Association between anemia and household water source or sanitation in preschool children: the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project

Abstract

Background The associations between anemia and household water source and sanitation remain unclear. Objectives We aimed to assess the associations between anemia and household water source or sanitation in preschool children (PSC; age 6–59 mo) using population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project. Methods We analyzed national and subnational data from 21 surveys, representing 19 countries (n = 35,963). Observations with hemoglobin (Hb) and ≥1 variable reflecting household water source or sanitation were included. Anemia was defined as an altitude-adjusted Hb concentration <110 g/L. Household water source and sanitation variables were dichotomized as “improved” or “unimproved.” Poisson regressions with robust variance estimates were conducted for each survey, adjusting for child sex, age, household socioeconomic status, maternal education, and type of residence. Results Access to an improved water source and improved sanitation ranged from 29.9% (Burkina Faso) to 98.4% (Bangladesh, 2012), and from 0.2% (Kenya, 2007) to 97.4% (Philippines), respectively. Prevalence of anemia ranged from 20.1% (Nicaragua) to 83.5% (Bangladesh, 2010). Seven surveys showed negative associations between anemia and improved sanitation. Three surveys showed association between anemia and improved water, with mixed directions. Meta-analyses suggested a protective association between improved household sanitation and anemia [adjusted prevalence ratio (aPR) = 0.88; 95% CI: 0.79, 0.98], and no association between improved household water and anemia (aPR = 1.00; 95% CI: 0.91, 1.10). There was heterogeneity across surveys for sanitation (P < 0.01; I2 = 66.3%) and water (P < 0.01; I2 = 55.8%). Conclusions Although improved household sanitation was associated with reduced anemia prevalence in PSC in some surveys, this association was not consistent. Access to an improved water source in general had no association with anemia across surveys. Additional research could help clarify the heterogeneity between these conditions across countries to inform anemia reduction programs.

Associations of bacterial enteropathogens with systemic inflammation, iron deficiency, and anemia in preschool-age children in southern Ghana

“…Our findings suggest that subclinical presence of specific invasive enteropathogenic bacteria, particularly EAEC and EIEC/Shigella, may contribute to anemia in young children. Prior literature has found that poor water and sanitation are associated with anemia among young children living in LMICs [48,49], with the hypothesis that exposure to enteropathogens underlies this relationship [14]. By demonstrating an association between certain enteropathogens and anemia, our results lend direct evidence to support this hypothesis.…”

“…However, EIEC/Shigella was associated with both iron deficiency and anemia, and children positive for EIEC/Shigella exhibited 5 g/L lower Hb concentrations on average than children without EIEC/Shigella. Several recent studies have linked indicators of enteropathogen exposure, such as poor water and sanitation conditions [48,49] and biomarkers of EED [28,29,31], to lower hemoglobin concentrations and anemia in young children, prompting the hypothesis that enteropathogen infections are directly linked to anemia [14]. Analysis of the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) multi-site birth cohort study indeed demonstrated that the mean number of different parasitic, viral, and bacterial enteropathogens detected in both diarrheal and nondiarrheal stools across children's first 24 months of life was associated with lower hemoglobin concentrations [23].…”

Household Water Access, Dietary Diversity and Nutritional Status among Preschoolers in Poor, Rural Areas of Central and Western China

“…For example, a multi-country study found an association between improved water access and lower risk of stunting [ 17 ]; however, a study conducted in Nepal failed to identify this association [ 18 ]. The association between water access and anemia was not established in multi-country pooled samples, however, it was significant in certain countries (e.g., Laos and Burundi) [ 19 , 20 ]. Furthermore, the extent to which other interventions can mitigate environmental risks is unclear.…”

Abordaje comunitario para la identificación de casos de anemia en gestantes, niños y niñas en tres comunidades del Perú

“…En el estudio se puede denotar un variable explicativa importante como la disposición y acceso al agua en los niños tamizados. Diversas investigaciones (13)(14)(15) demuestran la relación directa entre la fuente de agua, saneamiento y anemia. Siendo el acceso al agua mejorada un factor protector para el desarrollo infantil óptimo.…”