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Sunuwar DR, Singh DR, Pradhan PMS, Shrestha V, Rai P, Shah SK, Adhikari B. Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis. BMC Public Health 2023; 23:343. [PMID: 36793012 PMCID: PMC9933407 DOI: 10.1186/s12889-023-15265-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND South and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore the individual and community- level factors associated with childhood anemia across the six selected SSEA countries. METHODS Demographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, and Nepal) conducted between 2011 and 2016 were analyzed. A total of 167,017 children aged 6-59 months were included in the analysis. Multivariable multilevel logistic regression analysis was used to identify independent predictors of anemia. RESULTS The combined prevalence of childhood anemia across six SSEA countries was 57.3% (95% CI: 56.9-57.7%). At the individual level, childhood anemia was significantly higher among (1) mothers with anemia compared to non-anemic mothers (Bangladesh: aOR = 1.66, Cambodia: aOR = 1.56, India: aOR = 1.62, Maldives: aOR = 1.44, Myanmar: aOR = 1.59, and Nepal: aOR = 1.71); (2) children with a history of fever in the last two weeks compared to those without a history of fever (Cambodia: aOR = 1.29, India: aOR = 1.03, Myanmar: aOR = 1.08), and; (3) stunted children compared to those who were not (Bangladesh: aOR = 1.33, Cambodia: aOR = 1.42, India: aOR = 1.29, and Nepal: aOR = 1.27). In terms of community-level factors, children with mothers in communities with a high percentage of community maternal anemia had higher odds of childhood anemia in all countries (Bangladesh: aOR = 1.21, Cambodia: aOR = 1.31, India: aOR = 1.72, Maldives: aOR = 1.35, Myanmar: aOR = 1.33, and Nepal: aOR = 1.72). CONCLUSION Children with anemic mothers and stunted growth were found vulnerable to developing childhood anemia. Individual and community-level factors identified in this study can be considered to develop effective anemia control and prevention strategies.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
- Research and Innovation Section, Southeast Asia Development Action Network (SADAN), Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Nepalese Society of Community Medicine, Kathmandu, Nepal
| | | | - Pushpa Rai
- Department of Nursing, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal
| | - Sunil Kumar Shah
- Public Health and Nutrition Section, Bagmati Welfare Society Nepal, Sarlahi, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Traore SS, Bo Y, Kou G, Lyu Q. Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age: a study from Sub-Saharan Africa. BMC Pregnancy Childbirth 2023; 23:63. [PMID: 36698082 PMCID: PMC9875517 DOI: 10.1186/s12884-023-05399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, infant anemia, stunting and low birth weight remains major public health problems. It is unclear whether prenatal iron supplementation and/or deworming can reduce the risk of infant stunting, anemia and low birth weight. The aim of this study was to investigate the relationship between iron supplementation and/or deworming and stunting, anemia, and low birth weight in infants under two years of age in sub-Saharan Africa. METHODS Our studies examined pooled data from Demographic and Health Surveys (DHS) in twenty-three African countries collected between 2014 and 2020. childhood anemia and stunting in infants under the age of two were the primary outcomes. Iron supplementation and deworming during prenatal visits were the main exposure variables. A multivariate logistic regression model was used to investigate these relationships. RESULTS The prevalence of stunting was 29.9%, severe stunting was 10.6%, childhood anemia was 74.3%, childhood severe anemia was 3.2%, and low birth weight was 16.4%, respectively. The use of prenatal iron supplementation alone was associated with a significant reduction of childhood anemia [aOR (95% CI) = 0.9 (0.8-1.0)]. Prenatal deworming alone was associated with a significantly reduced risk of stunting [aOR (95% CI) = 0.7 (0.8-1.0)], childhood anemia [aOR (95% CI) = 0.7 (0.8-0.9)], and low birth weight [aOR (95% CI) = 0.7 (0.8-1.0)]. Prenatal iron supplementation plus deworming or iron supplementation (with or without deworming) were not associated with childhood anemia, infant stunting and low birth weight. CONCLUSIONS In Sub-Saharan Africa, prenatal deworming alone has the potential to improve infants' outcomes. Childhood anemia was improved with prenatal iron supplementation alone. Our recent findings indicate the necessity for prospective studies on the association between prenatal iron supplementation plus deworming and childhood anemia, stunting and low birth weight.
