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Caravedo MA, Morales ML, Tanabe M, Lopez M, White AC, Cabada MM. Demographic Characteristics and Low Iron Status Markers Are Associated with Hemoglobin Levels and Anemia among Children Living at High Elevation in Cusco, Peru. Am J Trop Med Hyg 2024; 110:1014-1020. [PMID: 38531100 PMCID: PMC11066345 DOI: 10.4269/ajtmh.23-0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/06/2023] [Indexed: 03/28/2024] Open
Abstract
Anemia is a complex condition associated with diet, chronic infections, and blood loss. Children living at high altitudes have higher absolute hemoglobin levels due to hypoxemia. However, they are exposed to repeated infections and dietary limitations. We conducted a cross-sectional study to identify factors affecting the hemoglobin concentration in children living in high-altitude rural communities in the Anta province of Peru. All children 3-16 years of age attending public schools were invited to participate. We enrolled children 3-16 years old in schools and visited their homes to collect demographic, socioeconomic, medical history, and anthropometric data. Children provided blood and stool samples for complete blood counts, iron status markers, and helminth infection testing. Among the 2,000 children enrolled, the mean age was 9.9 (±3.4) years, 1,004 (50.2%) were female, and the median residence altitude was 3,398 (interquartile range 3,35-3,497) meters. The mean hemoglobin level was 15 (±1.15) mg/dL; 320 (16%) had anemia as defined by WHO. Children with anemia were more likely to have lower serum iron levels (odds ratio [OR] 2.8 [95% CI 2.2-3.6], P <0.001) and serum transferrin saturation (OR 2.8 [95% CI 2-3.9], P <0.001). Younger age (OR 0.85 [95% CI 0.82-0.89], P <0.001), stunting (OR 0.68 [95% CI 0.59-0.79], P <0.001), education of the mother (OR 0.94 [95% CI 0.91-0.98], P <0.005), and low eosinophils (OR 0.49 [95% CI 0.26-0.9], P = 0.022) were associated with anemia. Helminth infections were not associated with anemia. Anemia among children at high altitude is multifactorial, but iron deficiency is a contributing factor. Further studies are needed to evaluate iron status and anemia in children living at high altitudes.
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Affiliation(s)
- Maria A. Caravedo
- Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas
| | - Maria Luisa Morales
- Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Melinda Tanabe
- Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas
| | - Martha Lopez
- Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - A. Clinton White
- Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas
| | - Miguel M. Cabada
- Division of Infectious Diseases, University of Texas Medical Branch, Galveston, Texas
- Sede Cusco – Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Cusco, Peru
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Cruz-Ausejo L, Figueroa-Collado J, Chavera-Caceres A, Vera-Ponce VJ, Valencia PD, Bendezú-Quispe G. Examining the relationship between intimate partner violence and child development program attendance in young children: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37618. [PMID: 38640330 PMCID: PMC11029928 DOI: 10.1097/md.0000000000037618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 04/21/2024] Open
Abstract
The aim of the present study was to determine the association between different types of intimate partner violence against women and nonattendance at the Growth and Development Control Program (CRED or well-child visits) of their children under 5 years of age. This was an analytical cross-sectional study that comprised a secondary analysis of data from the Demographic and Family Health Survey (ENDES in Spanish) of Peru, 2019. Data from 19,647 mothers (aged 15-49 years) and their children under 5 years were analyzed. The independent variables were the types of intimate partner violence = emotional, physical, and sexual. The outcome variable was nonattendance at CRED in the last 6 months. The mean maternal age was 30.47 ± 6.66 years; 66.1% of children were between 25 and 60 months of age; the prevalence of nonattendance at CRED was 29.9%. A relationship was found between partner violence against the mother and nonattendance at CRED. Specifically, there was a higher probability of nonattendance in the children of women who experienced partner violence (sexual = aPR = 1.25 [95% CI = 1.07-1.44]; physical = aPR = 1.17 [95% CI = 1.08-1.26]; emotional = aPR = 1.12 [95% CI = 1.03-1.21]). This study showed an association indicating that children born to mothers experiencing intimate partner violence exhibit an elevated likelihood of nonattendance at CRED when compared to children of mothers not subjected to such violence. Therefore, emphasizing the promotion and monitoring of child development, especially for those with a history of maternal violence, should be a primary priority, particularly in primary care.
