Ethiopia
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Aliyo A, Jibril A. Anemia and Associated Factors Among Under Five Year Old Children Who Attended Bule Hora General Hospital in West Guji zone, Southern Ethiopia. J Blood Med 2022; 13:395-406. [PMID: 35818561 PMCID: PMC9270905 DOI: 10.2147/jbm.s363876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Anemia is a major global public health public health problem in the early stages of childhood, particularly in developing countries. In Africa, anemia causes higher morbidity and mortality among children less than five years old, especially in Ethiopia. Objective This study aimed to assess the prevalence of anemia and its associated factors among children under five years old attending Bule Hora General Hospital, West Guji Zone, southern Ethiopia. Methods A hospital-based quantitative cross-sectional study was conducted at Bule Hora General Hospital, Southern Ethiopia from October to November 2020. A convenience sampling technique was used to include 375 under five children enrolled in the study. The pretested structure questionnaire was used to collect socioeconomic and demographic characteristics of study individuals after taking appropriate written informed consent. Then, a venous blood sample was collected from each child and analyzed for hemoglobin determination using a Cell-DYN 1800 machine. Binary logistic regression models were used to identify associated factors of anemia. A P value ≤ 0.05 was considered statistically significant. Results The overall prevalence of anemia among under five children was 13.2% (50) [95% CI=5.2–21.2%] of them anemic children, 11.1% (1) had mild anemia, and 33.3% (3) had moderate anemia and 55.6% (5) had severe anemia. In this study, anemia was significantly associated with recent intestinal protozoan infection [AOR=2.13, 95% CI=1.35–9.270], malaria infection [AOR=5.42, 95% CI=0.307–11.034] and soil-transmitted helminths infection [AOR=6.09, 95% CI=2.047–27.54]. Conclusion Anemia among under five children in this study was found to be a mild public health problem. It could be managed by preventing malaria infection, intestinal protozoa and soil-transmitted helminthic infection.
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Affiliation(s)
- Alqeer Aliyo
- Department of Medical Laboratory Science, Bule Hora University, Bule Hora, Ethiopia
- Correspondence: Alqeer Aliyo, Department of Medical Laboratory Science, Bule Hora University, Bule Hora, Ethiopia, Tel +251 968-467458, Email
| | - Abdurezak Jibril
- Department of Nursing, Bule Hora University, Bule Hora, Ethiopia
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Endris BS, Dinant GJ, Gebreyesus SH, Spigt M. Risk factors of anemia among preschool children in Ethiopia: a Bayesian geo-statistical model. BMC Nutr 2022; 8:2. [PMID: 34996515 PMCID: PMC8740428 DOI: 10.1186/s40795-021-00495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The etiology and risk factors of anemia are multifactorial and varies across context. Due to the geospatial clustering of anemia, identifying risk factors for anemia should account for the geographic variability. Failure to adjust for spatial dependence whilst identifying risk factors of anemia could give spurious association. We aimed to identify risk factors of anemia using a Bayesian geo-statistical model. METHODS We analyzed the Ethiopian Demographic and Health Survey (EDHS) 2016 data. The sample was selected using a stratified, two- stage cluster sampling design. In this survey, 9268 children had undergone anemia testing. Hemoglobin level was measured using a HemoCue photometer and the results were recorded onsite. Based on the World Health Organization's cut-off points, a child was considered anaemic if their altitude adjusted haemoglobin (Hb) level was less than 11 g/dL. Risk factors for anemia were identified using a Bayesian geo-statistical model, which accounted for spatial dependency structure in the data. Posterior means and 95% credible interval (BCI) were used to report our findings. We used a statistically significant level at 0.05. RESULT The 9267 children in our study were between 6 and 59 months old. Fifty two percent (52%) of children were males. Thirteen percent (13%) of children were from the highest wealth quintile whereas 23% from the lowest wealth quintile. Most of them lived in rural areas (90%). The overall prevalence of anemia among preschool children was 57% (95% CI: 54.4-59.4). We found that child stunting (OR = 1.26, 95% BCI (1.14-1.39), wasting (OR = 1.35, 95% BCI (1.15-1.57), maternal anemia (OR = 1.61, 95% BCI (1.44-1.79), mothers having two under five children (OR = 1.2, 95% BCI (1.08-1.33) were risk factors associated with anemia among preschool children. Children from wealthy households had lower risk of anemia (AOR = 0.73, 95% BCI (0.62-0.85). CONCLUSION Using the Bayesian geospatial statistical modeling, we were able to account for spatial dependent structure in the data, which minimize spurious association. Childhood Malnutrition, maternal anemia, increased fertility, and poor wealth status were risk factors of anemia among preschool children in Ethiopia. The existing anaemia control programs such as IFA supplementation during pregnancy should be strengthened to halt intergenerational effect of anaemia. Furthermore, routine childhood anaemia screening and intervention program should be part of the Primary health care in Ethiopia.
