Anemia Among Children Under 5 Years in India: A District-Level Spatial Analysis Using NFHS-5 Data

The 2015/2016 National Family Health Survey (NFHS-4) revealed that the prevalence of anemia among children under 5 years is 58% in India. Lack of nutritional supplementation and lack of health care facilities are found to be important influential factors of anemia among children. We aimed to examine district-level spatial heterogeneity and clustering of associated factors with childhood anemia in India. Geographically weighted regression was applied on the NFHS-5 data for 335 districts. Factors such as prevalence of nutritional supplementation in children and mothers, birth order, antenatal care, diarrhea in children, and stunting were found to be significantly associated. Spatial scan statistics technique identified 3 significant local spatial clusters of anemia. This study provides findings based on the latest available data which can further assist in the design and execution of tailor-made policies.

An Analysis of Maternal, Social and Household Factors Associated with Childhood Anemia

Anemia is highly prevalent in all strata of populations in India, with established evidence of intergenerational anemia. The state of Madhya Pradesh was selected to study childhood anemia as the population is mostly rural, with many tribal districts, and has the highest infant mortality rate in India. This study aims to understand the maternal, social and household factors that affect anemia among children aged 6 months to 5 years by analyzing the the National Family Health Survey (NFHS) conducted in 2015-2016. Children aged 6-59 months with estimated hemoglobin levels were included in this study. Bivariate and multivariable analyses were conducted to understand associations between childhood anemia and various socioeconomic factors. Two models to understand the presence of anemia and the levels of anemia were computed. Higher likelihood of having severe childhood anemia was observed among children of younger mothers (15- to 19-year-old mothers (adjusted odds ratio (aOR) 2.08, 95% confidence interval (CI): 1.06, 4.06, less educated (uneducated mothers aOR 2.25, 95% CI 1.13, 4.48) and belonged to a scheduled tribe (aOR 1.88, 95% CI 1.07, 3.29). Strong associations between anemia in mothers and their children suggest intergenerational anemia which has long-term effects. Malnourished children (severe stunting aOR 3.19, 95% CI 2.36, 4.31) and children born with very low birth weight (aOR 4.28, 95% CI 2.67, 6.87) were more likely to have anemia. These findings strongly suggest more proactive interventions including prenatal healthcare for women and monitoring of the nutrition children at the community level to combat childhood anemia. Evaluations of existing programs should be conducted to understand the gaps in reducing anemia and malnutrition in children.

Interventions for Addressing Anemia Among Children and Adolescents: An Overview of Systematic Reviews

Context: Anemia is a public health problem that can lead to growth, cognitive, and motor impairments. Objective: To collate evidence on interventions for addressing childhood and adolescent anemia. Methods: In this overview of systematic reviews, we included Cochrane as well as non-Cochrane systematic reviews (SRs) irrespective of language and publication status. Two sets of review authors independently screened articles for eligibility and extracted data from relevant SRs. We present data in a tabular format and summarize results based on outcome reported, age of participants, and type of interventions. We also adopt a "measurement for change" approach to assess the utility of measurement for development of interventions in childhood and adolescent anemia. Results: Our search yielded 2,601 records of which 31 SRs were found eligible for inclusion. Results were favorable for fortification and supplementation with clear reduction in the risk of anemia and increase in hemoglobin levels across all age groups. Other interventions reported by the SRs were inconclusive and suggest further research. Conclusions: Current evidence suggests that fortification or supplementation with iron and micronutrients leads to better reduction in the risk of anemia and improvements in hemoglobin levels among children and adolescents. Results of this overview can help decision makers in informing selection of interventions to address childhood and adolescent anemia. Review Registration: PROSPERO CRD42016053687.

Association of Socioeconomic Status With Childhood Anemia Among Infant, Toddler, and Preschool Children in Bangladesh

OBJECTIVES

This study aims to delineate the association between economic inequality, along with other confounders, and anemia among infants, toddlers, and preschool children.

METHODS

From the 2011 Bangladesh Demographic Health Survey, a cross-sectional population sample comprising 2068 children between ages 6 and 59 months were selected for this study. Analyses were performed with a proportional odds model and finally stratified with the child age groups.