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Affiliation(s)
| | | | | | | | - Pablo D. Valencia
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Tlalnepantla, México
| | - Guido Bendezú-Quispe
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencia en Salud, Universidad San Ignacio de Loyola, Lima, Peru
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Aparco JP, Santos-Antonio G, Bautista-Olortegui W, Alvis-Chirinos K, Velarde-Delgado P, Hinojosa-Mamani P, Solis-Sanchez G, Santa Cruz FE, Zavaleta N. Iron status and hemoglobin adjustment by altitude to define anemia in children aged 6 to 8 months living in Lima, Arequipa, Cusco and Puno. Rev Peru Med Exp Salud Publica 2024; 40:395-405. [PMID: 38597467 PMCID: PMC11138835 DOI: 10.17843/rpmesp.2023.404.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/08/2023] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVE. To describe the iron status profile and to propose hemoglobin adjustment factors for altitude for children aged 6 to 8 months in Lima, Arequipa, Cusco and Puno. MATERIALS AND METHODS. Cross-sectional study in children aged 6 to 8 months from four cities. We measured hemoglobin and other iron biomarkers, C-reactive protein (CRP), among others. To estimate the adjustment equation, we applied an exponential regression. We excluded children with iron deficiency (ID) and/or inflammation. RESULTS. The proportions of ID were higher in Puno and Arequipa, while inflammation did not exceed 19% in any of the cities. Hemoglobin showed an exponential increase at higher altitude. The adjustment equation was: 10.34249 x (1.00007 ^ Alt). CONCLUSIONS. Children residing in Arequipa and Puno showed higher rates of ID and lower iron reserves; furthermore, the increase in hemoglobin by altitude was exponential, showing the need to adjust hemoglobin at altitude.
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Affiliation(s)
- Juan Pablo Aparco
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Gabriela Santos-Antonio
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - William Bautista-Olortegui
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Katherine Alvis-Chirinos
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Patricia Velarde-Delgado
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Paul Hinojosa-Mamani
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Gilmer Solis-Sanchez
- National Center for Food, Nutrition, and Healthy Living, Instituto Nacional de Salud, (INS), Lima, Peru.National Center for Food, Nutrition, and Healthy LivingInstituto Nacional de Salud (INS)LimaPeru
| | - Flor Eliana Santa Cruz
- General Directorate of Strategic Interventions in Public Health, Ministry of Health (MINSA), Lima, Peru.General Directorate of Strategic Interventions in Public HealthMinistry of Health (MINSA)LimaPeru
| | - Nelly Zavaleta
- Nutritional Research Institute (IIN), Lima, Peru.Nutritional Research Institute (IIN)LimaPeru
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Choque-Quispe BM, Vásquez-Velásquez C, Gonzales GF. Evaluation of dietary composition between hemoglobin categories, total body iron content and adherence to multi-micronutrients in preschooler residents of the highlands of Puno, Peru. BMC Nutr 2024; 10:28. [PMID: 38347656 PMCID: PMC10860272 DOI: 10.1186/s40795-024-00837-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The anemia prevalence is higher in highlands populations. It is assumed that iron deficiency anemia (IDA) in children is mainly due to low dietary intake. However, other suggest that high prevalence of anemia is due to an inappropriate hemoglobin (Hb) adjustment for altitude. MATERIALS AND METHODS Cross-sectional study conducted in 338 preschoolers (PSC) from Puno-Peru. Hb was measured in whole blood, and ferritin, Soluble transferrin receptor, and Interleukin 6 in serum.The dietary iron intake was assessed by 24-h dietary recall, using NutriCap Software. Hb concentration was assessed as adjusted or unadjusted for altitude. RESULTS With unadjusted Hb, the anemia prevalence was 4.7%, whereas after Hb correction, the prevalence raised-up to 65.6% (p < 0.001). Reciprocally, erythrocytosis proportion decreased from 20.35 to 0.30% (p < 0.001). Total Body Iron (TBI) showed that 7.44% had ID and 0.32% had IDA. PSC with normal unadjusted Hb levels have more protein and micronutrients intake than anemic ones. PSC with erythrocytosis consumed less fat, and more niacin and ascorbic acid than anemics. Total iron intake was lower in anemic than the other groups, but without statistical significance due to the standard deviation of the data in a small number of anemic PSC (n = 16). TBI, unadjusted Hb, and adjusted Hb were not different between groups consuming or not multimicronutrients. CONCLUSIONS The consumption of iron and iron status in children who live at high altitude is adequate, and that anemia could be due to other micronutrient deficiencies and/or that the adjustment of Hb by altitude is inappropriate.