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Affiliation(s)
- Bilal Shikur Endris
- School of Public Health, Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Geert-Jan Dinant
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Seifu H Gebreyesus
- School of Public Health, Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mark Spigt
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
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Du Y, Liao Y, Leng F, Li L, Ye R, Mao Y, Raat H, Zhou H. Anaemia prevalence and its associated factors in children under 5 years in Western China: a systematic review. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001185. [PMID: 36053597 PMCID: PMC8753402 DOI: 10.1136/bmjpo-2021-001185] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Iron-deficiency anaemia disproportionately affects children in low-income and middle-income areas; Western China is a prime example. Given the health risks associated with childhood anaemia and the large heterogeneity of published studies on this subject, we conducted a systematic review of the evidence regarding anaemia prevalence and associated factors in children under 5 years in Western China. METHODS We searched for all relevant studies on the prevalence of iron deficiency anaemia in children under 5 years in Western China, obtaining research between 1 January 2011 and 30 June 2021, in English and Chinese from Medline, Embase, PubMed, Web of Science, CNKI, WanFang Data and VIP. Two reviewers independently screened titles and abstracts; three reviewed full texts of relevant articles for data extraction and performed quality assessments. The median prevalence was calculated on unweighted pooling, stratified by region, sex, age and ethnic group. Associated factors and a linear trend chart were conducted to identify trends and research highlights. RESULTS Among the 55 articles included, most were cross-sectional studies (39, 70.91%). The prevalence of anaemia in children under 5 years in Western China ranged from 3.69% to 75.74% (median 42.54% (IQR 25.62%-52.56%)); the highest levels were in Qinghai province: 59.10%-75.74% (median 67.80% (IQR 64.70%-72.75%)); the highest levels were reported in the subgroup of children aged 6-12 months (median 50.09% (IQR 34.35%-59.04%)). Regional contexts, individual sociodemographic characteristics and feeding behaviours, and nutritional programme interventions were factors associated with anaemia prevalence. CONCLUSION The prevalence of anaemia in children under 5 years in Western China is concerningly high. For this multiethnic and economically underdeveloped region, more high-quality and prospective studies are needed to inform evidence based and targeted preventive strategies to decrease the high prevalence of anaemia among young children.
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Affiliation(s)
- Yefan Du
- Department of Health Behavior and Social Science, Sichuan University, Chengdu, Sichuan, China
| | - Ying Liao
- Department of Health Behavior and Social Science, Sichuan University, Chengdu, Sichuan, China
| | - Fangqun Leng
- Department of Health Behavior and Social Science, Sichuan University, Chengdu, Sichuan, China
| | - Linhua Li
- Department of Health Behavior and Social Science, Sichuan University, Chengdu, Sichuan, China
| | - Ruixue Ye
- Department of Health Behavior and Social Science, Sichuan University, Chengdu, Sichuan, China
| | - Yuping Mao
- California State University Long Beach, Long Beach, California, USA
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Huan Zhou
- Department of Health Behavior and Social Science, Sichuan University, Chengdu, Sichuan, China
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Inequities in childhood anaemia at provincial borders in Mozambique: cross-sectional study results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey. BMJ Open 2021. [PMCID: PMC8718414 DOI: 10.1136/bmjopen-2021-051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aims to identify the child-level, maternal-level, household-level and community-level determinants of anaemia among children aged 6–59 months, and determine the inequities of anaemia prevalence across communities in Mozambique. Design Cross-sectional study. Setting Mozambique. Participants This study used data of a weighted population of 3946 children, 6–59 months, delivered by women between 15 and 49 years of age, from the 2018 Mozambique Malaria Indicator Survey. Primary outcome measure Child’s anaemic status, measured as altitude-adjusted haemoglobin concentration (in g/L); the severity of anaemia was categorised based on predefined threshold values. Multilevel Bayesian linear regressions identified key determinants of childhood anaemia. Based on data availability and policy implications, spatial analysis was used to determine geographical variation of anaemia at the community level and areas with higher risks. Results The mean prevalence of childhood anaemia was 77.7% (SD: 5.5%). Provincially, Cabo Delgado province (86.2%) had the highest prevalence, Maputo province (70.2%) the lowest. Children with excess risk were mostly found in communities that had proximity to provincial borders: Niassa-Cabo Delgado-Nampula triprovincial border, Gaza-Inhambane border, Zambezia-Nampula border and provinces of Manica and Inhambane. Children with anaemia tended to be younger, males and at risk of having malaria because they were not sleeping under mosquito nets. In addition, children from poor families relative to children from wealthier households and those living in female-headed households were prone to anaemia. Conclusion Findings from this study provide evidence that spatial inequities in childhood anaemia exist in Mozambique, mostly concentrated in the communities living close to the provincial borders. Anaemia among children could be effectively reduced through malaria prevention, for example, bed netting. Interventions are needed that generate income for households, increase community support for households headed by women, improve malaria control, build capacity of healthcare workers to manage severely anaemic children and health education for mothers.