RESULTS

Infants belonging to a low and medium socioeconomic status (SES) have approximately a 3-fold higher chance of being affected by mild, moderate, or severe anemia compared with infants of high SES (odds ratio [OR] 2.94; 95% CI 1.09-7.91; P=.03 and OR 2.76; 95% CI .87-8.82; P=.08, respectively). Preschool children from low and medium SES households are 2.73× (95% CI 1.20-6.18; P=.02) and 2.47× (95% CI .99-6.14; P=.04) more likely to be anemic compared with their counterparts from higher SES households. The place of residence and childhood stunting are associated with childhood anemia (urban vs rural: OR 1.27; 95% CI .21-.35; P = .04; and stunted vs normal: OR 1.34; 95% CI 1.11-1.63; P = .003). Besides, vitamin A supplementations appear to serve as protective agents against the occurrence of the childhood anemia (OR 1.18; 95% CI .99-1.41; P = .06).

CONCLUSION

Urgent preventive measures are needed to control the impending childhood anemia among infants and preschool children, especially in the low and medium SES households (ClinicalTrials.gov Identifier: NCT03126253).

Risk Factors of Childhood and Maternal Anemia in India

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. We analyzed a sample of 112,714 mothers aged 15 to 49 years and their children younger than 5 years from the 2005–2006 Indian National Fertility and Health Survey with available data on anemia to determine the anemia statuses and risk factors associated with maternal and childhood anemia. Logistic regression analyses were used to determine factors associated with anemia. The overall prevalence of maternal anemia was 52.0%, while the overall prevalence of childhood anemia was 66.7%. Predictors of maternal anemia are a young age ( p < .001), maternal health practices ( p < .001), and reproductive health-related infections ( p < .001), among others. On the other hand, predictors of childhood anemia included iron deficiency ( p = .007), vitamin deficiency ( p = .003), and common infections ( p = .008). Other predictors of childhood anemia included poor dietary intake ( p < .01) and childcare practices ( p < .001). Childcare practice has the strongest association with childhood anemia with an odds ratio of 1.67 (95% confidence interval [1.55, 1.79]). With respect to maternal anemia, the strongest risk factor was being infected with reproductive health infections with an odds ratio of 1.157 (95% confidence interval [1.11, 1.21]). Interventions designed to address prevalence of childhood and maternal anemia in India should take the risk factors in a holistic manner. A multifactorial framework should guide such interventions.

Joint spatial mapping of childhood anemia and malnutrition in sub-Saharan Africa: a cross-sectional study of small-scale geographical disparities

BACKGROUND

In epidemiological studies, several diseases share common risk factors or co-exist in their spatial prevalence. Disease mapping allows the health practitioners and epidemiologists to hypothesize the disease aetiology and gain better understanding of the geographical prevalence of the disease risks.

OBJECTIVE

This paper investigates the differences in small scale geographical variations and the underlying risk factors of child's health outcomes (anemia, stunting and wasting) in Sub-Saharan Africa using spatial epidemiology.

METHOD

The study first carried out an independent univariate analysis on each malnutrition indicator to identify underlying risk factors. A multivariate conditional autoregressive prior was explored to jointly model the spatial correlation between the undernutrition indicators and the small area-geographical disparities at sub-national levels in two sub-Saharan African countries.

