The Influence of Malnutrition and Micronutrient Status on Anemic Risk in Children under 3 Years Old in Poor Areas in China

Age and sex-based impacts of maternal iron deficiency on offspring's cognitive function and anemia: A systematic review

Iron deficiency is a recognized global health concern, particularly impactful during pregnancy where the mother serves as the primary source of iron for the developing fetus. Adequate maternal iron levels are crucial for fetal growth and cognitive development. This review investigates the correlation between maternal iron deficiency and cognitive impairment and anemia in offspring, considering age and gender differentials. PubMed, ScienceDirect, and Google Scholar databases were queried using keywords "maternal," "iron," "gender/sex," and "cognition." The review included studies on human and animal subjects where maternal iron deficiency was the exposure and offspring cognitive function and anemia were outcomes. Out of 1139 articles screened, fourteen met inclusion criteria. Twelve studies highlighted cognitive deficits in offspring of iron-deficient mothers, with females generally exhibiting milder impairment compared to males. Additionally, two studies noted increased anemia prevalence in offspring of iron-deficient mothers, particularly affecting males and younger individuals. The findings suggest that male offspring are at higher risk of both anemia and cognitive dysfunction during youth, while females face increased risks in adulthood. Thus, maternal iron deficiency elevates the likelihood of anemia and cognitive impairments in offspring, underscoring the importance of addressing maternal iron status for optimal child health.

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

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

Prevalence of anemia and its associated factors among children aged 6-23 months, in Ethiopia: a systematic review and meta analysis

INTRODUCTION

Despite several strategies exist for anemia prevention and control, it has been the major public health important problem in the world. Numerous immediate and long-term health issues were reported in children who have history of anemia including decreased work productivity in adult hood period. Although analyzing data on burden and risk factors of anemia are the recommended action areas of World Health Organization framework for accelerating anemia reduction, the aggregated national burden and contributors of anemia in Ethiopia has not been determined so far. There for, this systematic and meta-analysis study is aimed to assess the pooled prevalence and associated factors of anemia among children aged 6-23 months in Ethiopia.

METHODS

The electronic databases including PubMed, Scopus, EMBASE, Web of Science, Science Direct, Google scholar and institutional repositories were searched using search terms. The studies that reported the prevalence and/or risk factors of anemia in children 6-23 months of age were included. The JBI quality assessment tool was used to evaluate the quality of each study. The data was extracted with Microsoft Excel, 2019 and analyzed with STATA 17.0 statistical software. A random effect model was used to estimate the pooled prevalence of anemia and its associated factors. The Cochrane Q-test statistics and I2 test were used to measure heterogeneity between the included studies. Furthermore, publication bias was examined using the funnel plot graph and statistical tests (Egger's and begg tests). Outliers also visualized using Galbraith plot. When necessary, sensitivity analysis was also employed to detect small study effect.

RESULT

Ten studies with a total population of 14, 733 were included for analysis. The pooled prevalence of anemia among children aged 6-23 months of age in Ethiopia was found to be 57.76% (95%CI; 51.61-63.91; I2 = 97.192%; p < 0.001). Having history of diarrhea AOR = 2.44 (95%CI: 1.03-3.85), being stunted AOR = 2.00 (95%CI: 1.38-2.61), living in food insecure house hold AOR = 2.08 (95%CI: 1.10-3.07), consuming less diversified food AOR = 2.73 (95%CI: 2.06-3.39) and being 6-11 months of age AOR = 1.59 (95%CI: 1.23-1.95) were associated with anemia.

CONCLUSION AND RECOMMENDATION

The prevalence of anemia is in the range of severe public health problem among children aged 6-23 months in Ethiopia. Diarrhea, stunting, house hold food insecurity, dietary diversity, and age were the predictors of anemia. Further, prospective cohort and random controlled trial studies are recommended. Further, random controlled trial especially effectiveness of nutritional education interventions trial is important. To reduce prevalence of anemia, strengthening diarrhea reduction program, securing household food insecurity, preventing stunting, giving special attention for infants age 6-11 months and encouraging food diversification are important.

A pilot survey of selenium status and its geospatial variation among children and women in three rural districts of Zimbabwe

Introduction

Selenium (Se) deficiency is increasingly recognized as a public health problem in sub-Saharan Africa.

