Anemia and nutritional status of pre-school children in Kerala

The role of complementary feeding in India's high child malnutrition rates: findings from a comprehensive analysis of NFHS IV (2015-2016) data

Relative to its economic growth and poverty levels, Indian children suffer from higher levels of malnutrition than children in many other low- and middle-income countries. Research presented in this article examined the links between infant and young child feeding practices among Indian children and their rates of stunting, underweight, wasting, and anaemia, with a particular focus on the types of semisolid complementary food consumed. It did so through a comprehensive analysis of data on more than 57,000 6-to-23-month-old children obtained from the nationally representative National Family Health Survey IV (2015–2016). One of the key findings was that especially feeding children animal-sourced and vitamin-A-rich food was associated with lower malnutrition rates. The study further interrogated whether livestock ownership and participation in the Integrated Child Development Services programme could be supportive of better complementary child feeding and concluded that daily food receipts from the programme and poultry ownership were indeed linked with significantly higher rates of children following the recommended feeding practices as well as with somewhat lower children’s malnutrition rates.

Stunting and Wasting Among Indian Preschoolers have Moderate but Significant Associations with the Vegetarian Status of their Mothers

BACKGROUND

India has high rates of child undernutrition and widespread lactovegetarianism.

OBJECTIVES

The objective of this study was to examine how nutrition outcomes varied among Indian preschool children in relation to the vegetarian status of their parents.

METHODS

The 2015-2016 National Family Health Survey (NFHS) and the 2011-2012 National Sample Survey (NSS) were used to explore associations between parental vegetarian status and child stunting and wasting at ages 0-59 mo and anemia at ages 6-59 mo. In the NFHS, self-reports on usual consumption of foods were used to classify maternal diets, whereas in the NSS lactovegetarianism was defined at the household level.

RESULTS

Compared with children of nonvegetarian mothers, children aged 24-59 mo of lactovegetarian mothers were 2.9 percentage points (95% CI: -4.0, -1.9) less likely to be stunted and children aged 6-23 mo were 1.6 points less likely to be wasted (95% CI: -3.0, -0.03), whereas children aged 6-23 mo with vegan mothers were 5.2 points more likely to be stunted (95% CI: 0.1, 9.4). When compared with nonvegetarian households, lactovegetarian households had better socioeconomic status and were more likely to consume dairy frequently. Children in nonvegetarian households consumed nondairy animal-sourced foods (ASFs) with relatively low frequency. The frequency of maternal dairy consumption was significantly associated with lower risks of child stunting and wasting.

CONCLUSIONS

Anthropometric outcomes differed by maternal vegetarian status, which is itself strongly associated with socioeconomic position, location, religion, and caste.

Prevalence of Anaemia in Kerala State, Southern India - A Systematic Review

INTRODUCTION

Anaemia is the most common nutritional problem affecting children, adolescents and women. A systematic review was undertaken to find out the prevalence of anaemia and to identify the trend in the prevalence of anaemia in Kerala state, Southern India.

AIM

The aim of the review was to identify the prevalence of anaemia in Kerala and to comment on its trend across last 25 years.

MATERIALS AND METHODS

PubMed and google scholar searches and scanning of reference lists were used to identify studies. All population based studies on anaemia from Kerala, irrespective of its designs, published between Jan 1^st 1990 to Dec 31^st 2015 were included. Data extraction and quality assessment were carried out using structured proformas. Due to the heterogeneity of reviewed studies, meta-analysis was not done. A narrative approach was used.

RESULTS

A total of 10 studies in addition to two major survey reports- National Family Health Survey (NFHS) and District Level Household Survey (DLHS) were included in the final analysis. Prevalence of anaemia among adolescents from recent study reports was around 30% and prevalence of severe anaemia was less than 1% in all studies. Anaemia among tribal women and children were in the range of 78.3% to 96.5%. A key finding of this review was the paucity of data and inconsistency in haemoglobin estimation methods and population characteristics which made comparisons impossible.

CONCLUSION

The current prevalence of anaemia in Kerala is unclear. Though, there are many studies and reports regarding prevalence of anaemia in the state, those results could not be combined due to non uniform haemoglobin estimation methods. Standardised prospective study of general population including subgroups will be necessary.

