Child Anemia in Cambodia: A Descriptive Analysis of Temporal and Geospatial Trends and Logistic Regression-Based Examination of Factors Associated with Anemia in Children (original) (raw)
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medRxiv (Cold Spring Harbor Laboratory), 2023
Anemia in children remains a public health concern in developing countries. In Cambodia, the prevalence of anemia among children decreased slightly from 55.2% in 2014 to 49% in 2019. We examined descriptively temporal and geospatial trends of anemia and used logistic regression to analyze potential associations between individual and household characteristics and anemia among children aged 6-59 months using data from the Cambodia Demographic and Health Survey (CDHS) for 2005, 2010, and 2014. Survey weights were applied to account for the complex survey design of the CDHS. We used logistic regression to assess factors associated with anemia among children aged 6-59 months. The prevalence of anemia among children decreased from 62.2% in 2005 to 56.6% in 2014. The proportion of the Cambodian child population with anemia was highest in Pursat (84.3%) for 2005, Kampong Thom (67%) for 2010, and Preah Vihear and Steung Treng (68.6%) for 2014, respectively. Factors independently associated with increased odds of having anemia included children with mothers who were anemic (adjusted odds ratio (AOR) =1.77, 95% CI: 1.58-1.97); children who were male (AOR=1.20, 95% CI: 1.07-1.33), underweight (AOR=1.24, 95% CI: 1.14-1.57), stunted (AOR=1.24, 95% CI: 1.09-1.41), or had a recent episode of fever (AOR=1.16, 95% CI: 1.03-1.31). Children had decreased odds of having anemia if they were aged 12-23 months (AOR=0.68; 95%
Nutrients, 2016
Background: Anemia is highly prevalent in Cambodian women and children, but data on causes of anemia are scarce. We performed a national micronutrient survey in children and women that was linked to the Cambodian Demographic Health Survey 2014 (CDHS-2014) to assess the prevalence of micronutrient deficiency, hemoglobin disorders and intestinal parasite infection. Methods: One-sixth of households from the CDHS-2014 were selected for a follow-up visit for the micronutrient survey. Households were visited from two weeks to two months after the CDHS-2014 visit. Data on micronutrient status were available for 1512 subjects (792 children and 720 women). Results: Anemia was found in 43% of the women and 53% of the children. Hemoglobin disorders affected >50% of the population, with Hemoglobin-E the most prevalent disorder. Deficiencies of iron (ferritin < 15 g/L), vitamin A (retinol-binding-protein (RBP) < 0.70 mol/L) or vitamin B12 (<150 pmol/L) were not prevalent in the women (<5% for all), whereas 17.8% of the women had low concentrations of folic acid (<10 nmol/L). In the children, the prevalence of iron, vitamin A, vitamin B12 or folic acid deficiency was <10%. Zinc deficiency, hookworm infection and hemoglobinopathy were significantly associated with anemia in children, whereas in the women none of the factors was significantly associated with anemia. Iron deficiency anemia (IDA) was more prevalent in children <2 years, but in older children and women, the prevalence of IDA was <5%. The most prevalent, preventable causes of anemia were hookworm infection and zinc and folic acid deficiency. Over 40% of the anemia was not caused by nutritional factors. Conclusion: The very high prevalence of anemia in Cambodian women and children cannot be explained solely by micronutrient deficiencies and hemoglobin disorders. Micronutrient interventions to improve anemia prevalence are likely to have limited impact in the Cambodian setting. The focus of current interventions to reduce the high prevalence of anemia in children and women should be broadened to include zinc and folic acid as well as effective anti-hookworm measures.