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Shi H, Yang Y, Yin X, Li J, Fang J, Wang X. Determinants of exclusive breastfeeding for the first six months in China: a cross-sectional study. Int Breastfeed J 2021; 16:40. [PMID: 34001155 PMCID: PMC8130252 DOI: 10.1186/s13006-021-00388-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/06/2021] [Indexed: 11/26/2022] Open
Abstract
Background Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China. Methods Data were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding. Results About 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding. Conclusions The exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains.
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Affiliation(s)
- Huifeng Shi
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.,Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Yumei Yang
- School of Economics and Management, Beijing Forestry University, Beijing, China
| | - Xiaohan Yin
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China
| | - Jia Li
- China Development Research Foundation, Beijing, China
| | - Jin Fang
- China Development Research Foundation, Beijing, China.
| | - Xiaoli Wang
- Department of Maternal and Child Health, Peking University School of Public Health, Beijing, China. .,National Health Commission Key Laboratory of Reproductive Health, Beijing, China.
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11
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Tesema GA, Worku MG, Tessema ZT, Teshale AB, Alem AZ, Yeshaw Y, Alamneh TS, Liyew AM. Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis. PLoS One 2021; 16:e0249978. [PMID: 33891603 PMCID: PMC8064743 DOI: 10.1371/journal.pone.0249978] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa. METHODS This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia. RESULTS The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia. CONCLUSION Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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12
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Keokenchanh S, Kounnavong S, Midorikawa K, Ikeda W, Morita A, Kitajima T, Sokejima S. Prevalence of anemia and its associated factors among children aged 6-59 months in the Lao People's Democratic Republic: A multilevel analysis. PLoS One 2021; 16:e0248969. [PMID: 33765048 PMCID: PMC7993607 DOI: 10.1371/journal.pone.0248969] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 11/19/2022] Open
Abstract
Anemia is a major public health concern among children aged <5 years in the Lao People’s Democratic Republic. Thus far, no study has determined the factors associated with anemia among children aged <5 years in the Lao People’s Democratic Republic using a nationwide representative sample. Therefore, this study aimed to evaluate the prevalence of anemia and its associated factors with multilevel variations among children aged 6–59 months. This quantitative, cross-sectional study used a nationally representative sample from the Lao Social Indicator Survey II, 2017. Children aged 6–59 months tested for anemia were included in this study through multistage sampling approaches. Anemia was defined as a hemoglobin level of <11.0 g/dL. Multilevel binary logistic regression analyses were used to determine the adjusted effect of the factors associated with anemia. Among the 5,087 children included, the overall prevalence of anemia was 43.0%. Three factors were associated with higher odds of developing anemia—male sex (adjusted odds ratio, 1.16; 95% confidence interval, 1.01–1.34), underweight (adjusted odds ratio, 1.30; 95% confidence interval, 1.09–1.55), and residence in central provinces (adjusted odds ratio, 1.59; 95% confidence interval, 1.30–1.95) and southern provinces (adjusted odds ratio, 1.42; 95% confidence interval, 1.11–1.81). However, the other three factors—age, educational level of the household head, and Hmong-Mien ethnicity—were inversely associated with anemia. To resolve the problem regarding the severity of the anemia among children aged <5 years in the Lao People’s Democratic Republic. Our findings highlight the need for designing an effective approach to address each factor associated with childhood anemia. Interventions should focus on the prevention of childhood anemia, which is considered a major priority of public health intervention in the Lao People’s Democratic Republic.