Methods

The current cross-sectional study assessed the prevalence and geospatial patterns of Se deficiency among children aged 6-59 months (n = 741) and women of 15-49 years old (n = 831) selected by simple random sampling in rural Zimbabwe (Murewa, Shamva, and Mutasa districts). Venous blood samples were collected and stored according to World Health Organization guidelines. Plasma Se concentration was determined by inductively coupled plasma-mass spectrometry.

Results

Median, Q1, and Q3 plasma Se concentrations were 61.2, 48.7, and 73.3 μg/L for women and 40.5, 31.3, and 49.5 μg/L for children, respectively. Low plasma Se concentrations (9.41 μg/L in children and 10.20 μg/L in women) indicative of severe Se deficiency risk was observed. Overall, 94.6% of children and 69.8% of women had sub-optimal Se status defined by plasma Se concentrations of <64.8 μg/L and <70 μg/L, respectively.

Discussion

High and widespread Se deficiency among women and children in the three districts is of public health concern and might be prevalent in other rural districts in Zimbabwe. Geostatistical analysis by conditional kriging showed a high risk of Se deficiency and that the Se status in women and children in Murewa, Shamva, and Mutasa districts was driven by short-range variations of up to ⁓12 km. Selenium status was homogenous within each district. However, there was substantial inter-district variation, indicative of marked spatial patterns if the sampling area is scaled up. A nationwide survey that explores the extent and spatial distribution of Se deficiency is warranted.

Systematic Literature Review of the Nutrient Status, Intake, and Diet Quality of Chinese Children across Different Age Groups

There is a lack of comprehensive reports on nutrient deficiencies and dietary intake among various age groups of children in China. The objective of this review is to provide an overview of the nutrient status, intake, and diet adequacy of Chinese children (0-18 years old). PubMed and Scopus were searched for literature published between January 2010 and July 2022. A systematic review approach with a quality assessment was performed to analyze 2986 identified articles in English and Chinese. Eighty-three articles were included in the analysis. In younger children, anemia and iron and Vitamin A deficiencies remain severe public health problems, despite high Vitamin A and adequate iron intake. In older children, a high prevalence of selenium; Vitamin A and D deficiencies; and inadequate intakes of Vitamins A, D, B, C, selenium, and calcium were reported. Intakes of dairy, soybeans, fruits, and vegetables were below recommended levels. High intakes of iodine, total and saturated fat, and sodium and low dietary diversity scores were also reported. As nutritional concerns vary with age and region, future nutrition interventions should be tailored accordingly.

Anemia in children aged 6-59 months was significantly associated with maternal anemia status in rural Zimbabwe

Globally, anemia is a public health problem affecting mostly women of reproductive age (WRA, n = 452) and children aged 6-59 months (n = 452) from low- and lower-middle-income countries. This cross-sectional study assessed the prevalence and determinants of anemia in WRA and children aged 6-59 months in rural Zimbabwe. The venous blood sample was measured for hemoglobin utilizing a HemoCue machine. Anthropometric indices were assessed and classified based on World Health Organization standards. Socioeconomic characteristics were assessed. The median (±inter quartile range (IQR)) age of WRA was 29 ± 12 years and that for children was 29 ± 14 months. The prevalence of anemia was 29.6% and 17.9% in children and WRA, respectively, while the median (±IQR) hemoglobin levels were 13.4 ± 1.8 and 11.7 ± 1.5 g/dl among women and children, respectively. Multiple logistic regression analysis was used to assess determinants of anemia. Anemia in children was significantly associated with maternal anemia (odds ratio (OR) = 2.02; 95% CI 1.21-3.37; p = .007) and being a boy (OR = 0.63; 95% CI 0.41-0.95; p = .029), while anemia in WRA was significantly associated with the use of unimproved dug wells as a source of drinking water (OR = 0.36; 95% CI 0.20-0.66; p = .001) and lack of agricultural land ownership (OR = 0.51; 95% CI 0.31-0.85; p = .009). Anemia is a public health problem in the study setting. The positive association between maternal and child anemia reflects the possibility of cross-generational anemia. Therefore, interventions that focus on improving preconceptual and maternal nutritional status may help to reduce anemia in low-income settings.