Prevalence and risk factors of childhood anemia in Nepal: A multilevel analysis
PLOS ONE, 2020
Introduction Anemia is a common problem in children particularly in developing countries and taking steps to tackle it is one of the major public health challenges for Nepal. The objective of this study is to investigate the prevalence of individual, household and community level determinants of childhood anemia in Nepal. Methods Data was taken from a nationally representative sample of 1,942 Nepalese children aged from 6-59 months. The Chi-square test was used to determine the bivariate relationship between the selected variables and childhood anemia and a multilevel logistic regression model with a random intercept at household and community level was used to identify important determinants of this kind of anemia. Results The results showed that 52.6% (95% CI: 49.8%-55.4%) of the children were anemic while 26.6% (95% CI: 24.0%-29.3%) of them were moderate to severe. The prevalence of overall anemia was higher among children aged less than 11 months as well as in underweight children, children of underweight, anemic and uneducated mothers and those in the terrain ecological regions. Multivariable analysis showed that children aged less than 11 months, who were underweight and had anemic mothers were more likely to have moderate or severe anemia. Children in the hilly ecological region were less likely to have it compared to mountain and terrain ecological regions. Children in middle-class families and children of mothers who completed secondary education were more likely to have anemia.
Factors influencing childhood anaemia in Bangladesh: a two level logistic regression analysis
BMC Pediatrics, 2019
Background: Anemia is not only a major public health problem among children in developing countries, it is also an important predictor for their future growth and development. The objective of this study was to identify possible factors associated with anemia among preschool children in Bangladesh after removing a cluster effect of the population, and to determine the prevalence of this condition. Methods: Data for this study was extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS-2011). In this survey, data was collected using a two-stage stratified cluster sampling approach. The chi-square test and a two-level logistic regression model were used for further analysis. Results: Data from 2231 children aged 6-59 months were included for analysis. The prevalence of child anemia was noted to be 52.10%. Among these anemic children, 48.40% where from urban environment and 53.90% were from rural areas. The prevalence of mild, moderate and severe anemia among children was 57.10, 41.40 and 1.50% respectively. The two-level logistic regression model revealed that the following factors were associated with childhood anemia: children of anemic mothers (p < 0.01), undernourished children (p < 0.05), younger children (age < 2 years) (p < 0.01) and children from poor family (p < 0.05). Lastly, anemia was more common among children living in Barisal and Rangpur divisions compared to those from Dhaka division (p < 0.01), and among non-Muslims than Muslim (p < 0.05). Conclusions: Our study showed that prevalence of anemia among preschool children in Bangladesh was very high (52.10%). We noted that young children of anemic mothers, from poor families, and being undernourished were at higher risk of developing anemia. Since most of these risk factors were related to socioeconomic conditions, they were potentially modifiable. Therefore, our findings may be useful for the health authorities to identify children at risk for remedial action and to plan for preventive measures.
The Risk Factors for Child Anemia Are Consistent across 3 National Surveys in Nepal
Current Developments in Nutrition, 2021
ABSTRACTBackgroundAnemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue.ObjectivesThis study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013 to 2016 in Nepal.MethodsSame-season national surveys were administered in 2013, 2014, and 2016 in 63 sites across 21 districts, selected using multistage random sampling, representing the mountains, hills, and Tarai (plains). Among consenting households with children aged 6–59 mo, a random sample of capillary blood was selected each year for anemia assessment using an Hb 201+ hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin <11.0 g/dL with adjustment for altitude, was estimated each year and disaggregated by region and child age. Prevalenc...
Epidemiology of anaemia in children, adolescent girls, and women in Bhutan
Maternal & Child Nutrition, 2018
Anaemia inhibits health and development in Bhutan. We estimated anaemia prevalence and explored risk factors in children and women using data from Bhutan's National Nutrition Survey 2015. Prevalence was calculated using life‐stage‐specific cut‐offs adjusted for altitude and survey design. Risk factors were evaluated in modified Poisson regressions. Anaemia affected 42%, 29%, 36%, and 28% of children, adolescent girls, and non‐pregnant and pregnant women, respectively. Risk of anaemia was greater in children who were younger (RR 2.0, 95% CI [1.7, 2.3] and RR 1.9, 95% CI [1.6, 2.3], respectively, for 12–23 and 6–11 vs. 24–59 months), male (1.2, 1.1–1.4, ref.: female), and stunted (1.2, 1.0–1.3, ref.: height‐for‐age ≥ −2z). Older (15–19 years) versus younger (10–14 years) adolescents were at higher risk (1.5, 1.2–1.8), as were adolescents living at home versus at school (1.2, 0.9–1.6) and those working versus studying (1.3, 1.0–1.7). Among adult women, anaemia risk increased with a...