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Affiliation(s)
| | - Cinthya Vásquez-Velásquez
- Laboratorio de Endocrinología y Reproducción (Laboratorios de Investigación y Desarrollo), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Gustavo F Gonzales
- Laboratorio de Endocrinología y Reproducción (Laboratorios de Investigación y Desarrollo), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru
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Morocho-Alburqueque N, Quincho-Lopez A, Nesemann JM, Cañari-Casaño JL, Elorreaga OA, Muñoz M, Talero S, Harding-Esch EM, Saboyá-Díaz MI, Honorio-Morales HA, Durand S, Carey-Angeles CA, Klausner JD, Keenan JD, Lescano AG. Prevalence of and factors associated with childhood anaemia in remote villages of the Peruvian Amazon: a cross-sectional study and geospatial analysis. Trans R Soc Trop Med Hyg 2023; 117:598-605. [PMID: 37039044 PMCID: PMC10398418 DOI: 10.1093/trstmh/trad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/28/2023] [Accepted: 03/23/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Anaemia is a public health problem in Peru. In the Loreto region of the Amazon, ≥50% of children may be anaemic, although insufficient information exists for rural villages. METHODS To generate more data about childhood anaemia in the Peruvian Amazon, haemoglobin was measured as part of a trachoma survey in 21 randomly selected villages. All children 1-9 y of age from 30 randomly selected households per village were recruited. Anaemia was classified according to the World Health Organization guidelines and a socio-economic status (SES) index was created for each household using principal component analysis. Spatial autocorrelation was determined using Moran's I and Ripley's K function. RESULTS Of 678 children with complete haemoglobin data, 25.4% (95% confidence interval [CI] 21.2 to 30.1) had mild-or-worse anaemia and 22.1% (95% CI 15.6 to 30.3) had moderate-or-worse anaemia. Mild-or-worse anaemia was more common among children whose primary source of drinking water was surface water (prevalence ratio [PR] 1.26 [95% CI 1.14 to 1.40], p<0.001) and who were in the lowest SES tercile (PR 1.16 [95% CI 1.02 to 1.32], p=0.021). Moderate-or-worse anaemia was more common among boys (PR 1.32 [95% CI 1.09 to 1.60], p=0.005). No evidence of geospatial clustering was found. CONCLUSIONS Remote villages of the Amazon would benefit from interventions for childhood anaemia and the poorest households would have the most to gain. Integrating anaemia screening into neglected tropical diseases surveys is an opportunity to use public health resources more efficiently.
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Affiliation(s)
| | - Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru
| | - John M Nesemann
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Jorge L Cañari-Casaño
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Oliver A Elorreaga
- Clima, Latin American Center of Excellence for Climate Change and Health, Universidad Peruana Cayetano Heredia, Lima, Peru
- GMINIS Research Group, Pontificia Universidad Católica del Perú, Lima, Peru
| | - Marleny Muñoz
- Área de Epidemiología, Red de Salud Alto Amazonas, Yurimaguas, Peru
| | - Sandra Talero
- Escuela Superior de Oftalmología del Instituto Barraquer de América, Bogotá, Colombia
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Martha Idalí Saboyá-Díaz
- Pan American Health Organization, Department of Communicable Diseases and Environmental Determinants of Health, Washington, DC, USA
| | | | - Salomón Durand
- Área de Epidemiología, Dirección Regional de Salud Loreto, Iquitos, Peru
| | | | - Jeffrey D Klausner
- Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, San Francisco, USA
| | - Andres G Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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Vásquez-Velásquez C, Fernandez-Guzman D, Quispe-Vicuña C, Caira-Chuquineyra B, Ccami-Bernal F, Castillo-Gutierrez P, Arredondo-Nontol M, Gonzales GF. Evaluating the Diagnostic Performance of Hemoglobin in the Diagnosis of Iron Deficiency Anemia in High-Altitude Populations: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6117. [PMID: 37372704 DOI: 10.3390/ijerph20126117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/07/2023] [Accepted: 02/26/2023] [Indexed: 06/29/2023]