The perspective of meat and meat-alternative consumption in China

This study provides an overview of Chinese meat consumption based on literature review. China, having the largest mid-income population, has become the world's largest meat consumer. Its per capita meat consumption has been growing fast over the past decades to 49 kg, half of that of the US. Chinese consumers are aware of the environmental, health and animal welfare concerns, and can accept plant-based and lab cultured meats. Their adoption rate of these meat alternatives is low and their willingness-to-pay for them is also low from 5% below to 5% above conventional meat, compatible to the level in the US and EU countries. China, as an emerging economy, takes it as a serious challenge for food and nutrition security, where meat plays an indispensable role. Malnutrition still exists among children and the low-income population due to low meat intake. Government is playing an active role in boosting its domestic meat production to meet its market demand for more meat.

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

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

Modeling spatial pattern of anemia and malnutrition co-occurrence among under-five children in Ethiopia: A Bayesian geostatistical approach

Anemia and malnutrition among under-five children are some of the challenges to public health in Ethiopia. This study aims to determine the socio-economic, demographic, and geographical risk factors that increase the prevalence of the co-occurrence of anemia and malnutrition among under-five children in Ethiopia. The Ethiopia Demographic and Health Survey data for the survey years 2011 and 2016 were used. A Bayesian hierarchical mixed model with a stochastic partial differential equation was adopted to understand the spatial patterns of co-occurrence of these ailments in Ethiopia. The significant risk factors are gender, maternal education, birth order, preceding births, contraceptive use, vaccination, marital status, distance to a health facility, and birth weight. Findings revealed more vulnerability among children less than twenty months and existing geographical disparity with a higher burden of the prevalence of the co-occurrences of anemia and malnutrition in the North-East regions. For cost-effective intervention, policies and programs that improve individual-level risk factors of parents are a more promising approach to tackle these ailments in high-prevalent regions than the ones on the children and should be of utmost priority in the North-East region of the country.

Complementary Feeding and Malnutrition among Infants and Young Children Aged 6-23 Months in Rural Areas of China

This study investigated the nutrition and complementary feeding (CF) of infants and young children (IYC) aged 6–23 months in rural areas of China in 2018 and explored the relationship between CF and nutritional status. We measured the length and weight, calculated the z-scores, and detected micronutrients in the hair. The status of CF was obtained from the respondents by a 24-h dietary recall. IYC were classified into clusters using a two-step cluster analysis. The CF and nutritional status of each cluster were analyzed and compared. The prevalence of stunting, wasting, and overweight in the IYC in rural Chinese areas was 7.1%, 3.0%, and 3.7%, respectively. The median levels of Ca, Fe, and Zn in hair were 550.10 µg/g, 62.94 µg/g, and 132.86 µg/g, respectively. The prevalence of meeting the requirements of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) was 68.9%, 77.9%, and 46.4%, respectively. IYC with a higher prevalence of MDD, MMF, and MAD were more inclined to maintain a healthy status. The prevalence of undernutrition and overweight of 6- to 23-month-old IYC in rural areas of China was low. However, lack of trace elements was evident, and MAD prevalence remained low.

Prevalence and associated factors for stunting, underweight and wasting among children under 6 years of age in rural Hunan Province, China: a community-based cross-sectional study

Background

The existing epidemiological data cannot represent the situation of undernutrition among Chinese children, particularly those in rural China. Hence, in this community-based cross-sectional study, the prevalence and associated factors of stunting, underweight and wasting among children (age < 6 years) from rural Hunan Province were analyzed.

Methods

Totally 5529 children aged 0 to 71 months and their caregivers were randomly chosen by multistage stratified cluster sampling from 72 villages from rural Hunan, which were distributed in 24 towns of 12 counties. Data about the children and their mothers, caregivers and family conditions was acquired using unified questionnaire, and the length/height and weight of each child were measured using unified instruments. The prevalence of undernutrition among children was evaluated using the length/height for age, weight for age, weight for length/height, and body mass index for age z scores, which were computed according to the 2006 and 2007 WHO Child Growth Standards.

Results

The prevalence of stunting, underweight, and wasting among the 5529 children were 4.4% (241), 3.9% (217), and 4.0% (221), respectively. The significant associated factors on higher risks of undernutrition in the children were low birth weight, maternal gestational weight gain <10 kg (stunting); low birth weight, maternal gestational weight gain <10 kg, ethnicity of caregivers being minority, large family size (underweight); low birth weight, ethnicity of caregivers being minority, large family size (wasting). High education level of caregivers and high family food expenditure were common protective factors for all three types of undernutrition, except that high family food expenditure was not protective against wasting.