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Affiliation(s)
- Stanislav Seydou Traore
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yacong Bo
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, 999077 China
| | - Guangning Kou
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China ,grid.207374.50000 0001 2189 3846Centre of Sport Nutrition and Health, School of Physical Education, Zhengzhou University, Zhengzhou, 450001 China
| | - Quanjun Lyu
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China ,grid.412633.10000 0004 1799 0733Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
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Adam NS, Twabi HS, Manda SOM. A simulation study for evaluating the performance of clustering measures in multilevel logistic regression. BMC Med Res Methodol 2021; 21:245. [PMID: 34772354 PMCID: PMC8590272 DOI: 10.1186/s12874-021-01417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multilevel logistic regression models are widely used in health sciences research to account for clustering in multilevel data when estimating effects on subject binary outcomes of individual-level and cluster-level covariates. Several measures for quantifying between-cluster heterogeneity have been proposed. This study compared the performance of between-cluster variance based heterogeneity measures (the Intra-class Correlation Coefficient (ICC) and the Median Odds Ratio (MOR)), and cluster-level covariate based heterogeneity measures (the 80% Interval Odds Ratio (IOR-80) and the Sorting Out Index (SOI)). METHODS We used several simulation datasets of a two-level logistic regression model to assess the performance of the four clustering measures for a multilevel logistic regression model. We also empirically compared the four measures of cluster variation with an analysis of childhood anemia to investigate the importance of unexplained heterogeneity between communities and community geographic type (rural vs urban) effect in Malawi. RESULTS Our findings showed that the estimates of SOI and ICC were generally unbiased with at least 10 clusters and a cluster size of at least 20. On the other hand, estimates of MOR and IOR-80 were less accurate with 50 or fewer clusters regardless of the cluster size. The performance of the four clustering measures improved with increased clusters and cluster size at all cluster variances. In the analysis of childhood anemia, the estimate of the between-community variance was 0.455, and the effect of community geographic type (rural vs urban) had an odds ratio (OR)=1.21 (95% CI: 0.97, 1.52). The resulting estimates of ICC, MOR, IOR-80 and SOI were 0.122 (indicative of low homogeneity of childhood anemia in the same community); 1.898 (indicative of large unexplained heterogeneity); 0.345-3.978 and 56.7% (implying that the between community heterogeneity was more significant in explaining the variations in childhood anemia than the estimated effect of community geographic type (rural vs urban)), respectively. CONCLUSION At least 300 clusters with sizes of at least 50 would be adequate to estimate the strength of clustering in multilevel logistic regression with negligible bias. We recommend using the SOI to assess unexplained heterogeneity between clusters when the interest also involves the effect of cluster-level covariates, otherwise, the usual intra-cluster correlation coefficient would suffice in multilevel logistic regression analyses.
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Affiliation(s)
- Nicholas Siame Adam
- Department of Mathematical Sciences, University of Malawi, Chirunga, Zomba, P.O. Box 280, Malawi.,African Institute for Development Policy, Petroda Glasshouse, Area 14, plot number 14/191, Lilongwe 3, 31024, Malawi
| | - Halima S Twabi
- Department of Mathematical Sciences, University of Malawi, Chirunga, Zomba, P.O. Box 280, Malawi.