Abstract
We evaluated the available literature on the diagnostic performance of hemoglobin (Hb) in the diagnosis of iron deficiency anemia (IDA) in high-altitude populations. We searched PubMed, Web of Science, Scopus, Embase, Medline by Ovid, the Cochrane Library, and LILCAS until 3 May 2022. We included studies that evaluated the diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curves, and accuracy) of Hb (with and without an altitude correction factor) compared to any iron deficiency (ID) marker (e.g., ferritin, soluble transferrin receptor (sTFR), transferrin saturation, or total body iron (TBI)) in populations residing at altitudes (≥1000 m above sea level). We identified a total of 14 studies (with 4522 participants). We found disagreement in diagnostic performance test values between the studies, both in those comparing hemoglobin with and in those comparing hemoglobin without a correction factor for altitude. Sensitivity ranged from 7% to 100%, whereas specificity ranged from 30% to 100%. Three studies reported higher accuracy of uncorrected versus altitude-corrected hemoglobin. Similarly, two studies found that not correcting hemoglobin for altitude improved the receiver operating characteristic (ROC) curves for the diagnosis of iron deficiency anemia. Available studies on high-altitude populations suggest that the diagnostic accuracy of Hb is higher when altitude correction is not used. In addition, the high prevalence of anemia in altitude regions could be due to diagnostic misclassification.
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Affiliation(s)
- Cinthya Vásquez-Velásquez
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía Alberto Cazorla Tálleri, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | | | - Carlos Quispe-Vicuña
- Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
| | | | - Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa 04001, Peru
| | | | | | - Gustavo F Gonzales
- Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía Alberto Cazorla Tálleri, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
- Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
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Mairbäurl H, Kilian S, Seide S, Muckenthaler MU, Gassmann M, Benedict RK. The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults. Hemasphere 2023; 7:e854. [PMID: 37038466 PMCID: PMC10082317 DOI: 10.1097/hs9.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/28/2023] [Indexed: 04/12/2023] Open
Abstract
To compensate for decreased oxygen partial pressure, high-altitude residents increase hemoglobin concentrations [Hb]. The elevation varies between world regions, posing problems in defining cutoff values for anemia or polycythemia. The currently used altitude adjustments (World Health Organization [WHO]), however, do not account for regional differences. Data from The Demographic and Health Survey (DHS) Program were analyzed from 32 countries harboring >4% of residents at altitudes above 1000 m. [Hb]-increase, (ΔHb/km altitude) was calculated by linear regression analysis. Tables show 95% reference intervals (RIs) for different altitude ranges, world regions, and age groups. The prevalence of anemia and polycythemia was calculated using regressions in comparison to WHO adjustments. The most pronounced Δ[Hb]/km was found in East Africans and South Americans while [Hb] increased least in South/South-East Asia. In African regions and Middle East, [Hb] was decreased in some altitude regions showing inconsistent changes in different age groups. Of note, in all regions, the Δ[Hb]/km was lower in children than in adults, and in the Middle East, it was even negative. Overall, the Δ[Hb]/km from our analysis differed from the region-independent adjustments currently suggested by the WHO resulting in a lower anemia prevalence at very high altitudes. The distinct patterns of Δ[Hb] with altitude in residents from different world regions imply that one single, region-independent correction factor for altitude is not be applicable for diagnosing abnormal [Hb]. Therefore, we provide regression coefficients and reference-tables that are specific for world regions and altitude ranges to improve diagnosing abnormal [Hb].