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Affiliation(s)
- Sengtavanh Keokenchanh
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
- Foreign Relation Division, Cabinet of the Ministry of Health, Sisattanack District, Vientiane Capital, Lao PDR
- * E-mail:
| | - Sengchanh Kounnavong
- Lao Tropical and Public Health Institute, Ministry of Health, Sisattanack district, Vientiane Capital, Lao PDR
| | - Kaoru Midorikawa
- Faculty of Child Education, Suzuka University, Suzuka, Mie, Japan
| | - Wakaha Ikeda
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi, Mie, Japan
| | - Akemi Morita
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
| | - Takumi Kitajima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
| | - Shigeru Sokejima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine, Tsu-shi, Mie, Japan
- Epidemiology Centre for Disease Control and Prevention, Mie University Hospital, Tsu-shi, Mie, Japan
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13
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Chowdhury MRK, Khan MMH, Khan HTA, Rahman MS, Islam MR, Islam MM, Billah B. Prevalence and risk factors of childhood anemia in Nepal: A multilevel analysis. PLoS One 2020; 15:e0239409. [PMID: 33021981 PMCID: PMC7537867 DOI: 10.1371/journal.pone.0239409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/05/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal. METHODS Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6-59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia. RESULTS The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia. CONCLUSION Nepal is facing a serious public health problem due to the high prevalence of childhood anemia. This adverse situation occurs due to socio-demographic and geographical factors such as age, malnutrition status, mother's anemia status, socio-economic status and regional variations. Prevention of childhood anemia should be given top priority in Nepal and should be considered as a major public health intervention.
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Affiliation(s)
| | | | - Hafiz T. A. Khan
- College of Nursing, Midwifery and Healthcare, University of West London, London, United Kingdom
| | - Md. Shafiur Rahman
- Research Center for Child Mental Development, Hamamatsu University School of Medicine, Japan
| | - Md Rashedul Islam
- Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Md Moinul Islam
- School of Business, Middlesex University, London, United Kingdom
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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14
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Magnitude, Severity, and Associated Factors of Anemia among Under-Five Children Attending Hawassa University Teaching and Referral Hospital, Hawassa, Southern Ethiopia, 2016. Anemia 2020; 2020:7580104. [PMID: 32832148 PMCID: PMC7428954 DOI: 10.1155/2020/7580104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Background Anemia is a widespread public health problem associated with increased risk of morbidity and mortality. Infants, under-5-year-old children, and pregnant women have greater susceptibility to anemia. The magnitude and associated risk factors for anemia vary in different settings. The study aimed to assess the magnitude, severity, and associated factors of anemia at Hawassa University Teaching and Referral hospital, Hawassa, southern Ethiopia. Methods In a hospital-based cross-sectional study, a total of 422 under-five children were included. Sociodemographic data and other predisposing factors were collected by structured questionnaire. Venous blood samples were collected and analyzed for hemoglobin determination using a Cell-Dyn 1800 automated analyzer. Stool samples were collected and processed using direct wet mount and formol-ether concentration method to detect intestinal parasites. Data were entered and analyzed using SPSS version 20 statistical packages. Binary and multiple logistic regressions were computed to assess factors associated with anemia. p value less than 0.05 was taken as statistically significant. Result The overall prevalence of anemia was found to be 41.7%. The mean hemoglobin level was 10.59 g/dl. Anemia was of mild, moderate, and severe type in 6.6%, 19%, and 16.1% of the children, respectively. Children in the age group 6-23 months (AOR = 2.04 (95% CI: 1.13, 3.69)), and mothers having no formal education (AOR = 1.73 (95% CI: 0.99, 3.02)) were identified as associated factors for anemia. Conclusion The prevalence of anemia among the study subjects was 41.7% indicative of the fact that anemia is an important public health problem. It was associated with the child's age, residence, mother's education level, and intestinal parasite (Ascaris lumbricoides). It clearly indicates that there should be well integrated public health interventions to improve the health status that needs to be prioritized to prevent anemia among children under five years of age.