Conclusions

The prevalence of stunting, underweight and wasting is low among rural children under age of 6 years in Hunan. As for the measures, the gestational care and reasonable diet of mothers should be strengthened, and nutritional deficiency during pregnancy be avoided, which will prevent low birth weight. The local economic development and the education level of caregivers need to be further improved, especially for minorities.

Incidence of anemia and predictors among Human Immunodeficiency Virus-infected children on antiretroviral therapy at public health facilities of Bahir Dar City, Northwest Ethiopia: multicenter retrospective follow up study

Background

Anemia is one of the common hematological problems among HIV-infected children. It impairs physical functioning, affects the quality of life, increases HIV progression, and decreases survival of HIV-infected children. In Ethiopia, limited studies were conducted on the incidence and predictors of anemia among HIV-infected children on antiretroviral therapy (ART). Therefore, this study aims to assess the incidence of anemia and predictors among HIV- infected children on ART at public health facilities of Bahir Dar City, Northwest Ethiopia.

Methods

An institution-based retrospective follow-up study was conducted among 403 HIV- infected children who have followed at ART clinics in public health facilities of Bahir Dar City from 2010 to 2020. A simple random sampling technique was employed to select the study units. Data was entered using Epi-data version 4.6 and analyzed using STATA 14.0. Cox proportional hazard model assumption was checked graphically and by scaled Schoenfeld residual test. Bivariable Cox-proportional hazards regression model was employed for each explanatory variable to check the association with the outcome variable. Variables with a p-value of < 0.2 in the bivariable analysis were candidates to the multivariable proportional hazard model. Cox proportional hazards model was used at a 5% level of significance to identify predictors of anemia.

Results

The overall follow up time was 1587 person–years. The overall incidence density of anemia was 6.87 with 95% confidence interval (CI) = (5.60, 8.16) per 100 person-years. The independent predictors show an association were child age from 0.25 to 5 years adjusted hazard ratio (AHR) = (1.83; 95% CI = 1.22, 2.77), World health organization clinical stage III and IV (AHR = 1.80; 95% CI = 1.22, 2.67), being underweight (AHR = 1.5; 95% CI = 1.01, 2.26), having fair/poor adherence to anti-retroviral therapy (AHR = 1.75; 95% CI = 1.08, 2.85) and zidovidine based anti -retroviral therapy regimen (AHR = 1.72; 95% CI = 1.12, 2.64).

Conclusion

The overall incidence rate of anemia was high compared to other country reports. Age, clinical, and ART-related variables provoked the incidence of anemia. Therefore, a need to emphasize the younger age group, prevent and manage opportunistic infections of WHO clinical stage III and IV, and select and monitor appropriate ART regimen types.

Risk factors of anemia among preschool children in Ethiopia: a Bayesian geo-statistical model

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.

Geospatial inequality of anaemia among children in Ethiopia

Anaemia remains a severe public health problem among children in Ethiopia and targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. An analysis was performed using Ethiopia Demographic and Health Survey 2016 data. Blood specimens for anaemia testing were collected from 9268 children aged 6-59 months. A child was considered as anaemic if the bloodhaemoglobin count was less than 11.0 g/dL. We applied Kulldorf's spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran the local indicator of spatial association and the Getis-Ord Gi* statistics to detect and locate hotspots and multilevel multivariable analysis to identify risk factors for anaemia clustering. More than half of children aged 6-59 months (57%) were found to be anaemic in Ethiopia. We found significant geospatial inequality of anaemia among children and identified clusters (hotspots) in the eastern part of Ethiopia. The odds of anaemia among children found within the identified cluster was 1.5 times higher than children found outside the cluster. Women anaemia, stunting and high fertility were associated with anaemia clustering.

Factors associated with undernutrition among children aged between 6-36 months in Semien Bench district, Ethiopia

BACKGROUND

Malnutrition is a term used to refer a condition of both excessive and under-nutrition. Even in the 21st c, it is yet among the major public health challenges that affect the health, growth, and development of millions of children across continents. Studies show that malnutrition during early childhood could result in devastating long-term effects such as poor school performance, weak immune system, and growth and development. Unfortunately, Ethiopia is among the developing countries hard hit by the problem of malnutrition (under-nutrition).