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Affiliation(s)
- Heimo Mairbäurl
- Translational Pneumology, University Hospital Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
| | - Samuel Kilian
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | - Svenja Seide
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany
| | - Martina U. Muckenthaler
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany
- Pediatric Oncology, Hematology & Immunology, University Hospital Heidelberg, Germany
| | - Max Gassmann
- Institute of Veterinary Physiology, Vetsuisse Faculty, and Zurich Center for Integrative Human Physiology (ZIHP), University of Zürich, Switzerland
- Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru
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Armah-Ansah EK. Determinants of anemia among women of childbearing age: analysis of the 2018 Mali demographic and health survey. Arch Public Health 2023; 81:10. [PMID: 36658651 PMCID: PMC9854152 DOI: 10.1186/s13690-023-01023-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/01/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Anemia occurs at all stages of life and it is of public health concern as it serves as an indicator of quality nutrition and health of a society. Almost one third of the global prevalence of anemia occur among reproductive aged women and almost 40% of these women reside in sub-Saharan Africa including Mali. This study, therefore, sought to assess the determinants of anemia among women of childbearing age in Mali. METHODS Secondary data analysis of the 2018 Mali Demographic and health Survey (MDHS). Anemia in women was the outcome variable for the study. Data of 5,048 women aged 15-49 was used for the study. Using binary and multivariate logistic regression models, factors associated with anemia among women were identified. The analysis was conducted using Stata version 14.2 software and adjusted Odds Ratio (aOR) with a 95% Confidence Interval (CI) and p-value < 0.05 were used to see the significant association. RESULTS The prevalence of anemia among women of childbearing age in Mali is 63.5%. Of these, 4.3% and 24.9% were severely and mildly anemic respectively, and the rest 34.3% were moderately anemic. Women who had secondary education (aOR = 0.70, 95% CI: 0.58-0.84), overweight (aOR = 0.63, 95% CI: 0.50-0.81), exposure to mass media (aOR = 0.90, 95% CI = 0.76-1.49) and women with two births (aOR = 0.86, 95% CI = 0.71-1.05) were less likely to be anemic. Likely, richest wealth quintile (aOR = 0.73, 95% CI = 0.51-1.05), living in urban setting (aOR = 0.85, 95% CI = 0.70-1.03) and women in Kidal Region (aOR = 0.42, 95% CI = 0.27-0.65) were less likely to be anemic. However, pregnant women, women covered by health insurance, women with unimproved drinking water, women in communities with low literacy and low socioeconomic status had higher odds of anemia. CONCLUSION These findings point to the need for community and household level public health sensitization interventions to highlight the pro-anemic factors and mitigating strategies. More especially, women with no education, pregnant women, women covered by health insurance, women from communities with low literacy and socioeconomic status ought to be the focus of such interventions.
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Affiliation(s)
- Ebenezer Kwesi Armah-Ansah
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana ,grid.410682.90000 0004 0578 2005Department of Population and Development, National Research University - Higher School of Economics, Moscow, Russia ,grid.413355.50000 0001 2221 4219Population Dynamics Sexual and Reproductive Health Unit, African Population and Health Research Center, Nairobi, Kenya
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Sangeetha T, Anand AV, Begum TN. Assessment of Inter-relationship between Anemia and COPD In Accordance with Altitude. Open Respir Med J 2022. [DOI: 10.2174/18743064-v16-e2206270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Anemia, a common blood disorder has been analysed for the risk for chronic obstructive pulmonary disease (COPD), a predominant respiratory condition. The COPD patients have been found to have anemia due to inflammation, accounting for about 7.5-33%.
Objectives:
To predict the influence of anemia in the COPD occurrence as well as to depict the role of change in altitudes in the occurrence of anemic as well as COPD.
Methodology:
A total of 17 hematological parameters has been analysed in the anemic and COPD patients along with the control samples of low and high altitude regions and the significance of the results has been calculated.
Results:
The hematological parameter comparison between anemia and COPD samples of two different altitudes showed highly significant variations (p<0.001) as well as slighter significant variations (p<0.01, p<0.05 and p<0.1) in most of the parameters as well as the prevalence of anemic condition among the COPD patients was significant.
Conclusion:
The considered hematological parameters shown to have a considerable influence in the occurrence of anemia and COPD as well as in the occurrence of anemia in COPD patients along with the change in altitudes.