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15
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Melku M, Alene KA, Terefe B, Enawgaw B, Biadgo B, Abebe M, Muchie KF, Kebede A, Melak T, Melku T. Anemia severity among children aged 6-59 months in Gondar town, Ethiopia: a community-based cross-sectional study. Ital J Pediatr 2018; 44:107. [PMID: 30176919 PMCID: PMC6122612 DOI: 10.1186/s13052-018-0547-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background Anemia is a public health problem affecting both developed and developing countries. Childhood anemia is associated with serious consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Hence, this study aimed at assessing the prevalence and factors associated with severity of anemia among children aged 6–59 months in Gondar town, northwest Ethiopia. Method A community-based cross-sectional study was conducted. A multi-stage sampling technique was employed to select study participants. Socio demographic and socioeconomic data were collected using a pre-tested structured questionnaire. Anthropometric measurements were taken as per WHO recommendation. Hemoglobin (Hb) concentration was measured using a portable HemoCue301 instrument (A Quest Diagnostic Company, Sweden). Mild anemia corresponds to a level of adjusted Hb of 10.0–10.9 g/dl; moderate anemia corresponds to a level of 7.0–9.9 g/dl, while severe anemia corresponds to a level less than 7.0 g/dl. Descriptive statistics were used to describe the study participants. Both bivariable and multivariable ordinal logistic regression were done, and proportional odds ratio (POR) with a 95% confidence interval (CI) was reported to show the strength of association. A p-value < 0.05 was considered statistically significant. Result Out of the total of 707 children included in this study, more than half (53.5%) of them were male. The median age of children was 30 months. Two hundred two (28.6%) of children were anemic: 124(17.5%) were mildly anemic, 73(10.3%) were moderately anemic, and 5 (0.7%) were severely anemic. The young age of the child, low frequency of child complementary feeding per day, primary maternal educational status, unmarried maternal marital status, and home delivery were factors associated with severity of childhood anemia. Conclusion Anemia among children aged 6–59 months in Gondar Town was a moderate public health problem. Improving access to education, providing regular health education about childcare and child feeding practices, strengthening the socioeconomic support for single-parent families and conducting regular community-based screening are recommended to reduce childhood anemia.
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Affiliation(s)
- Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kefyalew Addis Alene
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Betelihem Terefe
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asemarie Kebede
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Melak
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsedalu Melku
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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16
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Zhang Y, Jin L, Liu JM, Ye R, Ren A. Maternal haemoglobin concentrations before and during pregnancy as determinants of the concentrations of children at 3-5 years of age: A large follow-up study. Eur J Clin Nutr 2018; 73:1102-1109. [PMID: 30120385 DOI: 10.1038/s41430-018-0284-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 07/01/2018] [Accepted: 07/26/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the association between haemoglobin (Hb) concentrations in mothers before and during pregnancy and those in children at 3-5 years of age. METHODS The study included 78,923 women who conceived during 1993-1996 and delivered a singleton live infant. Maternal Hb concentrations were measured at pre-pregnancy health check-up and first prenatal visit, and during the second and third trimester. Hb concentrations of children born to these women were measured at 3-5 years of age. Associations between Hb levels in mothers and children were examined. Unconditional logistic regression was used to explore the association between maternal Hb levels and risk for anaemia in children. RESULTS Maternal Hb levels before and during pregnancy were positively associated with children's Hb levels. Using maternal Hb ≥ 130 g/L as the referent, the risk for anaemia in children at 3-5 years of age was higher when maternal second trimester Hb concentrations were 70-99 g/L (odds ratio [OR] = 1.76, 95% confidence interval [CI] = 1.56-1.99), 100-109 g/L (OR = 1.45, 95% CI = 1.29-1.64), and 110-119 g/L (OR = 1.18, 95% CI = 1.04-1.33). Children were 1.52 and 1.23-times more likely to suffer from anaemia when maternal third trimester Hb concentrations were 70-99 and 100-109 g/L, respectively. A pre-pregnancy Hb concentration of 80-109 g/L and first prenatal visit Hb concentrations of 80-109 and 100-119 g/L were also associated with increased risks for childhood anaemia. CONCLUSION Low maternal Hb concentrations before or during pregnancy increase the risk for anaemia in children at 3-5 years of age.