Clinical Epidemiology and Global Health, 2020
Background: Anemia is an important risk factor for the health of children as it leads to delayed growth and has long term impacts on neurodevelopment and behavior which causes child morbidity and mortality. Though the rate of severe anemia is almost ignorable in Bangladesh, the overall prevalence of anemia is still very high. Thus this study designed to identify determinants of severity levels of anemia among children aged 6-59 months from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS). Method: A total of 2188 children aged 6-59 months with complete information on the selected predictors were finally identified from data of this cross sectional survey. Proportional odds model was applied to assess the impacts of determinant on severity level of anemia. Results: Among 2188 children sampled, 24.8%, 32.3% and 42.9% were severely or moderately anemic, mildly anemic, and non-anemic, respectively. Out of children who resided in urban areas, 27.1% were mildly anemic, and 21.1% were severely or moderately anemic. Stunting, division, wealth index, mother's anemia status, age of child, water facility and mother's body mass index were found to be statistically significant determinants of severity levels of childhood anemia. Test of parallelism showed that the odds ratios were constant across all cutoff points of childhood anemia status at 5% level. Conclusions: In summary, our analysis highlights concerning continuing public health challenge presented by anemia in Bangladesh. This study explores the factors associated with the severity level anemia.
Prevalence of Anemia and Its Risk Factors Among Children 6-36 Months Old in Burma
American Journal of Tropical Medicine and Hygiene, 2012
Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. In this study, children from 6 to 36 months were investigated to determine (1) the prevalence of anemia and (2) risk factors associated with anemia. Convenience sampling was used to select three villages in three different regions in Burma. Hemoglobin and anthropometric indicators were measured for 872 children. Logistic regression analyses were used to determine factors associated with anemia. The overall prevalence of anemia was 72.6%, with 40.0% having severe anemia. Predictors of anemia are a young age (P 0.001), mother with anemia (P 0.001), height-forage Z score −2 (P = 0.017), low family income (P 0.001), mothers without primary education (P = 0.007), drinking unboiled water (P = 0.029), and fever in the last 3 months (P = 0.001). There is a high prevalence of anemia in children, and their nutritional status is quite poor. To control anemia, humanitarians and governments should launch comprehensive interventions.
Maternal & Child Nutrition
There is inconsistent evidence on the efficacy of agriculture programmes at improving women and children's anaemia and nutritional status. The primary aim of this study was to evaluate the impact of a nutrition-sensitive enhanced homestead food production (EHFP) programme on anaemia in women (18-45 years) and children (6-59 months) in rural Cambodia. Secondary outcomes were women's micronutrient status and women and children's anthropometry. In this cluster-randomized controlled trial, 900 households from 90 villages (clusters) were randomized to either (a) home gardens and behaviour change communication (BCC) on nutrition, hygiene, women's empowerment, and marketing (EHFP); (b) home gardens plus fishponds and BCC (EHFP + F); or (c) control (no intervention). Haemoglobin concentration and anthropometry were measured in women and children at baseline and at 22 months. Venous blood samples were collected in a subset of women (n = 450) at baseline and at 22 months. Generalized linear mixed effect models with repeated measures were used to evaluate the difference across groups and the change from baseline to end of study. Ninety clusters, 552 women, and 754 children completed the trial. Compared with control, we found a statistically significant impact on anaemia prevalence in children (−14.0 percentage points; P = 0.02) and retinol binding protein concentrations in women (difference in difference: 0.34; P = 0.02) randomized to EHFP and EHFP + F groups, respectively. No other statistically significant effects on anaemia, nutritional biomarker concentrations, or anthropometry were observed. Future research is needed to examine longer term impacts of EHFP on anthropometry in women and children and into the nutritional causes of anaemia among children in Cambodia.