OBJECTIVE

To assess the magnitude of stunting, wasting, and underweight and risk factors associated with them; among Children aged between 6- 36 months.

METHODS

A community-based cross-sectional study design was conducted on 700 study participants from April to May 2020. Nutritional status of children aged between 6-36 months was determined based on the WHO reference population with Z score ≤ -2 SD (HAZ, WHZ and WAZ) was looked upon for stunting, wasting and underweight accordingly. Data were collected through structured and measuring anthropometric of the eligible sample unit. The questionnaire data were first entered into Epi-data and later analyzed following binary and multiple logistic regression analysis procedures with the help of IBM SPSS 26. Adjusted odds ratios, with 95% CI of the association and statistical significance declared at P-values ≤ 0.05 in this study.

RESULTS

In the present study, the response rate of the respondent was 100%. Factors significantly associated with undernutrition: stunting, Mothers who have no formal education (AOR = 2.58, 95% CI; 1.44-4.63), food insecure (AOR = 1.9, 95% CI; 1.23-2.9) and children had no feeding plate (AOR = 1.53, 95% CI; 1.07-2.19).

FOR UNDERWEIGHT

have not individual feeding plate (AOR = 2.39, 95% CI; 1.42-4.03), poor dietary diversity (AOR = 1.82, 95% CI; 1.23-2.69) and food insecurity (AOR = 4.24, 95% CI; 2.68-6.71).We have also identified age between 6-11 months (AOR = 6.81, 95% CI; 2.93-15.79), 12-23 months (AOR = 2.28, 95% CI; 1.03-5.06), food insecure (AOR = 10.34, 95% CI; 5.22-20.45) and poor dietary diversity (AOR = 5.58, 95% CI; 2.36-13.19) as risk factors associated with wasting.

CONCLUSION

This study relived that six variables significantly associate with undernutrition. These are: children have not his/her own feeding plate, household food insecurity, mother who had no formal education, poor dietary diversity and children aged between 6-11months and children age 6-23 months. Based on the findings of this study, the following recommendations are made. First, strategies and programs targeted towards the reduction and prevention of undernutrition among 6-36-month children should be made at all level to improve childhood nutritional status. Second, provide health information to families regarding the importance of separating children's feeding plate. Three, provide nutritional counselling about feeding practice and dietary diversity for mothers who have no formal education.

Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015

INTRODUCTION

Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children.

METHODS

Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl.

RESULTS

Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition.

CONCLUSIONS

There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.

Prevalence of Anemia and Associated Factors among Infants and Young Children Aged 6-23 Months in Debre Berhan Town, North Shewa, Ethiopia

Background

Anemia is a problem of both the developed and developing world, which occurs in all age groups of the population. Half of the anemia cases are due to iron deficiency and affects physical growth and mental development. Nevertheless, there is a scarcity of information about anemia and associated factors among infants and young children aged 6 to 23 months in low-income countries like Ethiopia.

Objective

The aim of this study was to assess the prevalence of anemia and associated factors among infants and young children aged 6–23 months.

Methods

A community-based cross-sectional study design was used among 531 mothers/caregivers-children pairs in Debre Berhan Town, North Shewa, Ethiopia, from February 1 to March 2, 2018. The cluster sampling technique was used to select the study participants. Sociodemographic data were collected from mothers/caregivers using pretested structured questionnaires. Hemoglobin levels were measured using a HemoCue analyzer machine (HemoCue® Hb 301, Ängelholm, Sweden). All relevant data were described using descriptive statistics such as frequencies, proportions, mean, and standard deviation. Odds ratio and 95% CI were estimated using binary logistic regression to measure the strength of the association between anemia and explanatory variables. The level of statistical significance was declared at P < 0.05.

Results

The overall prevalence of anemia was 47.5% (95% CI: 43.1–51.4%) of which 18.3% were mildly anemic, 25% were moderately anemic, and 4.1% were severely anemic. In multivariable logistic regression analysis, household food insecurity (AOR = 2.7, 95% CI: 1.6–4.5), unmet minimum dietary diversity (AOR = 2.5, 95% CI: 1.4–4.3), stunting (AOR = 2.3, 95% CI: 1.2–4.3), and underweight (AOR = 2.7, 95% CI: 1.4–5.4) positively associated with anemia while having ≥4 antenatal care visits (AOR = 0.5, 95% CI: 0.3–0.9) and met minimum meal frequency (AOR = 0.25, 95% CI: 0.14–0.45) had a protective effect against anemia.