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Affiliation(s)
- Yiting Zhang
- Health Care Department, Haidian Maternal and Child Health Hospital, Beijing, 100080, China.,Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China
| | - Lei Jin
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Jian-Meng Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Rongwei Ye
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Aiguo Ren
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University, Beijing, 100191, China. .,Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
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17
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Ntenda PAM, Nkoka O, Bass P, Senghore T. Maternal anemia is a potential risk factor for anemia in children aged 6-59 months in Southern Africa: a multilevel analysis. BMC Public Health 2018; 18:650. [PMID: 29788935 PMCID: PMC5964691 DOI: 10.1186/s12889-018-5568-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/15/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The effect of maternal anemia on childhood hemoglobin status has received little attention. Thus, we examined the potential association between maternal anemia and childhood anemia (aged 6-59 months) from selected Southern Africa countries. METHODS A cross-sectional study using nationally representative samples of children aged 6-59 months from the 2010 Malawi, 2011 Mozambique, 2013 Namibia, and 2010-11 Zimbabwe demographic and health surveys (DHS) was conducted. Generalized linear mixed models (GLMMs) were constructed to test the associations between maternal anemia and childhood anemia, controlling for individual and community sociodemographic covariates. RESULTS The GLMMs showed that anemic mothers had increased odds of having an anemic child in all four countries; adjusted odds ratio (aOR = 1.69 and 95% confidence interval [CI]:1.37-2.13) in Malawi, (aOR = 1.71; 95% CI: 1.37-2.13) in Mozambique, (aOR = 1.55; 95% CI: 1.08-2.22) in Namibia, and (aOR = 1.52; 95% CI: 1.25-1.84) in Zimbabwe. Furthermore, the odds of having an anemic child was higher in communities with a low percentage of anemic mothers (aOR = 1.52; 95% CI: 1.19-1.94) in Mozambique. CONCLUSIONS Despite the long-standing efforts to combat childhood anemia, the burden of this condition is still rampant and remains a significant problem in Southern Africa. Thus, public health strategies aimed at reducing childhood anemia should focus more on addressing infections, and micronutrient deficiencies both at individual and community levels in Southern Africa.
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Affiliation(s)
- Peter A. M. Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
| | - Paul Bass
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
- School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
| | - Thomas Senghore
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
- School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
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18
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Zijlmans C, Stuursma A, Roelofs AJ, Jubitana BC, MacDonald-Ottevanger MS. Anemia in young children living in the Surinamese interior: the influence of age, nutritional status and ethnicity. Res Rep Trop Med 2017; 8:21-24. [PMID: 30050342 PMCID: PMC6038890 DOI: 10.2147/rrtm.s125125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This study investigates the prevalence of anemia in young children living in the interior of Suriname and the influence of the associated factors age, nutritional status and ethnicity. Results In this cross-sectional observational study, 606 children aged 1-5 years from three different regions of Suriname's interior were included, and hemoglobin levels and anthropometric measurements were collected. Logistic regression models were computed to examine independent associations between anemic and nonanemic groups and to measure the influence of age, nutritional status and ethnicity. Results A total of 606 children were included, of whom 330 (55%) were aged 1-3 years and 276 were aged 4-5 years. The overall prevalence of anemia was 63%. Younger age was associated with anemia (odds ratio [OR]=1.78; 95% confidence interval [CI]: 1.27-2.51). Anemia was less prevalent in Amerindian than in Maroon children (OR=0.51; 95% CI: 0.34-0.76). Hemoglobin level was not influenced by nutritional status nor by sex. Conclusion The prevalence of anemia in children aged 1-5 years living in Suriname's interior is high (63%) compared to that in similar aged children in Latin America and the Caribbean (4-45%). Children aged 1-3 years were more affected than those aged 4-5 years as were Maroon children compared to Amerindian children. Nutritional status and sex were not of influence.
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Affiliation(s)
- Cwr Zijlmans
- Department of Mother & Child Health Care, Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname;
| | - A Stuursma
- Faculty of Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - A J Roelofs
- Faculty of Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - B C Jubitana
- Department of Monitoring Evaluation Surveillance & Research, Medical Mission PHCS, Paramaribo, Suriname
| | - M S MacDonald-Ottevanger
- Department of Mother & Child Health Care, Scientific Research Center Suriname, Academic Hospital Paramaribo, Paramaribo, Suriname;
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19
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Xin QQ, Chen BW, Yin DL, Xiao F, Li RL, Yin T, Yang HM, Zheng XG, Wang LH. Prevalence of Anemia and its Risk Factors among Children under 36 Months Old in China. J Trop Pediatr 2017; 63:36-42. [PMID: 27543970 DOI: 10.1093/tropej/fmw049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This study aims to evaluate the prevalence and sociodemographic factors of anemia in children <36 months old in China. In this study, data of 24 235 children were investigated from 32 primary health care (PHC) facilities in 11 province-level regions. Pearson χ2-test and logistic regression model were used to estimate potential risk factors associated with anemia. The overall prevalence of anemia was 24.4%, and 32.8% children from rural areas were anemic, but no statistically significant difference was observed between male and female. Predictors of anemia are different regions of China, cesarean delivery, premature birth and neonatal asphyxia. We also found that education level and income of children's parents are important determinants of childhood anemia. In additional, feeding practice would affect anemia among children aged 6-12 months. Our results could provide some insights for prevention and control of childhood anemia in PHC facilities.