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Prevalence Rate and Associated Risk Factors of Anaemia among under Five Years Children in Ethiopia. Nutrients 2022; 14:nu14132693. [PMID: 35807875 PMCID: PMC9268795 DOI: 10.3390/nu14132693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Anaemia is a condition characterised by a decrease in the concentration of haemoglobin (Hb) in the blood. Anaemia suffers under five years children about 47.4% and 67.6% worldwide and developing countries including Ethiopia, respectively. The aim of this study was to assess the prevalence rate and the associated socio-economic, geographic and demographic factors of anaemia status of under five years children in Ethiopia. Methods: The data for this study were obtained from the 2011 Ethiopia National Malaria Indicator Survey (EMIS 2011). A sample of 4356 under five years age children was obtained from three regional states of Ethiopia. Based on haemoglobin level, child anaemia status was ordered and takes an ordinal value as no anaemia, mild anaemia, moderate anaemia and severe anaemia, respectively. Ordinal logistic regression model, specifically the proportional odds model was used by considering with and without survey design features. Results: Of the 4356 complete cases, 2190 (50.28%) were male and 1966 (49.72%) were female children under five years old. The children overall mean (SD) age was 2.68 (1.21) years. It was observed that both the mean ages and their variabilities in the regions are approximately equal to the overall mean and variability. It was also observed that in Amhara, Oromiya and SNNP regions 72.28%, 67.99% and 73.63% of the children, respectively had no anaemia; 15.93%, 13.47% and 13.56% of the children, respectively had mild anaemia; 10.99%, 15.61% and 11.33% of the children, respectively had moderate anaemia; and only 0.81%, 2.93% and 1.49% had severe anaemia, respectively. The prevalence of severe child anaemia status was higher in Oromiya region compared to Amhara and SNNP regions, respectively. Our result indicates that age, use of mosquito net, malaria RDT outcome, type of toilet facility, household wealth index, region and median altitude were significantly related to child anaemia status. However, it was observed that some covariates were model dependent, for example household wealth index and type of toilet facility were not significant when considering survey features. Conclusions: Anaemia burden remains high particularly in developing countries. Controlling the burden of anaemia necessitates the formulation of integrated interventions which prioritise the highest risk groups including children under five years. The statistical model used in this paper identified individual, household and cluster level risk factors of child anaemia. The identified risk factors for example not having improved toilet facility in the dwelling where a child lived as well as poorest household wealth index suggest the policymakers should target to focus more on children from poor community. Further, the strong association between malaria infection and anaemia suggests that malaria preventative methods such as vector control methods namely, long-lasting insecticidal nets (LLINs) and indoor residual spraying of households with insecticides and including case diagnostic testing and treatment may be the most effective ways to reduce infections associated with anaemia. Such collective assessment approach may lead to more effective public health strategies and could have important policy implications for health promotion and for the reduction of health disparities.
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Sakung J, Tosae D, Gunarmi G, Arundhana AI. Differences in Hemoglobin Levels in Pregnant Women through Multi-Micronutrient Supplements and Iron Tablets. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: A high incidence of anemia, particularly severe anemia, among pregnant women has been a major cause of maternal mortality worldwide. Multi-micronutrient supplement (MMS) has been beneficial for health outcomes.
AIM: The study was aimed to examine the effect of MMS compared to iron-folic acid supplement (IFA) on hemoglobin (Hb) levels among pregnant women.
METHODS: The study was a quasi-experiment with a three-group pre-post-test design, namely, IFA group, MMS group, and MMS + IFA group. A total of 120 participants enrolled were divided equally in each group. The statistical analysis performed was paired t-test and one-way ANOVA using SPSS.
RESULTS: The study result shows that there was a significant difference in the Hb levels of pregnant women after the intervention in all groups (p < 0.001). The highest increase in Hb levels was in the IFA + MMS combining group by 1.1 g/dL of Hb followed by MMS and IFA (0.8 ± 0.37 and 0.4 ± 0.31, respectively).
CONCLUSION: The combination of Fe and MMS groups could increase Hb levels compared to IFA. Thus, replacing IFA with MMS is reasonably in preventing anemia among pregnant women.
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12
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Molecular mechanisms of hematological and biochemical alterations in malaria: A review. Mol Biochem Parasitol 2021; 247:111446. [PMID: 34953384 DOI: 10.1016/j.molbiopara.2021.111446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/20/2021] [Accepted: 12/19/2021] [Indexed: 11/20/2022]
Abstract
Malaria is a dangerous disease that contributes to millions of hospital visits and hundreds of thousands of deaths, especially in children residing in sub-Saharan Africa. Although several interventions such as vector control, case detection, and treatment are already in place, there is no substantive reduction in the disease burden. Several studies in the past have reported the emergence of resistant strains of malaria parasites (MPs) and mosquitoes, and poor adherence and inaccessibility to effective antimalarial drugs as the major factors for this persistent menace of malaria infections. Moreover, victory against MP infections for many years has been hampered by an incomplete understanding of the complex nature of malaria pathogenesis. Very recent studies have identified different complex interactions and hematological alterations induced by malaria parasites. However, no studies have hybridized these alterations for a better understanding of Malaria pathogenesis. Hence, this review thoroughly discusses the molecular mechanisms of all reported hematological and biochemical alterations induced by MPs infections. Specifically, the mechanisms in which MP-infection induces anemia, thrombocytopenia, leukopenia, dyslipidemia, hypoglycemia, oxidative stress, and liver and kidney malfunctions were presented. The study also discussed how MPs evade the host's immune response and suggested strategies to limit evasion of the host's immune response to combat malaria and its complications.
