Prevalence and risk factors of anemia in children

Zuffo, Cristie Regine Klotz; Osório, Mônica Maria; Taconeli, Cesar Augusto; Schmidt, Suely Teresinha; Silva, Bruno Henrique Corrêa da; Almeida, Cláudia Choma Bettega

doi:10.1016/j.jped.2015.09.007

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Original articles • J. Pediatr. (Rio J.) 92 (4) • Jul-Aug 2016 • https://doi.org/10.1016/j.jped.2015.09.007 copy

Prevalence and risk factors of anemia in children^☆ ☆ Please cite this article as: Zuffo CR, Osório MM, Taconeli CA, Schmidt ST, da Silva BH, Almeida CC. Prevalence and risk factors of anemia in children. J Pediatr (Rio J). 2016;92:353–60. ,^☆☆ ☆☆ The article is part of the first author's Master's Degree dissertation in Postgraduate Program in Food and Nutrition Security, Department of Health Sciences, Universidade Federal do Paraná, Curitiba, PR, Brazil.

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Abstract

Objective:

To identify the prevalence and factors associated with anemia in children attending Municipal Early Childhood Education Day Care Center (Centros Municipais de Educação Infantil [CMEI]) nurseries in Colombo-PR.

Methods:

Analytical, cross-sectional study with a representative sample of 334 children obtained by stratified cluster sampling, with random selection of 26 nurseries. Data collection was conducted through interviews with parents, assessment of iron intake by direct food weighing, and hemoglobin measurement using the finger-stick test. Bivariate association tests were performed followed by multiple logistic regression adjustment.

Results:

The prevalence of anemia was 34.7%. Factors associated with anemia were: maternal age younger than 28 years old (p = 0.03), male children (p = 0.02), children younger than 24 months (p = 0.01), and children who did not consume iron food sources (meat + beans + dark green leafy vegetables) (p = 0.02). There was no association between anemia and iron food intake in CMEI. However, iron intake was well below the recommended levels according to the National Education Development Fund resolution, higher prevalence of anemia was observed in children whose intake of iron, heme iron, and nonheme iron was below the median.

Conclusions:

In terms of public health, the prevalence of anemia is characterized as a moderate problem in the studied population and demonstrates the need for coordination of interdisciplinary actions for its reduction in CMEI nurseries.

Keywords
Anemia; Risk factors; Infant nutrition; Iron

Variables	Mean (Standard deviation)	Median	Minimum–Maximum	% anemia (<median)	% anemia (≥median)
Total iron (mg)	3.10 (1.46)	3.01	0.12–8.81	39.9	31.1
Heme iron (mg)	0.13 (0.12)	0.09	0.00–0.68	38.9	32.9
Nonheme iron (mg)	2.97 (1.40)	2.89	0.09–8.71	39.8	31.1
Total iron density (mg/1000 kcal)	5.64 (1.85)	5.41	0.70–15.89	35.7	35.7
Heme iron density (mg/1000 kcal)	0.25 (0.20)	0.18	0.00–1.27	39.1	32.5
Nonheme iron density (mg/1000 kcal)	5.40 (1.78)	5.17	0.61–15.89	35.1	36.4

VARIABLES	n^a a Rate of non-response: 0.9–15.7%.	Prevalence of anemia	Chi-squared	Crude OR	p
		n (%)		(95% CI)
Gender
Male	168	70 (41.7%)	7.17	1.86 (1.17–2.94)	0.00
Female	166	46 (27.7%)

Child's age
<24 months	198	79 (39.9%)	6.46	1.88 (1.15–3.09)	0.01
≥24 months	123	32 (26.0%)

Maternal age
<28 years	156	65 (41.7)	6.42	1.80 (1.14–2.84)	0.01
≥28 years	176	50 (28.4)

Short stature for age
Yes	16	8 (50.0)	1.77	1.96 (0.71–5.37)	0.18
No	305	103 (33.8)

Fever in the last 15 days
Yes	157	64 (40.8%)	4.60	1.64 (1.04–2.58)	0.03
No	176	52 (29.5%)

Previous history of anemia
Yes	229	25 (44.6%)	4.01	1.83 (1.01–3.33)	0.04
No	56	70 (30.6%)

Diarrhea in the last 15 days
Yes	73	31 (42.5)	2.46	1.52 (0.89–2.60)	0.11
No	261	85 (32.6)

Duration of maternal breastfeeding (days)
≤180 days	156	44 (28.2)	4.06	0.70 (0.36–1.36)	0.13
>180 to ≤360 days	62	26 (41.9)		1.29 (0.60–2.74)
>360 days	53	19 (35.8)		1

Consumption of meat
Yes	292	95 (32.4%)	6.06	4.83 (1.22–19.12)	0.03
No	10	7 (70.0%)

Consumption of dark-green leafy vegetables
Yes	229	70 (30.7)	3.74	0.58(0.34–1.01)	0.05
No	72	31 (43.1)		1

Consumption of foods that are sources of iron (meat + beans + dark-green leafy vegetables)
Yes	223	68 (30.5%)	3.61	1	0.05
No	78	33 (42.3%)		1.67 (0.98–2.84)

Consumption of bovine liver
Yes	163	48 (29.6)	2.57	1.48 (0.91–2.39)	0.10
No	138	53 (38.4)		1

Total iron intake at CMEI
<3.10 mg	163	65 (39.9)	2.61	1.46 (0.92–2.33)	0.10
≥3.10 mg	151	47 (31.1)

Nonheme iron intake at CMEI
<2.97 mg	166	66 (39.8)	2.56	1.46 (0.91–2.33)	0.10
≥2.97 mg	148	46 (31.1)

Variables	Crude OR (CI)	p	Adjusted OR (CI)	p
Child's gender
Male	1.86 (1.17–2.94)	0.00	1.82 (1.08–3.06)	0.02
Female	1		1

Child's age
<24 months	1.88 (1.15–3.09)	0.01	2.12 (1.19–3.75)	0.01
>24 months	1		1

Maternal age
<28 years	1.80 (1.14–2.84)	0.01	1.72 (1.03–2.87)	0.03
>28 years	1		1

Consumption of foods that are sources of iron (meat + beans + dark-green leafy vegetables)
Yes	1	0.05	1	0.02
No	1.67 (0.98–2.84)		1.91 (1.06–3.44)

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[1] * Corresponding author. E-mail:clauchoma@gmail.com (C.C.B. Almeida).