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Affiliation(s)
- Qian-Qian Xin
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Bo-Wen Chen
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - De-Lu Yin
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Feng Xiao
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Rui-Li Li
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Tao Yin
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Hui-Min Yang
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Xiao-Guo Zheng
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
| | - Li-Hong Wang
- Department of Child Health Development, Capital Institute of Pediatric, Beijing, China
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20
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Early severe anemia as the first sign of cystic fibrosis. Eur J Pediatr 2016; 175:1157-1163. [PMID: 27496146 DOI: 10.1007/s00431-016-2752-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/27/2016] [Accepted: 07/12/2016] [Indexed: 01/17/2023]
Abstract
UNLABELLED Severe anemia is reported to occur rarely in patients with cystic fibrosis (CF). This study aimed to determine the factors associated with early severe anemia in infants with CF. This study included 231 infants with CF from 3 pediatric CF centers ten year period that were retrospectively reviewed in terms of severe anemia as the first sign of CF. Factors that could affect anemia, such as age, pancreatic insufficiency, mutations, vitamin A and E, and albumin level were evaluated. Clinical and laboratory findings in CF patients that presented with severe anemia and no respiratory symptoms were compared to those in CF patients that did not present with severe anemia. Severe anemia as the first sign of CF was noted in 17 of 231 patients. Patient age, prolonged PT/INR and the albumin level differed significantly between the 2 groups of patients (P < 0.001). Feeding pattern, pancreatic insufficiency, vitamin E and A levels, and the types of genetic mutations did not differ between the 2 groups. The mean hemoglobin level was 5.59 ± 0.21 g/dL and respiratory symptoms began a mean 6.3 months after diagnosis of CF in the anemia group. CONCLUSION In early infancy severe anemia in the absence of respiratory symptoms can be the first sign of CF. CF should be considered in the differential diagnosis of severe anemia in infants. Anemia can occur several months before respiratory symptoms in patients with CF and may be caused due to several reasons. WHAT IS KNOWN • Severe anemia as a first sign is reported to occur rarely in patients with cystic fibrosis. • Although anemia is well known in cystic fibrosis, factors that cause severe anemia are not known clearly. What is New: • This study shows the importance of severe anemia as the first sign of cystic fibrosis. • Anemia can occur several months before respiratory symptoms in patients with CF.
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Wang J, Wang H, Chang S, Zhao L, Fu P, Yu W, Man Q, Scherpbier R, Pan L, Duan Y, Yin SA. The Influence of Malnutrition and Micronutrient Status on Anemic Risk in Children under 3 Years Old in Poor Areas in China. PLoS One 2015; 10:e0140840. [PMID: 26488490 PMCID: PMC4619061 DOI: 10.1371/journal.pone.0140840] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition and anemia affect large numbers of young children living in poor areas of China. Multi-micronutrient deficiencies may be related to the prevalence of anemia in different populations, and identifying the risk factors that render children susceptible to anemia is the first step in combating anemia effectively. METHODS In this cross-sectional study, a total of 1370 children under 3 years old were selected based on probability proportional to size sampling principles from poor counties of China. Basic characteristics data were collected by questionnaire; then anthropometrics and hemoglobin were measured in the field and anemia prevalence evaluated. Venous blood was drawn from children aged 12-35 months (N = 553) to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia. RESULTS Among children aged 0-35 months, the prevalence of stunting, low body weight and wasting was 17.5%, 8.6% and 5.1%, respectively, and 25.6% of the children were affected by anemia, with more anemic infants and younger children than older children (P <0.01). There were 26.5%, 12.8%, 14.1% and 20.0% of the children aged 12-35 months affected by iron deficiency, vitamin D deficiency, folic acid deficiency and vitamin B12 deficiency, respectively. For children aged 0-11 months who were breastfed, the mothers' anemic status was the only factor associated with the child's anemia (OR = 2.6; 95% CI: 1.2-5.4, P < 0.05). For children aged 12-35 months, multivariate logistic regression indicated that anemia was significantly associated with iron and vitamin B12 deficiency (OR = 5.3; 95% CI: 1.9-14.5, P < 0.01) and monotonous diet (OR = 2.3; 95% CI: 1.1-4.7, P < 0.05) after adjusting for age and gender. CONCLUSION The prevalence of anemia was higher in children under 2 years old and requires urgent intervention. An effective intervention strategy should include iron and vitamin B12 supplements, improving dietary diversity and controlling breastfeeding mothers' anemia.