| | - Samuel O M Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria, South Africa.,Department of Statistics, University of Pretoria, Pretoria, South Africa
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Hasan MM, Magalhaes RJS, Ahmed S, Pervin S, Tariqujjaman M, Fatima Y, Mamun AA. Geographical variation and temporal trend in anemia among children aged 6-59 months in low- and middle-income countries during 2000-2018: forecasting the 2030 SDG target. Public Health Nutr 2021;:1-11. [PMID: 34103114 DOI: 10.1017/S1368980021002482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine geographical variations, trends and projections in the prevalence of childhood anemia at national and subpopulation levels. DESIGN Repeated cross-sectional Demographic and Health Survey (DHS) conducted during 2000-2018. SETTING Fifty-three low- and middle-income countries (LMIC). PARTICIPANTS Totally, 776 689 children aged 6-59 months. RESULTS During the latest DHS rounds between 2005 and 2018, the prevalence of child anemia was > 20 % in fifty-two out of fifty-three countries and ranged from 15·9 % in Armenia in 2016 to 87·8 % in Burkina Faso in 2010. Out of thirty-six countries with at least two surveys during 2000-2018, the prevalence of child anemia decreased in twenty-two countries, highest in Zimbabwe (-4·2 %) and increased in fourteen countries, highest in Burundi (5·0 %). Based on the trend, eleven and twenty-two out of thirty-six countries are projected to experience, respectively, moderate and severe public health problem according to the WHO criteria (moderate problem: 20-39·9 % and severe problem: ≥ 40 %) due to child anemia in 2030, with the highest prevalence in Liberia (87·5 %, 95 % credible interval 52·0-98·8 %). The prevalence of child anemia varied across the mother's education and age, child sex, wealth quintiles, and place of residence, with the highest rate of child anemia among the poorest, rural and low-educated mothers. These scenarios are projected to continue. The probability of reducing child anemia at < 0·5 % by 2030 is 0 % for all study countries. CONCLUSIONS The prevalence of child anemia varied between and within countries. None of the thirty-six LMIC is likely to eradicate child anemia by 2030.
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Tahir E, Ayotte P, Little M, Bélanger RE, Lucas M, Mergler D, Laouan Sidi EA, McHugh NGL, Lemire M. Anemia, iron status, and associated protective and risk factors among children and adolescents aged 3 to 19 years old from four First Nations communities in Quebec. Can J Public Health 2020; 111:682-693. [PMID: 32170646 PMCID: PMC7501325 DOI: 10.17269/s41997-020-00304-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 02/13/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Anemia and iron deficiency (ID) are frequent among Indigenous children of Canada, but few data are available in Quebec. The present study aimed to characterize anemia and ID prevalence and associated protective and risk factors among First Nations youth in Quebec. METHODS The 2015 First Nations (JES!-YEH!) pilot study was conducted among children and adolescents (3 to 19 years; n = 198) from four First Nations communities in Quebec. Blood and urine samples and anthropometric measurements were collected. Hemoglobin (Hb), serum ferritin (SF), plasma hs-CRP, and urinary cotinine levels were measured. Factors associated with anemia and ID (including traditional and market food consumption) were assessed using an interview-administered food frequency questionnaire, based on which nutritional intakes were calculated. Structural equation models were used to test associations. RESULTS The prevalence of anemia and ID was elevated (16.8% and 20.5% respectively). Traditional meat, fruit, and fruit juice (natural and powdered)-via their positive association with vitamin C intake-were the only food variables positively associated with SF (coefficient [95% CI] 0.017 [0.000, 0.114]; 0.090 [0.027, 0.161]; and 0.237 [0.060, 0.411]). Male sex was also associated with higher SF (0.295 [0.093, 0.502]). Inflammation status (hs-CRP > 5 mg/L) was inversely associated with Hb (- 0.015 [- 0.025, - 0.005]), whereas SF was positively associated with Hb (0.066 [0.040, 0.096]). Fruit and juice consumption was also positively associated with Hb, via vitamin C intake and SF (0.004 [0.001, 0.010]; 0.008 [0.003, 0.017]). CONCLUSIONS Interventions fostering healthier food environments as well as higher consumption of traditional meats and foods naturally rich in vitamin C, which is known to enhance iron absorption, and fighting inflammation could contribute to decrease the high prevalence of anemia and ID in this young Indigenous population.