RESULTS

The approach was implemented on data from National cross-sectional household- based demographic and health surveys conducted in 17,307 under-five children in Burkina Faso and Mozambique in 2010-012. Out of these children, 31.8% are found to be stunted, 15.5% wasted and 30.9% had anemia among Burkina Faso children, while 42.5% of Mozambican children were stunted, 5.9% wasted and 30.9% suffered from iron-deficiency anemia. The multivariate analysis revealed that the spatial prevalence existed across regions in Burkina Faso with geographical variations in stunting estimated as: 0.7549, CI (0.4693, 1.264); wasting 0.9197; (95%CI: 0.535, 1.591)and anemia: 0.734; (0.4606, 1.214). In additin, the spatial correlation between stunting and wasting was negatively correlated: -0.998; 95% CI (-1.000, -0.984), and a perfect negative correlation;(-1) between stunting and anemia, and positive for wasting and anemia: 0.997; (0.978, 1.000). The spatial occurrence across provinces in Mozambique indicated that there was strong positive correlation between stunting and wasting; 0.986; (0.899, 1.000) and a significant negative correlation between stunting and anemia: -0.720, (-0.934, -0.308) and wasting and anemia: -0.640; (-0.903 -0.174) with individual geographical variability in child stunting: 1427, (913.6, 2268); wasting:1751, (1117, 2803) and anemia: 556, (279.5, 978.9). These extra random effect parameters computed in our multivariate approach would outperform a univariate analysis in similar studies. Our model further detected high prevalent of malnutrition and anemia in the northern Burkina Faso, but high anemia prevalent found in central Mozambique, and high stunting and wasting identified Southern Mozambique. In addition, the risk factors of malnutrition and iron deficiency anemia included household poverty, morbidity, short birth interval (less 18 months), breast feeding, antenatal attendance and maternal literacy.

CONCLUSION

The statistical relevance of the identified risk factors in this study is useful to target specific individual interventions and the maps of the geographical inequalities in sub-national region can be used for designing nutrition interventions and allocation of scarce health resources.

Oxidative stress, hepcidin and nesfatin-I status in childhood iron and vitamin B12 deficiency anemias

BACKGROUND

Anemia is a disease that is long and often repetitive and can result in a great burden to the national economy. The most frequent nutritional deficiency anemias in children are related with iron and vitamin B12 deficiencies.

OBJECTIVES

The aim of this study was to determine the oxidative stress, hepcidin, and nesfatin-I levels in childhood iron and vitamin B12 deficiency anemias.

MATERIAL AND METHODS

The study had 3 groups of 15 children, iron anemia deficiency group, vitamin B12 deficiency group and a control group.

RESULTS

The TBARS and nesfatin-I levels were significantly higher in the iron and vitamin B12 deficiency groups and the total antioxidant levels were significantly lower when compared to the control group. In contrast, the plasma hepcidin levels were significantly lower in the iron deficiency group (p < 0.01) when compared to the control group; however, no significant differences were observed in the vitamin B12 deficiency group. Plasma homocysteine levels were significantly higher in the vitamin B12 deficiency group when compared to the control group (p < 0.001), but no differences were determined between the iron deficiency and control groups.

CONCLUSIONS

Our results showed that there are high levels of oxidative stress in childhood iron and vitamin B12 deficiency anemias, and we propose that plasma hepcidin and homocycteine levels may be useful in the differential diagnosis of childhood nutritional deficiency anemias. Nesfatin-1 hormone levels were identified for the first time in childhood iron deficiency and vitamin B12 deficiency anemias within this study and this hormone may also be useful in the differential diagnosis of anemias.

Vitamin D deficiency and anemia risk in children: a review of emerging evidence

There has been renewed scientific interest in the sequelae of vitamin D deficiency, given the emerging evidence on the diverse biologic functions of vitamin D, besides its fundamental role in bone and mineral metabolism. For the past decade, the evidence in the medical literature pointing to a relationship between anemia risk and vitamin D deficiency has been accumulating. This paper critically reviews the current evidence linking vitamin D deficiency to anemia risk in children. The synthesized evidence indicates that the studies, which were preponderantly conducted among the adult population, not only reported a bidirectional relationship between vitamin D deficiency and anemia but also showed a racial effect. In studies conducted among children, similar results were reported. Although the causal association of vitamin D deficiency with anemia risk (especially iron-deficiency anemia) remains debatable, the noncalcemic actions of the vitamin and its analogs hold prospects for several novel clinical applications. There is, however, unanimity in many reports suggesting that vitamin D deficiency is directly associated with anemia of chronic disease or inflammation. Despite the advances in unraveling the role of vitamin D in iron homeostasis, further research is still required to validate causality in the relationship between vitamin D deficiency and anemia, as well as to determine its optimal dosing, the ideal recipients for therapeutic intervention, and the preferred analogs to administer.