Key Predictors of Anemia in Under Five Children in Rural Setting of Bangladesh: A Cross Sectional Study

Md. Moniruzzaman Mollah^{1, 2,} , Ashik Mosaddik³, Asgor Hossain⁴, Sultana Naznin⁵, Andrew Asim Roy⁶, Md. ShukurAli⁷, Parvez Hassan² and Md. Ashraful Islam⁸

¹Department of Paediatrics, Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh and PhD Fellow, IBSc, RU

²Institute of Biological Sciences (IBSc), Rajshahi University, Rajshahi, Bangladesh

³Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh

⁴Department of Paediatrics, Rajshahi Medical College, Rajshahi, Bangladesh

⁵Department of Gynae and Obstetrics, IBMCH, Rajshahi, Bangladesh

⁶Department of Medicine and Biomedical Sciences, Maastricht University, the Netherlands

⁷Department of English, University of Development Alternative (UODA), Dhaka, Bangladesh

⁸College of Clinical Pharmacy, Imam Abdurrahman Bin Faisal University, Saudia Arabia

Cite this paper:
Md. Moniruzzaman Mollah, Ashik Mosaddik, Asgor Hossain, Sultana Naznin, Andrew Asim Roy, Md. ShukurAli, Parvez Hassan and Md. Ashraful Islam. Key Predictors of Anemia in Under Five Children in Rural Setting of Bangladesh: A Cross Sectional Study. American Journal of Medical and Biological Research. 2021; 9(1):10-15. doi: 10.12691/ajmbr-9-1-3

Abstract

Introduction: Anemia is a substantial public health problem that happens worldwide with higher prevalence noted in children less than 5 years and rural children. The studywas aimed to explore the keypredictors of anemia of study population in rural setting of Bangladesh. Methodology & Materials: This cross-sectional study was conducted in the rural Bangladesh from 1 July 2018 to December 2019. Under-five children aged six months to below sixty months were enrolled in the study. Data were collected through face-to-face interview from attending primary caregiver and from the results of laboratory tests of blood sample from target children. Data were analyzed through SPSS 23 software. Initially univariate analysis was done to identify predictors of anaemia followed by multivariate analysis to explore the key predictors through logistic regression. Results: A total data of258 under-five children aged 6-59 month were included in this study from the rural areas of Bangladesh. Among the studied children overall prevalence of anaemia was found 61.8%. The significant predictors (p <0.05) of anaemia through univariate analysis are age, maternal education level, monthly family income, exclusive breast feeding, proper complementary feeding practice as well as regular consumption of animal protein, fruits and vegetables. In addition, children who were under-weight stunted and wasted. Through multivariate analysis the key factors were explored as age group 6-24 month (AOR=0.02; p=0.006), family income less than 10000 BDT group-i.e 5000BDT or below (AOR=0.27;p=0.01) and 5001- 10000 BDT (AOR=8.84; 0.02), early and late weaning practiced children (AOR=0.23;p=0.002), low consumption of animal protein (AOR=0.05; p=0.001), and vegetables (AOR=0.18; p<0.001), stunting (AOR=0.18;p<0.001), wasting (AOR=0.14; p=0.03) and children who have chronic or recent infection (AOR=0.33; p=0.008). Conclusion: The keypredictors of anaemia are explored in this study are age below 2 year, family income less than 10000 BDT (in 2018 AD) or below, early and late weaning practice, low consumption of animal protein and vegetables, chronic malnutrition, acute malnutrition and chronic or recent infection. Rising mass awareness among the caregiver group on child care, nutrition and special focus to the children below age of two years will be the key strategies to prevent and control this extensive public health problem in Bangladesh.

Keywords:
anemia rural area Childhood Aanaemia Anaemia Predictors under-five children. (stunting wasting and infestation) under- nutrition

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References:

