Potential Contribution of Iron Deficiency and Multiple Factors to Anemia Among 6- to 72-Month-Old Children in the Kokang Area of Myanmar

Anemia and associated factors among internally displaced children at Debark refugee camp, North Gondar, Northwest Ethiopia

BACKGROUND

Children in refugee camps, due to their living conditions, are the most vulnerable groups to suffer from anemia. Nutritional deficiencies, especially iron deficiency is the most common causes of anemia. However, there is limited information on the prevalence and associated factors of anemia in Ethiopia. Hence, this study aimed to assess the prevalence and associated factors of anemia among internally displaced children at Debark refugee camp, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted on 354 internally displaced children, at Debark refugee camp from March to May 2022. A systematic sampling technique was employed. The socio demographic characteristics were collected by using structured questionnaire via face-to-face interview with the caregivers. The hemoglobin level was determined using HemoCue301+. Form anemic children, venous blood sample was collected for iron profile analysis. Parasitological and anthropometric measurements were also done. The data were entered using Epi-data version 4.6.0.6 and exported to STATA version 14 for analysis. Bi-variable and multivariable binary logistic regression analysis were done. Both crude odds ratio and adjusted odds ratio with the corresponding 95% confidence interval were calculated to measure the strength of association. P-Value < 0.05 was considered as statistically significant association.

RESULTS

From the total of 354 children included in this study, more than half (54.8%) of them were male. The median age of children was 7 years with interquartile range of (4-10) years. The total prevalence of anemia in this study was 33.62% (95% CI:28.7, 38.7). Moderate type anemia was predominant in this study. From anemic children 30 (25.2%) had iron deficiency anemia. In this study, low dietary diversity (AOR = 4.9; 95% CI: 2.0, 11.7), duration in the camp more than six months (AOR = 4.2; 95% CI:1.9, 9.4), presence of diarrhea (AOR = 2.7; 95% CI:1.3, 5.7), fever (AOR = 3.4; 95% CI:1.6, 7.1), and wasting (AOR = 3.6; 95% CI:1.3, 10.3) were significantly associated with the prevalence of anemia.

CONCLUSION

Anemia was moderate public health problem in the current study. Focused policies and strategies towards to internally displaced children should be designed to reduce anemia, by preventing the significant risk factors associated with anemia.

Risk factors for undernutrition among children 0-59 months of age in Myanmar

The prevalence of childhood stunting in Myanmar is one of the highest among the countries of Southeast Asia. Cross-sectional data from the Myanmar Demographic Health Survey 2015-2016 were used to examine risk factors for stunting, wasting, and underweight among children aged 0-59 months. The prevalence of stunting, wasting, and underweight was 29.0%, 7.3%, and 19.2%, respectively. Accounting for sampling design and weights, multivariable logistic regression was conducted with 35 household, maternal, and child characteristics. Current pregnancy and maternal height <145 cm, home delivery, child's small birth size recalled by mother, and older age (ref: 0-5 months) predicted both stunting and underweight. Larger than average birth size was protective for all stunting, wasting, and underweight. Maternal body mass index <18.5 kg m-2 was a common risk factor for wasting and underweight. Lower wealth quintiles, maternal engagement in nonagricultural occupation, and male child predicted stunting only. Younger child age and not receiving vitamin A supplementation in the previous 6 months were risk factors for wasting only. Regional variation was also seen, with a higher odds of stunting in the West-South Region, North-East States, and West States, compared with the Central Regions. In Myanmar, socio-economic and demographic factors, poor maternal nutritional status, and living in certain geographical locations are affecting children's undernutrition. It is recommended that interventions for growth faltering focus on the first 1,000 days of life; optimum maternal nutrition be ensured during and before pregnancy and at adolescence; societal support be provided for mothers in poverty or engaged in nonagriculture; and region-specific undernutrition pathways be understood.