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Affiliation(s)
- Emad Tahir
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Pierre Ayotte
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Centre de toxicologie du Québec, INSPQ, Quebec City, Canada
| | - Matthew Little
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard E Bélanger
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
- Département de pédiatrie, Université Laval, Quebec City, QC, Canada
| | - Michel Lucas
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Donna Mergler
- CINBIOSE, Université du Québec à Montréal, Montreal, QC, Canada
| | - Elhadji A Laouan Sidi
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada
| | - Nancy Gros-Louis McHugh
- First Nations of Québec and Labrador Health and Social Services Commission, Wendake, QC, Canada
| | - Mélanie Lemire
- Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada.
- Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada.
- Centre de Recherche du CHU de Québec, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Quebec City, QC, G1S 4L8, Canada.
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Muñoz Del Carpio-Toia Á, Cornejo-Roselló I, Rojas-Pauca S, Alvarez-Cervantes G, Bernabé-Ortiz JC, Gallegos A, Mercado-Mamani S, Veliz-Burgos A, Toia-Larsen M. [ Childhood anemia in populations residing at different geographical altitudes of Arequipa, Peru: A descriptive and retrospective study]. Medwave 2020; 20:e8004. [PMID: 32876624 DOI: 10.5867/medwave.2020.07.8004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/19/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To identify the characteristics of anemia in children living at different geographical altitude in the Arequipa Region of Peru. Methods We did a descriptive and retrospective study. The population consisted of 106 499 children under five years of age living in the Arequipa Region at different geographical altitude and receiving care by the Ministry of Health of Arequipa. Of these, 32 454 had anemia (30.5%). Socio-demographic data related to age, province, and beneficiary of the Comprehensive Health System program, home visits, and growth and development were obtained, in addition to data regarding anemia such as frequency, hemoglobin, and severity. Results The results were categorized by the geographical altitude of origin of children under 0 to 59 months of age and hemoglobin levels according to geographical altitude. Of the sample studied, the frequency of anemia at different geographical altitudes of Arequipa in children under five for the 2017 to 2019 period was: 18.7% at 0 to 999 meters above sea level; 29.6% at 1000 to 1999 meters; 31.6% at 2000 to 2999 meters; 42.9% at 3000 to 3999 meters; and 54.4% at 4000 to 4999 meters. There was a higher prevalence of anemia when the geographic altitude correction factor was used. Conclusions A significant statistical relationship (p < 0.05) was observed between the corrected hemoglobin according to the World Health Organization parameters and the altitude at which children with anemia live: the higher the geographical altitude, the greater the anemia in children. Supplementation programs should be included during home visits and at the time of evaluation of children's growth and development.
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Affiliation(s)
- Águeda Muñoz Del Carpio-Toia
- Vicerrectorado de Investigación, Escuela de Medicina Humana, Universidad Católica de Santa María, Arequipa, Perú. Dirección: Calle Garcilazo de la Vega 108 segundo piso Umacollo, Arequipa, Perú, Código postal: 04001. . ORCID: 0000-0003-0501-7314
| | | | - Sandrino Rojas-Pauca
- Dirección Regional de Salud de Arequipa, Arequipa, Perú. ORCID: 0000-0002-1682-857X
| | - Giancarlo Alvarez-Cervantes
- Vicerrectorado de Investigación, Universidad Católica de Santa María, Arequipa, Perú. ORCID: 0000-0003-0514-3556
| | - Julio César Bernabé-Ortiz
- Escuela de Postgrado, Universidad Católica de Santa María, Arequipa, Perú. ORCID: 0000-0003-0313-1033
| | - Ada Gallegos
- Facultad de Educación, Universidad Nacional Mayor de San Marcos, Lima, Perú. ORCID: 0000-0002-8264-711X
| | - Sively Mercado-Mamani
- Escuela de Postgrado, Universidad Nacional del Altiplano, Puno, Perú. ORCID: 0000-0002-8149-4641
| | - Alex Veliz-Burgos
- Departamento de Ciencias Sociales, Universidad de Los Lagos, Osorno, Chile. ORCID: 0000-0003-1371-9041
| | - Milena Toia-Larsen
- Escuela de postgrado, Universidad Católica de Santa María, Arequipa, Perú. ORCID: 0000-0002-4194-8223