Conclusion

Generally, the study showed that anemia was a severe public health problem among infants and young children in the study setting. Antenatal care visit, meal frequency, dietary diversity, underweight, stunting, and food insecurity significantly associated with anemia. Therefore, efforts should be made to strengthen infant and young child feeding practices and antenatal care utilization and ensure household food security, thereby improving the nutritional status of children.

<p>Incidence and Predictors of Anemia Among Children on Antiretroviral Therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2007–2017: A Retrospective Follow-Up Study</p>

Background

Anemia is the most common hematological abnormality among children on antiretroviral therapy. In Ethiopia, as far as our search, there are no studies done on the incidence and predictors of anemia among children on antiretroviral therapy. This study aimed to assess the incidence and predictors of anemia among children on antiretroviral therapy, attending antiretroviral therapy care at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, from 2007 to 2017.

Methods

A retrospective follow-up study was conducted among 391 children on antiretroviral therapy. Mean survival time for children to be anemia free was estimated. A Log rank test was used to compare survival curves among different independent variables. The Cox regression model was used. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was calculated. P-value ≤0.05 was considered as statically significant.

Results

The overall incidence rate of anemia was 10.5 (95% confidence interval (8.6, 12.8)) per 100 child-year. Being severe-immunosuppressed (AHR=2.9, 95% CI: 1.23–6.77), undernutrition (AHR =2.7, 95% CI: 1.5–5), taking zidovudine-based ART regimen (AHR =4, 95% CI: 1.23–12.9), and tuberculosis (AHR =2.1, 95% CI: 1.4–3.3) were independent predictors of anemia among children.

Conclusion

In this study, the incidence rate of anemia among children on antiretroviral therapy was found to be high. Tuberculosis, zidovudine-based drugs, severe immunosuppression, and undernutrition have remained statically significant predictors of anemia among children on antiretroviral therapy. Children with HIV were the most vulnerable group for anemia, especially in developing countries. Therefore, improving their nutritional status and considering other predictors of anemia were very important for children to reduce the incidence of anemia among children with HIV.

Prevalence of Stunting and Its Associated Factors among Children of 6-59 Months in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia: A Community-Based Cross-Sectional Study

Methods

The community-based cross sectional study was conducted in the Arba Minch Health and Demographic Surveillance Site, Southern Ethiopia. The simple random sampling method was used to recruit 656 mother-child pairs. Height for age Z score was computed using WHO Anthro version 3.2.2 software. Multivariable logistic regression model was fitted, and adjusted odds ratio (AOR) at p value <0.05 was used to determine statistically significant association between predictors and outcome variable.

Result

The prevalence of stunting among children of 6-59 months in the study area was 47.9% (95% CI; 44.0-51.7). The likelihood of stunting was significantly higher among children who live in households with medium (AOR 2.20, 95% CI: 1.43-3.37) and poor (AOR 2.87, 95% CI: 1.72-4.81) wealth status. In addition, children who were not exclusively breast fed (AOR 1.55, 95% CI: 1.07-2.24), whose mothers had not participated in decision of major household purchases (AOR 2.27, 95% CI: 1.21-4.26), and whose mothers lacked decision on freedom of mobility (AOR 1.96, 95% CI: 1.05-3.66) were significantly stunted compared with counterparts.

Conclusion

Stunting is a severe public health problem in the area. Therefore, efforts should be taken to enhance maternal empowerment, household wealth, and infant and young child feeding practice for reducing stunting among children.

Dynamic Anemia Status from Infancy to Preschool-Age: Evidence from Rural China

Anemia is a serious nutritional deficiency among infants and toddlers in rural China. However, it is unclear how the anemia status changes among China's rural children as they age. This study investigates the prevalence of anemia as children grow from infancy to preschool-age, as well as the dynamic anemia status of children over time. We conducted longitudinal surveys of 1170 children in the Qinba Mountain Area of China in 2013, 2015 and 2017. The results show that 51% of children were anemic in infancy (6-12 months), 24% in toddlerhood (22-30 months) and 19% at preschool-age (49-65 months). An even larger share of children (67%) suffered from anemia at some point over the course of study. The data also show that although only 4% of children were persistently anemic from infancy to preschool-age, 8% of children saw their anemia status deteriorate. We further found that children may be at greater risk for developing anemia, or for having persistent anemia, during the period between toddlerhood and preschool-age. Combined with the finding that children with improving anemia status showed higher cognition than persistently anemic children, there is an urgent need for effective nutritional interventions to combat anemia as children grow, especially between toddlerhood and preschool age.