Age-specific risk factors for child anaemia in Myanmar: Analysis from the Demographic and Health Survey 2015-2016

Anaemia is prevalent among preschool-aged children in Myanmar, but few epidemiological studies of anaemia at the national level were reported. Using data from the Myanmar Demographic and Health Survey 2015-2016, we examined risk factors for anaemia at household, maternal, and individual levels for children aged 6-23 months (n = 1,133) and 24-59 months (n = 2,393) separately. Survey design and sampling weights were adjusted for in multivariate regression analyses. The prevalence of anaemia was 77.2% in children aged 6-23 months and 50.8% in those aged 24-59 months. Living in geographic zones other than the hilly zone was associated with a higher odds of anaemia in both age groups (OR = 1.86-2.51 [95% lower limit > 1.0]). Maternal anaemia predicted child anaemia in a dose-response manner in both groups (6-23 months of age, OR = 2.01, 95% CI [1.38, 2.92; mild] and OR = 2.41, 95% CI [1.12, 5.19; moderate]; and 24-59 months of age, OR = 1.42, 95% CI [1.12, 1.81; mild] and OR = 2.92, 95% CI [1.91,4.46; moderate]). A maternal age of 14-24 years (ref: 25-34 years, OR = 1.67, 95% CI [1.06, 2.64]) and maternal tolerant attitude to domestic violence (OR = 1.61, 95% CI [1.13, 2.31]) predicted anaemia in children aged 6-23 months only. Younger child age (OR = 0.97, 95% CI [0.96, 0.98]), stunting (OR = 1.35, 95% CI [1.08, 1.69]) and using unimproved drinking water sources (OR = 1.38, 95% CI [1.10, 1.75]) were associated with anaemia in children aged 24-59 months. Consideration of age-specific risks factors for child anaemia will help in planning anaemia control programmes in Myanmar.

Prevalence and temporal trend (2005-2015) of anaemia among children in Northeast Brazil

OBJECTIVE

Anaemia is the main nutritional deficiency in Brazil, and a prevention and control programme (National Program for Iron Supplementation) has been developed since 2005. Studies on the temporal evolution of anaemia prevalence contribute to assessment of the effectiveness of the actions undertaken. The present study aimed to identify the prevalence and temporal trend of anaemia in children.

DESIGN

Study based on two cross-sectional household surveys carried out in 2005 and 2015. Anaemia was defined as Hb<11 g/dl (HemoCue®). Trend analysis was performed using the prevalence ratio (PR), calculated by Poisson regression with a robust adjustment of the variance. Differences were significant when P<0·05 in both crude analyses and those adjusted for possible confounding factors (e.g. socio-economic, demographic and health variables).

SETTING

Alagoas, Brazil.

SUBJECTS

In total, 666 and 782 children in the first and second Alagoas State Health and Nutrition Survey, respectively (probabilistic samples).

RESULTS

In 2005 and 2015, anaemia prevalence was 45·1 and 27·4 %, respectively (-39·1 %; PR=0·61; 95 % CI 0·52, 0·70). In both surveys, children aged ≤24 months were more affected (P24 months (67·2 v. 40·7 %; 27·0 v. 19·3 %, respectively).

CONCLUSIONS

The prevalence of anaemia reduced significantly in the evaluated period. Thus, it may no longer be a severe public health problem but can instead be considered a problem of moderate magnitude. It remains, however, above the level considered acceptable according to WHO criteria. These results justify the implementation of prevention and control actions.

Inappropriate Feeding Behavior: One of the Important Causes of Malnutrition in 6- to 36-Month-Old Children in Myanmar

The complementary feeding period is an important time for children's growth and development. This study was conducted to 1) determine the feeding behaviors of 6- to 36-month-old children in Myanmar, 2) explore health effects of feeding behaviors, and 3) determine factors associated with feeding behaviors. A total of 807 children and their mothers (N = 642) were recruited from nine villages in Kachin, Shan, and Kokang, Myanmar. Feeding behaviors and sociodemographic characteristics were investigated using a validated questionnaire. Hemoglobin and anthropometric indicators were measured during the fieldwork. In our sample, 18.6%, 72.7%, and 9.8% of children were introduced to complementary foods (CFs) earlier than 4 months of age, between 4 and 8 months of age, and later than 8 months of age, respectively. For different types of CFs, up to the age of 24.1-36 months, there were still 6.5% and 4.1% of the children who had never been introduced to eggs and meat. Introduction of CFs earlier than 4 months of age was a risk factor for being underweight (age-adjusted odds ratio (ORadjust-age) = 1.7, 95% confidence interval (CI) = 1.2-2.5) and for stunting (ORadjust-age = 1.6, 95% CI = 1.1-2.3), whereas introduction of CFs later than 8 months of age was a risk factor for anemia (ORadjust-age = 3.5, 95% CI = 1.7-7.2). Mothers who had anemia (OR = 3.7, 95% CI = 2.0-6.9) tended toward early introduction of CFs. Women with a lower family income tended toward later introduction of CFs (OR = 2.0, 95% CI = 1.3-3.3). This study demonstrated that inappropriate feeding behavior was one of the important causes of malnutrition.