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Anjorin S, Yaya S. Anaemia among under-five children: Is maternal marriage at 18th birthday and above protective? Evidence from 15 countries in Sub-Saharan Africa. MATERNAL AND CHILD NUTRITION 2021; 17:e13226. [PMID: 34081411 PMCID: PMC8476440 DOI: 10.1111/mcn.13226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022]
Abstract
Prevalence of child marriage has remained high in many parts of Africa despite its multisectoral adverse effect. As it is now being suggested to have intergeneration impact, we examined if marriage at or after 18th birthday is associated with the risk of anaemia among under-five children. Cross-sectional data from Demographic and Health Surveys (DHS) conducted between 2010 and 2018 in 15 African countries as of August 2020 were used. Maternal age of marriage was defined as when they started living with their husband or partner. Children with haemoglobin level below 11.0 g/dl after adjustment for altitude were categorised to be anaemic. The study involved a multivariable logistic regression analysis of 17,033 children data born by women between the childbearing ages. About 65% of under-five children in Sub-Saharan Africa (SSA) were anaemic, ranging from 40% in Rwanda to 82% in Mali. Girl child marriage ranged from 40% in South Africa to 97% in Niger with an average of about 60%. We observed a significant reduction (20%) in the risk of anaemia among under-five children when their mothers married after at or after their 18th birthday. Country-specific analysis showed that increased risk of anaemia was strongly associated with early marriage in Côte d'Ivoire and Mozambique. This study contributed to the growing evidence that maternal age of marriage might have an intergenerational impact. Maternal marriage at or after their 18th birthday reduces the risk of anaemia among under-five children in Africa. Interventions aimed at tackling anaemia in Africa should capture and affect household socioeconomic risks and children's exposures.
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Affiliation(s)
- Seun Anjorin
- Warwick Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sanni Yaya
- University of Parakou, Rte de l'Okpara, Parakou, Benin
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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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Whitney R, Centrone WA, Mamani HS, Falkenstein K, Levine RS, Harris J, Hazlitt M, Lim CA. Impact of a collaborative childhood anaemia intervention programme in Peru. Trop Med Int Health 2021; 26:680-686. [PMID: 33605012 DOI: 10.1111/tmi.13564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To evaluate the impact of a 12-month multi-modal public health intervention programme for treating and preventing anaemia among children aged 6 months to 4 years in an underserved community in Peru. METHODS The intervention included nutritional education, use of a Lucky Iron Fish® cooking tool, and dietary supplementation. The primary outcome measure was anaemia resolution. Secondary outcomes included absolute changes in haemoglobin, change in knowledge survey scores and adherence to interventions. Chi-square test and Mann-Whitney U-test were employed to identify associations between anaemia and intervention-related measures. Variables found to be significantly associated in bivariate analysis or of clinical importance were included in a logistic regression model. RESULTS Of the 406 children enrolled, 256 (63.1%) completed the programme. Of those, 34.0% had anaemia at baseline; this decreased to 13.0% over 12 months. The mean haemoglobin for all ages at baseline was 11.3 g/dL (SD 0.9). At 12 months, the mean was 11.9 g/dL (SD 0.8), with a mean increase of 0.5 g/dL (95% CI 0.4-0.6). Children with anaemia at baseline saw an increase of 1.19 g/dL at the 12-month follow-up (95% CI 1.12-1.37). Parents correctly answered 79.0% of knowledge assessment questions at baseline, which increased to 86.6% at 12 months. CONCLUSIONS We observed a reduction in the prevalence of mild to moderate anaemia among study participants in this vulnerable population and conclude that multi-modal intervention programmes providing nutrition education in conjunction with low-cost iron supplementation and easy-to-use Lucky Iron Fish® cooking tools may reduce and prevent anaemia in children.