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Ntenda PAM, Nkoka O, Bass P, Senghore T. Maternal anemia is a potential risk factor for anemia in children aged 6-59 months in Southern Africa: a multilevel analysis. BMC Public Health 2018; 18:650. [PMID: 29788935 PMCID: PMC5964691 DOI: 10.1186/s12889-018-5568-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/15/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The effect of maternal anemia on childhood hemoglobin status has received little attention. Thus, we examined the potential association between maternal anemia and childhood anemia (aged 6-59 months) from selected Southern Africa countries. METHODS A cross-sectional study using nationally representative samples of children aged 6-59 months from the 2010 Malawi, 2011 Mozambique, 2013 Namibia, and 2010-11 Zimbabwe demographic and health surveys (DHS) was conducted. Generalized linear mixed models (GLMMs) were constructed to test the associations between maternal anemia and childhood anemia, controlling for individual and community sociodemographic covariates. RESULTS The GLMMs showed that anemic mothers had increased odds of having an anemic child in all four countries; adjusted odds ratio (aOR = 1.69 and 95% confidence interval [CI]:1.37-2.13) in Malawi, (aOR = 1.71; 95% CI: 1.37-2.13) in Mozambique, (aOR = 1.55; 95% CI: 1.08-2.22) in Namibia, and (aOR = 1.52; 95% CI: 1.25-1.84) in Zimbabwe. Furthermore, the odds of having an anemic child was higher in communities with a low percentage of anemic mothers (aOR = 1.52; 95% CI: 1.19-1.94) in Mozambique. CONCLUSIONS Despite the long-standing efforts to combat childhood anemia, the burden of this condition is still rampant and remains a significant problem in Southern Africa. Thus, public health strategies aimed at reducing childhood anemia should focus more on addressing infections, and micronutrient deficiencies both at individual and community levels in Southern Africa.
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Affiliation(s)
- Peter A. M. Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
| | - Paul Bass
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
- School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
| | - Thomas Senghore
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
- School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
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Shet AS, Rao A, Jebaraj P, Mascarenhas M, Zwarenstein M, Galanti MR, Atkins S. Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study. BMC Public Health 2017; 17:720. [PMID: 28923041 PMCID: PMC5604152 DOI: 10.1186/s12889-017-4758-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Lay health workers (LHWs) are increasingly used to complement health services internationally. Their perceptions of the interventions they implement and their experiences in delivering community based interventions in India have been infrequently studied. We developed a novel LHW led intervention to improve anemia cure rates in rural community dwelling children attending village day care centers in South India. Since the intervention is delivered by the village day care center LHW, we sought to understand participating LHWs’ acceptance of and perspectives regarding the intervention, particularly in relation to factors affecting daily implementation. Methods We conducted a qualitative study alongside a cluster randomized controlled trial evaluating a complex community intervention for childhood anemia control in Karnataka, South India. Focus group discussions (FGDs) were conducted with trained LHWs assigned to deliver the educational intervention. These were complemented by non-participant observations of LHWs delivering the intervention. Transcripts of the FGDs were translated and analyzed using the framework analysis method. Results Several factors made the intervention acceptable to the LHWs and facilitated its implementation including pre-implementation training modules, intervention simplicity, and ability to incorporate the intervention into the routine work schedule. LHWs felt that the intervention impacted negatively on their preexisting workload. Fluctuating relationships with mothers weakened the LHWs position as providers of the intervention and hampered efficient implementation, despite the LHWs’ highly valued position in the community. Modifiable barriers to the successful implementation of this intervention were seen at two levels. At a broader contextual level, hindering factors included the LHW being overburdened, inadequately reimbursed, and receiving insufficient employer support. At the health system level, lack of streamlining of LHW duties, inability of LHWs to diagnose anemia and temporary shortfalls in the availability of iron supplements constituted potentially modifiable barriers. Conclusion This qualitative study identified some of the practical challenges as experienced by LHWs while delivering a community health intervention in India. Methodologically, it highlights the value of qualitative research in understanding implementation of complex community interventions. On the contextual level, the results indicate that efficient delivery of community interventions will require streamlining of LHW workloads and improved health system infrastructure support. Trial registration This trial was registered with ISRCTN.com (identifier: ISRCTN68413407) on 23 September 2013.