Multilevel Analysis of the Effects of Individual- and Community-Level Factors on Childhood Anemia, Severe Anemia, and Hemoglobin Concentration in Malawi

BACKGROUND

The purpose of this article was to examine individual- and community-level factors associated with childhood anemia, severe anemia, and hemoglobin (Hb) concentration in Malawi.

METHODS

Using data from the 2010 Malawi demographic and health survey (MDHS), the multilevel regression models were constructed to analyze 2597 children aged 6-59 months living in 849 communities.

RESULTS

The results showed that both childhood anemia and severe anemia were negatively associated with child's age, no fever in the previous 2 weeks and height-for-age, and positively associated with residing in poor household. Childhood anemia was negatively associated with community female education. Child's age, no fever in the previous 2 weeks and maternal Hb levels were positively associated with child Hb concentration, while residing in poorest households was negatively associated with children's Hb concentration.

CONCLUSION

Comprehensive public health strategies aimed at reducing childhood anemia need to focus more on the significant characteristics addressed in this study.

The Prevalence and Predictors of Iron Deficiency Anemia among Rural Infants in Nablus Governorate

BACKGROUND

Iron deficiency anemia (IDA) in infants and young children remains a significant public health problem in most developing countries. IDA had short and long-term adverse impacts on infants' health and development. We aimed to assess the frequency of IDA and associated risk factors among infants aged between 9-12 months in rural areas of Nablus Governorate.

STUDY DESIGN

A cross-sectional study.

METHODS

The study was conducted between Jan and Mar 2015. A random sample of 654 infants aged 9-12 months were selected from thirty villages in Nablus Governorate, Central Highlands of the West Bank, north of Jerusalem. Data were collected using pre-designed structured interviewing questionnaire, complete blood count analysis and anthropometric measurements were done.

RESULTS

The prevalence of anemia and IDA among infants was 34.6%, and 32.6%, respectively. Predictors of IDA were increased in infants' age OR=1.19 (95% CI: 1.02, 1.40), maternal anemia during the third trimester OR=2.39 (95% CI: 1.55, 3.71), birth spacing less than three years OR=2.86 (95%CI: 1.58, 5.18), exclusive breastfeeding during the first six months OR=2.40 (95% CI: 1.46, 3.95), early OR=1.64 (95%CI: 1.03, 2.613) and late introduction of complementary feeding OR=2.26 (95% CI: 1.27, 4.05), and non-compliance to iron supplement in the correct frequency and duration during pregnancy OR=1.81 (95% CI: 1.19, 2.75).

CONCLUSIONS

Different dietary and non-dietary risk factors for IDA should be considered for any intervention aimed to reduce the prevalence of IDA among infants.

Prevalence of vitamin D insufficiency among children in southern china: A cross-sectional survey

Vitamin D deficiency is associated with numerous public health issues. Limited data are available for children in southern China, a region that receives abundant sunlight. We aimed to estimate the 25-hydroxyvitamin D (25(OH)D) levels in children in that area, and to determine seasonal variations in serum 25(OH)D levels. A total of 16,755 children aged 0 to 6 years, who visited the Guangdong Women and Children's Hospital for health examination between January 2016 and May 2017, were included in the present study. The serum 25(OH)D levels ranged from 10.5 to 307.4 nmol/L (mean ± standard deviation: 78.5 ± 26.3 nmol/L). The prevalence of vitamin D deficiency and insufficiency were 10.8% and 39.0%, respectively. The mean serum 25(OH)D level in spring (71.8 ± 24.9 nmol/L) was lower than that in other seasons. From January to April, we found a relatively high prevalence of vitamin D deficiency or insufficiency, both of which were also found to increase with age. Logistic regression analysis revealed that vitamin D deficiency and insufficiency were significantly associated with age and season. Deficiency and insufficiency of vitamin D are common among children in southern China, despite the area receiving sufficient sunlight.

Maternal anemia is a potential risk factor for anemia in children aged 6-59 months in Southern Africa: a multilevel analysis

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.