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Affiliation(s)
- Jie Wang
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui Wang
- Department of Population Research, China Population and Development Research Center, Beijing, China
| | - Suying Chang
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Liyun Zhao
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ping Fu
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wentao Yu
- Department of Nutrition Surveillance, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingqing Man
- Department of Nutrition on Aging, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Robert Scherpbier
- Section of Health and Nutrition and Water, Environment and Sanitation, United Nations Children’s Fund, Beijing, China
| | - Lili Pan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yifan Duan
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shi-an Yin
- Department of Maternal and Child Nutrition, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
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Goswmai S, Das KK. Socio-economic and demographic determinants of childhood anemia. J Pediatr (Rio J) 2015; 91:471-7. [PMID: 26070864 DOI: 10.1016/j.jped.2014.09.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 08/23/2014] [Accepted: 12/02/2014] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate socio-economic and demographic determinants of anemia among Indian children aged 6-59 months. METHODS Statistical analysis was performed on the cross-sectional weighted sample of 40,885 children from 2005 to 2006 National Family Health Survey by using multinomial logistic regression to assess the significance of some risk factors in different degrees of child anemia. Anemia was diagnosed by World Health Organization (WHO) cut-off points on hemoglobin level. Pearson's chi-squared test was applied to justify the associations of anemia with different categories of the study population. RESULTS The prevalence of anemia was 69.5%; 26.2% mild, 40.4% moderate, and 2.9% severe anemia. Overall prevalence rate, along with mild and moderate cases, showed an increasing trend up to 2 years of age and then decreased. Rural children had a higher prevalence rate. Of 28 Indian states in the study, 10 states showed very high prevalence, the highest being Bihar (77.9%). Higher birth order, high index of poverty, low level of maternal education, mother's anemia, non-intake of iron supplements during pregnancy, and vegetarian mother increased the risks of all types of anemia among children (p<0.05). Christian population was at lower risk; and Scheduled Caste, Scheduled Tribe, and Other Backward Class categories were at higher risk of anemia. CONCLUSION The results suggest a need for proper planning and implementation of preventive measures to combat child anemia. Economically under-privileged groups, maternal nutrition and education, and birth control measures should be priorities in the programs.
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Affiliation(s)
- Sankar Goswmai
- Department of Statistics, Gurucharan College, Silchar, India.
| | - Kishore K Das
- Department of Statistics, Gauhati University, Guwahati, India
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Socio‐economic and demographic determinants of childhood anemia. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Extent of Anaemia among Preschool Children in EAG States, India: A Challenge to Policy Makers. Anemia 2014; 2014:868752. [PMID: 25140250 PMCID: PMC4129919 DOI: 10.1155/2014/868752] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/24/2014] [Accepted: 07/08/2014] [Indexed: 11/18/2022] Open
Abstract
Background. India is the highest contributor to child anemia. About 89 million children in India are anemic. The study determines the factors that contributed to child anemia and examines the role of the existing programs in reducing the prevalence of child anemia particularly in the EAG states. Methods. The data from the latest round of the National Family Health Survey (NFHS-3) is used. Simple bivariate and multinomial logistics regression analyses are used. Results. About 70% children are anemic in all the EAG states. The prevalence of severe anemia is the highest (6.7%) in Rajasthan followed by Uttar Pradesh (3.6%) and Madhya Pradesh (3.4%). Children aged 12 to 17 months are significantly seven times (RR = 7.99, P < 0.001) more likely to be severely anemic compared to children of 36 to 59 months. Children of severely anemic mothers are also found to be more severely anemic (RR = 15.97, P < 0.001) than the children of not anemic mothers. Conclusions. The study reveals that the existing government program fails to control anemia among preschool children in the backward states of India. Therefore, there is an urgent need for monitoring of program in regular interval, particularly for EAG states to reduce the prevalence of anemia among preschool children.
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