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Affiliation(s)
- Arun S Shet
- Hematology Research Division, St. Johns Research Institute, St. Johns National Academy of Health Sciences, Bangalore, 560034, India. .,Department of Hematology/Medical Oncology, St. Johns Medical College and Hospital, Bangalore, India. .,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Abha Rao
- Hematology Research Division, St. Johns Research Institute, St. Johns National Academy of Health Sciences, Bangalore, 560034, India
| | - Paul Jebaraj
- Hematology Research Division, St. Johns Research Institute, St. Johns National Academy of Health Sciences, Bangalore, 560034, India
| | | | - Merrick Zwarenstein
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Maria Rosaria Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Stockholm, Sweden
| | - Salla Atkins
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Abstract
Imerslund Grasbeck syndrome (IGS) is a rare autosomal recessive childhood disorder characterized by selective Vitamin (vit) B 12 malabsorption with asymptomatic proteinuria without any structural renal pathology. The patients stay healthy for decades with life-long parenteral vit B12. We report a case of young female who presented with pancytopenia and proteinuria, evaluated in local hospitals as chronic hemolytic anemia (autoimmune cause), finally diagnosed as IGS on complete evaluation. She was treated with injectable vit B12 (1000 μg cyanocobalalmin) and showed drastic recovery. IGS should be considered in patients with megaloblastic anemia not responding to oral vit B12 and associated proteinuria.
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Shibuya A, Kaneko L, Ishii S, Sasaki N. A Case of Childhood Anemia Complicated by a Red Cell Membrane Sugar Chain Anomaly with Low Levels of Sialic Acid. Hematology 2001; 6:279-86. [PMID: 27414848 DOI: 10.1080/10245332.2001.11746582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
An 8-year-old girl presented with the pallor and purpura. She was diagnosed to suffer from anemia of an unknown cause with leukocytopenia and thrombocytopenia. The patient's red cells showed marked agglutination with peanut lectin (PNA), and erythroblasts forming CFU-E in the bone marrow reacted positively to avidin labeled PNA on enzyme immunohistochemistry, suggesting an abnormality of sugar chain on red cell and also erythroblast membranes. Membrane O-glycan sugar chains of her red cells showed a low level of sialic acid on high performance liquid chromatography (HPLC). Her anemia failed to respond to the corticosteroids, γ-globulin, recombinant erythropoietin (rhEPO), and recombinant granulocyte colony stimulating factor (G-CSF), and frequent red cell transfusion was required. After 6 years, the patient underwent an unrelated bone marrow transplantation (U-BMT). From 2 weeks after transplantation, the PNA reactivity of her red cells decreased and then disappeared and the red cell membrane antigens changed to the donor type after 4 weeks. These results suggested that the sugar chain abnormality causing low levels of sialic acid in the red cell membrane was already present on erythroid progenitor cells in the bone marrow.
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Affiliation(s)
- A Shibuya
- a Department of Pediatrics , Saitama Medical School , 38 Morohongo, Iruma-gun, Saitama 350-0495 , Japan
| | - L Kaneko
- a Department of Pediatrics , Saitama Medical School , 38 Morohongo, Iruma-gun, Saitama 350-0495 , Japan
| | - S Ishii
- a Department of Pediatrics , Saitama Medical School , 38 Morohongo, Iruma-gun, Saitama 350-0495 , Japan
| | - N Sasaki
- a Department of Pediatrics , Saitama Medical School , 38 Morohongo, Iruma-gun, Saitama 350-0495 , Japan
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