Age and altitude of residence determine anemia prevalence in Peruvian 6 to 35 months old children

Abstract

Background A Demographic and Family Health Survey (ENDES, for Encuesta Demográ fica y de Salud Familiar in Spanish) is carried out annually in Peru. Based on it, the anemia prevalence was 43.6% in 2016 and 43.8% in 2017 using the WHO cutoff value of 11 g/dL and the altitudecorrection equation. Objective To assess factors contributing to anemia and to determine its prevalence in Peruvian children 6 to 35 months old. Methods We used the MEASURE DHS-based ENDES survey to obtain representative data for11364 children from 6 to 35 months old on hemoglobin and health determinants. To evaluate normal hemoglobin levels, we used the original WHO criterion of the 5 th percentile in children without chronic malnutrition and then applied it to the overall population. Relationships between hemoglobin and altitude levels, usage of cleaning methods to sanitize water safe to drink, usage of solid fuels and poverty status were tested using methodology for complex survey data. Percentile curves were made for altitude intervals by plotting hemoglobin compared to age. The new anemia rates are presented in graphs by Peruvian political regions according to the degree of public health significance. Results Hemoglobin increased as age and altitude of residence increased. Using the 5 th percentile, anemia prevalence was 7.3% in 2016 and 2017. Children from low altitudes had higher anemia prevalence (8.5%) than those from high altitudes (1.2%, p<0.0001). In the rainforest area of Peru, anemia prevalence was highest (13.5%), while in the highlands it was lowest

Changes in hemoglobin levels with age and altitude in preschool‐aged children in Peru: the assessment of two individual‐based national databases

“…This age‐related pattern of an increase in Hb concentration, independent of altitude, was observed in a subsample of PSC with normal nutrition and higher SES. The data indicated that Hb concentration at any altitude is lower at 6–11, intermediate at 12–35, and higher at 36–59 months, which is consistent with the earlier reports 4,5,9,29,30 …”

“…The WHO recommendation to use an Hb value <11 g/dL for diagnosis of anemia in children aged 6–59 months does not account for these physiological changes. It has been suggested that the higher prevalence of apparent anemia in children aged 6–35 months is more because of the normal decrease in postpartum Hb, which may fall below the cutoff point of 11 g/dL, than to actual anemia 30 …”

“…An observational study that assessed Hb levels, iron status, and the suitability of altitude‐adjusted Hb values for defining IDA in PSC living at high altitudes in the Southern Andes of Peru showed that the prevalence of anemia was 66% after adjustment for altitude, whereas it was only 4.8% without such adjustment 12 . Several research groups have argued against the recommendation to correct Hb concentrations for altitude on the grounds of a seemingly disproportionate increase in the rate of anemia, particularly at altitudes over 3000 meters 8–12,19,30,46 …”

Trends and patterns of the double burden of malnutrition (DBM) in Peru: a pooled analysis of 129,159 mother–child dyads

“…Since nearly half of Peru’s children under 5 are anaemic there is scope to include it in future work if we are looking for a holistic measure of the double burden. 40 …”

“…Finally, we note that other problematic aspects of nutritional status, such as anaemia, persist, and are not reflected in our analysis. Since nearly half of Peru's children under 5 are anaemic there is scope to include it in future work if we are looking for a holistic measure of the double burden [40].…”