Determinants of Iron Deficiency Anemia in a Cohort of Children Aged 6-71 Months Living in the Northeast of Minas Gerais, Brazil

Abstract

Iron deficiency anemia is one of the most common nutritional disorders worldwide. The aim was to identify the prevalence and incidence of anemia in children and to identify predictors of this condition, including intestinal parasites, social, nutritional and environmental factors, and comorbidities. A population-based cohort study was conducted in a sample of 414 children aged 6–71 months living in Novo Cruzeiro in the Minas Gerais State. Data were collected in 2008 and 2009 by interview and included socio-economic and demographic information about the children and their families. Blood samples were collected for testing of hemoglobin, ferritin and C-reactive protein. Anthropometric measurements and parasitological analyses of fecal samples were performed. To identify risk factors associated with anemia multivariate analyses were performed using the generalized estimating equations (GEE). In 2008 and 2009, respectively, the prevalence rates of anemia were 35.9% (95%CI 31.2–40.8) and 9.8% (95%CI 7.2–12.9), the prevalence rates of iron deficiency were 18.4% (95%CI 14.7–22.6) and 21.8% (95%CI 17.8–26.2), and the incidence rates of anemia and iron deficiency were 3.2% and 21.8%. The following risk factors associated with anemia were: iron deficiency (OR = 3.2; 95%CI 2.0-.5.3), parasitic infections (OR = 1.9; 95%CI 1.2–2.8), being of risk of or being a low length/height-for-age (OR = 2.1; 95%CI 1.4–3.2), and lower retinol intake (OR = 1.7; 95%CI 1.1–2.7), adjusted over time. Nutritional factors, parasitic infections and chronic malnutrition were identified as risk factors for anemia. These factors can be verified in a chronic process and have been classically described as risk factors for these conditions.

Factors associated with anemia in young children in Brazil

“…Although only less than 5% of children presented stunting (defined as HAZ < -2), stunted children had a 2.4 times higher risk for anemia compared with those who were not stunted. This finding is in accordance with other studies published in the literature [ 9 , 13 , 25 ]. According to Woldie et al [ 13 ], this association can be explained by noting three aspects: 1) undernourished children are often anemic, 2) low hemoglobin concentration can compromise linear growth, and 3) the coexistence of other micronutrient deficiencies and stunting may increase the development of anemia by a synergistic association.…”

“…Nevertheless, it is important to highlight that, although the frequency found in the present study was lower than the prevalence found in previously published studies [ 25 ], it is still high and of concern because of the severe consequences of anemia in young children [ 19 ].…”

“…Infections caused by helminthes can cause anemia due to chronic intestinal blood loss and by reducing appetite and nutrition uptake in the intestine [ 34 ], and schistosomiasis can cause anemia via four possible mechanisms that includes iron loss in the feces, splenomegaly leading to sequestration and destruction of erythrocytes, autoimmune hemolysis and inflammation [ 35 ]. It’s important to highlight that anti helmintics treatment are available in all primary health care facilities in Brazil [ 25 ].…”

Anaemia among children in a drought affected community in south-central Ethiopia

“…The poor the families are the less likely to afford adequate and diversified foods, and they are also less likely to seek early treatment for anaemia [42]. The observed increased risk of anaemia among children with stunting was consistent with previous research findings [12, 21]. This can be related to deficiency of protein energy that could result in impaired immune function with repeated infection that depletes iron stores [43].…”

Child Health in the Peruvian Amazon: Prevalence and Factors Associated with Referred Morbidity and Health Care Access in the City of Iñapari

“…Zanin et al [ 19 ] found a prevalence rate of anemia of 35.9% in Brazilian children from Minas Gerais, which was associated with iron deficiency, parasitic infections, being at risk of or being a low length/height-for-age, and lower retinol intake. All of these are well-known risk factors for anemia in children.…”