[1]	Khan JR, Awan N, Misu F. Determinants of anemiaamong 6-59 months aged children in Bangladesh: Evidence from nationally representative data. BMC Pediatrics. (2016); 16; 3.
[2]	UNICEF, U. Iron deficiency anaemia: Assessment, prevention and control: a guide for programme managers. Geneva; 2001.
[3]	De Benoist B, M. E. Worldwide prevalence of anaemia 1993-2005: WHO Global Database on Anaemia. Geneva: World Health Organization, 2008.
[4]	Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019; 1450 (1): 15-31.
[5]	Pasricha SR, BlackJ, Muthayya S, Shet A, Bhat V, Nagaraj S, Shet AS. Determinants of anemia among young childrenin rural India. Pediatrics. 2010; 126(1); e140-e149.
[6]	Haas JA. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. The Journal of nutrition. 2001; 131(2): 676S-690S.
[7]	Villalpando S, Shamah-Levy T, Ramírez-Silva CI, Mejía- Rodríguez F, Rivera JA. Prevalence of anemia in children 1 to 12 years of age. Results from a nationwide probabilistic survey in Mexico. Salud publica de Mexico. 45;4(4): S490-8.
[8]	A. Shet, S. Mehta, N. Rajagopalan et al., “Nemia and growth failure among HIV-infected children in India: a retrospective analysis,” BMC Pediatrics. vol. 9, article 37, 2009.
[9]	NIPORT, Mitra and Associates, ICF International. Bangladesh Demographic and Health Survey, 2011 & NIPORT, Mitra & Associates and ICF International, Dhaka, Bangladesh and Calverton, MD, USA2013.
[10]	HKI, B. (2006). The burden of anaemia in rural Bangladesh: the need for urgent action. Dhaka:: Helen Keller International, NSP Bulletin 16.
[11]	Rashid M, Flora MS, Moni MA, Akhter A, Mahmud Z. Reviewing Anemia and iron folic acid supplementation program in Bangladesh- a special article. Bangladesh Med J. 2010; 39(3).
[12]	International Centre for Diarrheal Disease Research Bangladesh (icddr,b), United Nations Children’s Fund (UNICEF), Global Alliance for Improved Nutrition (GAIN), and Institute of Public Nutrition. National Micronutrients Status Survey 2011-12: Final Report. Dhaka, Bangladesh: Centre for Nutrition and Food Security, icddr, b; 2013.
[13]	Hussain, A. Z. (2015). Nutrition Background Paper to inform the preparation of the 7 th Five Year Plan. Dhaka.
[14]	Gamit MJ, T. H. (2017). Survey of different types of anemia. . Int J Med Sci Public Health, 6(3):493-496.
[15]	E. Pollitt. Early iron deficiency anemia and later mental retardation. The American Journal of Clinical Nutrition, vol. 69, no. 1, pp. 4-5, 1999.
[16]	National Strategy for Anaemia Prevention and Control in Bangladesh, Feb 2007, IPHN, MOHFW.
[17]	World Health Organization, Iron Deficiency Anemia Assessment, Prevention and Control: A Guide for Programme Managers, WHO, Geneva, Switzerland, 2001.
[18]	WHO. The global prevalence of anaemia in 2011, Geneva: World Health Organization, 2015.
[19]	Semba RD, de Pee S, Ricks MO, Sari M, Bloem MW. Diarrhea and fever as risk factors for anemia among children under age five living in urban slum areas of Indonesia. Int J Infect Dis. 2008; 12(1): 62-70.
[20]	Ngnie-Teta I, Receveur O, Kuate-Defo B. Risk factors for moderate to severe anemia among children in Benin and Mali: insights from a multilevel analysis. Food Nutr Bull. 2007; 28(1): 76-89.
[21]	Ewusie JE, Ahiadeke C, Beyene J, Hamid JS. Prevalence of anemia among under 5 children in the Ghanaian population: estimates from the Ghana demographic and health survey. BMC Public Health. 2014; 14:626.
[22]	Habib MA, Black K, Soofi SB, Hussain I, Bhatti Z, Bhutta ZA, et al. 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. PLoS One. 2016; 11(5): e0155051.
[23]	S RP, T R, Ramachandran R, Mathew G, L SA, S S, S K. Anemia among school children from southern Kerala, India: a cross-sectional study. Natl Med J India. 2015; 28(5): 225-227.
[24]	Singh S, Parihar S. Prevalence of anemia in under five- year-old children: a hospital-based study. Int J Contemp Pediatr. 2019 Mar; 6(2): 842-847.
[25]	Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Home fortification of complementary foods with micronutrient supplements is well accepted and has positive effects on infant iron status in Ghana. Am J Clin Nutr. 2008; 87(4): 929-938.
[26]	El Kishawi RR, Soo KL, Abed YA, Muda WAMW. Anemia among children aged 2–5 years in the Gaza Strip- Palestinian: a cross sectional study. BMC Public Health. 2015; 15(1): 1.
[27]	Rukhsana A, Nabia T, Malik MA, Mobeen I, Tara J, Shan RR. Low haemoglobin levels, its determinants and associated features among pregnant women in Islamabad and surrounding region. J Pak Med Assoc. 2009; 59(2): 86-9.
[28]	Tatala S, Svanberg U, Mduma B. Low dietary iron availability is a major cause of anemia: a nutrition survey in the Lindi District of Tanzania. Am J Clin Nutr. 1998; 68(1): 171-178.
[29]	Hallberg L, Rossander-Hultén L, Brune M, Gleerup A. Bioavailability in man of iron in human milk and cow’s milk in relation to their calcium contents. Pediatr Res. 1992; 31(5): 524-527.
[30]	Zuffo CR, OsórioMM, Taconeli CA, Schmidt ST, DaSilva BH, Almeida CC. Prevalence and risk factors of anemia in children. JPediatr (RioJ). 2016; 92: 353-60.
[31]	Rahman MS, Mushfiquee M, Masud MS, Howlader T.Association between malnutrition and anemia in under- five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011. PLoS One. 2019; 14(7): e0219170. Published 2019 Jul 3.
[32]	Yang, W., Li, X., Li, Y. et al. Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0-18 months in rural areas of Shaanxi province in northwestern China: a cross-sectional study. BMC Public Health 12, 1127 (2012).
[33]	Madu AJ, Ughasoro MD. Anaemia of Chronic Disease: An In-Depth Review. Med Princ Pract. 2017; 26(1): 1-9.