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Affiliation(s)
- Rachel Whitney
- Department of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Czer Anthoney Lim
- Department of Emergency Medicine and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pomati M, Mendoza-Quispe D, Anza-Ramirez C, Hernández-Vásquez A, Carrillo Larco RM, Fernandez G, Nandy S, Miranda JJ, Bernabé-Ortiz A. Trends and patterns of the double burden of malnutrition (DBM) in Peru: a pooled analysis of 129,159 mother-child dyads. Int J Obes (Lond) 2021; 45:609-618. [PMID: 33402688 PMCID: PMC7906898 DOI: 10.1038/s41366-020-00725-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/27/2020] [Accepted: 11/25/2020] [Indexed: 12/03/2022]
Abstract
Background This study aims to evaluate trends of DBM in Peru over the last 20 years. Methods Using individual-level data collected in nationally representative household surveys from Peru between 1996 and 2017, we analysed trends in the prevalence and patterning of the DBM. We classified the nutritional status of children and their mothers as undernourished (either underweight, stunted or wasted for children), normal, overweight or obese. Children classified as experiencing the DBM were those undernourished and living with an overweight or obese mother. We also fitted logistic regression models to evaluate the probability of children having an overweight/obese mother across subgroups of socioeconomic status, place of residence and education. Results The overall percentage of children experiencing the DBM in 2016 was 7%, and constitutes ~203,600 children (90% of whom were stunted). Between 1996 and 2016, undernourished children have seen the largest relative increase in the risk of having an overweight mother (31% vs. 37%) or obese mother (6% vs. 17%); however, due to the substantial decrease in the absolute number of undernourished children, the DBM has not grown. Moreover, all children, irrespective of their own nutritional status, are now more likely to live with an overweight or obese mother, a consistent pattern across wealth, location and education subgroups, and all regions of Peru. Conclusions DBM prevalence in Peru has decreased, although the number of DBM cases is estimated to be above 200,000. In addition, all children are now more likely to live with overweight or obese mothers. The basic pattern has shifted from one of undernourished children whose mothers have a ‘normal’ BMI, to one where now most children have a ‘normal’ or healthy anthropometric status, but whose mothers are overweight or obese. This suggest that Peru is on the cusp of a major public health challenge requiring significant action.
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Affiliation(s)
- Marco Pomati
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, Wales, CF24 3PG, UK.
| | - Daniel Mendoza-Quispe
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cecilia Anza-Ramirez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Akram Hernández-Vásquez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rodrigo M Carrillo Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | | | - Shailen Nandy
- School of Social Sciences, Cardiff University, Glamorgan Building, King Edward VII Avenue, Cardiff, Wales, CF24 3PG, UK
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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17
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Gonzales GF, Tapia V, Vásquez-Velásquez C. Changes in hemoglobin levels with age and altitude in preschool-aged children in Peru: the assessment of two individual-based national databases. Ann N Y Acad Sci 2020; 1488:67-82. [PMID: 33147649 DOI: 10.1111/nyas.14520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/30/2022]
Abstract
According to the World Health Organization, the cutoff hemoglobin (Hb) value for defining anemia is 11 g/dL in preschool-aged children, and Hb measurements should be corrected above an altitude of 1000 meters. This study sought to determine the altitude at which the Hb value increases compared with that at sea level, Hb changes with age and region in Peru, the prevalence of anemia according to three different models used to correct Hb for altitude, and the association of the Hb value with stunting. Two individual-based Peruvian national databases were analyzed. Hb increased from an altitude of 375 meters. Hb concentration was lower at younger ages and higher at older ages. The increase in Hb with increasing altitude was lower in southern Peru. Implementing the different models for Hb measurement correction resulted in a higher and lower prevalence of anemia at altitudes >2500 and <2500 m, respectively, using the CDC adjustment. In children aged 6-23 months, the rate of stunting was lower in those with an Hb level of 10-12 g/dL (including mild anemia). In conclusion, the adjustment of Hb values for altitude should be considered before 1000 m and reference ranges should be adjusted to smaller groups of children instead of the same reference range for children aged 6-59 months.
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Affiliation(s)
- Gustavo F Gonzales
- Laboratories of Investigation and Development and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Vilma Tapia
- Laboratories of Investigation and Development and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cinthya Vásquez-Velásquez
- Laboratories of Investigation and Development and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.,High Altitude Research Institute, Universidad Peruana Cayetano Heredia, Lima, Peru
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