Adherence to multiple micronutrient powders and associated factors in children aged 6 to 35 months treated in sentinel health facilities, Ministry of Health of Peru

Introduction:

Anemia in children is a public health issue, and the current strategies include treatment and iron supplementation, but their level of adherence or compliance is unknown.

Objective:

To consider the adherence to multiple micronutrient powders and the associated factors.

Methods:

Epidemiological study of active surveillance through sentinel facilities in 2,024 children aged 6 to 35 months treated in health facilities of the Ministry of Health of Peru, from October to December 2014. Household visits were conducted in which counting of multiple micronutrient powders was applied and determined an adherence of consumption ≥ 90% envelopes, besides a form on the associated factors (anemia knowledge, iron-rich food, side effects, dosage regimen, drugs used, and motivation) was applied. Descriptive statistics, χ² test, Odds Ratio with a 95% confidence interval (CI), and binary logistic regression or adjusted Odds Ratio (aOR) were used.

Results:

Of all, 79.1% participants were aged 6 to 23 months; 75.9% received multiple micronutrient powders; and the adherence was equivalent to 24.4% (95%CI 22.3 - 26.6). The factors: continue supplementation (OR = 3.5; 95%CI 1.7 - 7.5); no nausea (OR = 3.0; 95%CI 2.0 - 4.3); no use of antibiotics (OR = 2.5; 95%CI 1.7 - 3.6); and intention to continue treatment (OR = 2.3; 95%CI 1.3 - 4.1) were associated with adherence. The variables: thought of continuing treatment (aOR = 2.6; 95%CI 1.1 - 6.1); presence of side effects, but no discontinuation of the treatment (aOR = 2.5; 95%CI 1.4 - 4.3); no use of antibiotics (aOR = 2.0; 95%CI 1.1 - 3.4); and belief that not only drugs cure anemia (aOR = 1.6; 95%CI 1.0 - 2.6) were associated in the multivariate analysis.

Conclusion:

There was a low prevalence of adherence to a demanding cut-off point (≥ 90% of envelopes of multiple micronutrient powders), and the associated factors are associated with absence of infections, side effects, and mother's beliefs.

Effectiveness of community-based complementary food supplement (Yingyangbao) distribution in children aged 6-23 months in poor areas in China

BACKGROUND

Poor growth and micronutrient deficiency mainly attack older infants and young children. Some countries have adopted clinically effective measures to combat malnutrition, but the compliance and improvement in efficacy of intervention vehicles in national programs require evaluation.

METHODS

Baseline and follow-up cross-sectional surveys were conducted before and after a nutrition intervention program in 3 national poverty counties in China. Soybean-based complementary food supplements called Yingyangbao (YYB) in Chinese and training materials on child feeding were distributed to households with children aged 6-23 months for 18 months. Representative children were selected by probability proportional to size sampling methods to assess compliance of YYB and the intervention efficacy. A questionnaire was designed to collect data on basic characteristics of children, breastfeeding, 24-hour dietary intake, and consumption and appetite of YYB. Anthropometrics and hemoglobin were measured in the field, and anemia prevalence was evaluated. Venous blood was drawn from children aged 12-35 months to evaluate micronutrient status. Logistic regression was used to identify the risk factors for children's anemia.

RESULTS

Of the children involved in the follow-up survey (n = 693), the P50 (P25, P75) intake of YYB was 6.7 (3.5, 7.0) sachets weekly, and 54.7% of the children liked the taste of YYB. Compared with the baseline situation (n = 823), the proportion of children fed a diverse diet and foods rich in iron or vitamin A increased (P < 0.01) in the follow-up study. The prevalence of stunting and underweight decreased (P < 0.05), the prevalence of anemia decreased from 28.0% to 19.9% (P < 0.01), and the prevalence of vitamin B12 deficiency decreased from 26.8% to 15.4% (P < 0.01). For children aged 12-23 months, those who liked YYB and consumed 6 or more sachets of YYB weekly were at lower risk for anemia (OR = 0.34, 95% CI 0.13-0.90, P < 0.05), but the risk of stunting was associated with a non-diverse diet (OR = 1.48, 95% CI 1.06-2.07, P < 0.05).

CONCLUSION

The quality of diet and nutritional status of children aged 6-23 months are significantly improved by the intervention of YYB and nutrition education, and good compliance to YYB contributes to a low risk for anemia.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-OOC-16008846.