Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011–2012

Abstract

BackgroundIron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey.MethodsSecondary analysis was performed on the National Nutrition Survey in Pakistan 2011–2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of <110 g/L and ferritin levels of < 12 μg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS.FindingsA total of 7138 children aged between 6–59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age < 24 months (AOR 1.40, 95% CI 1.18–1.55 p <0.05), stunting (AOR 1.42 CI 1.23–1.63 p<0.05), presence of clinical anemia (AOR 5.69 CI 4.93–6.56 p<0.05), having a mother with IDA (AOR 1.72 CI 1.47–2.01 p<0.05) and household food insecurity (AOR 1.20 CI 1.10–1.40 P<0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65–0.90 p<0.05) and being a female child (AOR 0.87 CI 0.76–0.98 p<0.05) were associated with reduced odds of IDA.ConclusionThe prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification.

Frequency of Anemia and Iron Deficiency among Children Starting First Year of School Life and Their Association with Weight and Height

“…A study by Killip et al showed that, in Pakistan among children from 6 months to five years of age, 62.3% were anemic (hemoglobin levels <110 g/L), while 33.2% had iron deficiency anemia (defined as having both hemoglobin levels <110 g/L and ferritin levels <12  μ g/L). Ferritin deficiency (ferritin levels <12  μ g/L) was present in 47.1% cases, and 13.9% had ferritin deficiency without anemia [10, 11]. …”

“…A meta-analysis, conducted among children from 6 months to 59 months of age, showed that anemia was associated with both underweight and stunting in majority of the studies [19]. Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011-2012 conducted by Killip et al which showed that stunting was associated with iron deficiency anemia among the children from 6 months to 5 years of age [10, 11]. Regression model of our study showed that ferritin level was not predictable by status of height and weight, gender, age, and presence of anemia.…”

“…Serum ferritin is the preferred initial diagnostic test for iron deficiency. It depicts the status of iron stores in body [10, 11]. The first year of school life is important because it is the start of academic career.…”

Ferritin Is a Marker of Inflammation rather than Iron Deficiency in Overweight and Obese People

“…Obesity is an emerging health related concern in Pakistan and so are ID and IDA [18–20]. It is also worth mentioning that serum ferritin assay is the most commonly used blood test to diagnose ID or IDA, not only in Pakistan, but in other developing countries of the world also.…”

Correlation between maternal and childhood VitB12, folic acid and ferritin levels

“…The youngest are the worst affected as a study shows that iron deficiency is most prevalent in areas of poor access where mothers are also deficient 4. It is imperative to address anemia in mothers to prevent its occurrence in children.…”