A High Prevalence of Biochemical Evidence of Vitamin B12 or Folate Deficiency does not Translate into a Comparable Prevalence of Anemia

Based on biochemical evidence, a high prevalence of biochemical evidence of vitamin B12 or folate deficiency has been reported in a number of areas in the world. The evidence that these biochemical abnormalities lead to a comparable prevalence of anemia is reviewed. The overall contribution of vitamin B12 deficiency to the global burden of anemia is probably not significant, except perhaps in women and their infants and children in vegetarian communities. In developed countries, folate-deficiency anemia is uncommon. In some developing countries, this anemia is still seen, but there are no comprehensive data on the relative prevalence compared with anemia due to malaria, iron-deficiency, hemoglobinopathy, and HIV disease. It seems unlikely that folate deficiency makes a major contribution to the burden of anemia in developing countries. Iron-deficiency anemia may coexist with vitamin B12 and especially folate deficiency, and may confound the hematological features of the vitamin deficiencies whose prevalence would then be underestimated. Supplementation of the diet of pregnant women with folic acid can virtually eliminate folate-deficiency anemia in these women. There are very few data on the hematological effect of vitamin B12 supplementation or fortification at the population level. The addition of vitamin B12 to the supplementation of the diet of pregnant women with iron and folic acid does not produce an increased hematological response, at least in nonvegetarian populations. There are numerous reports of the effect of folic acid fortification of food on tests of folate status, but only a single published report on the hematological response was found.

Stunting, underweight and wasting among Integrated Child Development Services (ICDS) scheme children aged 3-5 years of Chapra, Nadia District, West Bengal, India

This study investigated age and sex variations in height and weight, levels of stunting, underweight and wasting among 533 (254 boys; 279 girls) 3- to 5-year-old rural children of Bengalee ethnicity at 11 Integrated Child Development Services centres of Nadia District, West Bengal, India. Height-for-age, weight-for-age and weight-for-height < -2 z-scores were used to evaluate stunting, underweight and wasting, respectively, following the National Center for Health Statistics (NCHS) Guidelines. Results revealed that boys were significantly heavier than girls at age 3 years. Significant age differences existed in mean height and weight in both sexes. Mean z-scores of height-for-age, weight-for-age and weight-for-height were lower than those of NCHS for both sexes at all ages. The overall (age and sex combined) rates of stunting, underweight and wasting were 23.9%, 31.0% and 9.4%, respectively. The rate of underweight and wasting was higher among girls (underweight = 35.1%, wasting = 12.2%) compared with boys (underweight = 26.5%, wasting = 6.3%). In general, the frequency of stunting increased with increasing age in both sexes. Based on the World Health Organization classification of severity of malnutrition, the overall prevalence of underweight was very high (>or=30%). The prevalence rates of stunting (20-29%) and wasting (5-9%) were medium. In conclusion, the nutritional status of the subjects is unsatisfactory. There is scope for improvement in the form of enhanced supplementary nutrition.

Nutritional risk factors for iron-deficiency anaemia in children 12-24 months old in the area of Thessalia in Greece

Iron-deficiency anaemia (IDA) is a common problem all over the world, which mainly attacks pregnant women, infants and children. The main objectives were to assess the prevalence of IDA in children 12-24 months old in the area of Thessalia located in the central part of Greece and to identify, by means of a simple questionnaire, its nutritional risk factors. The research was applied as a cross-sectional and case-control study. In the first part of the study, the haemoglobin (Hb) levels were estimated by a mobile photometer analyser in 938 children (approximately one-third of the total children population). In the second part, children with Hb?<?11 g/dl were compared with their random selected healthy controls in haematological, anthropometric and nutritional parameters. The estimated laboratory values were Hb, haematocrit, mean corpuscular volume, mean corpuscular Hb, mean corpuscular Hb concentration, zinc protoporphyrin, serum iron, serum ferritin, transferring saturation, total iron binding capacity and Hb electrophoresis. Finally, 75 children (34 boys, 41 girls; mean age 17.51+/-3.5 months), who were found to have IDA, constituted the case group while 75 healthy children constituted the control group. The studied nutritional variables through the application of a standardized food frequency questionnaire were: duration of breast feeding, milk that the child drinks during the research, age of solid food introduction, child's health status according to the mother's point of view, child's appetite and frequency of bread, cereals, meat, fish, egg, legumes, chocolate, marmalade, vegetables, fruit and tea intake. The prevalence of IDA in the region was 7.99%. The carriers of b-thalassaemia (2.13%) were excluded from the study. Significant statistical difference has been observed between the two groups (P?<?0.001) in all haematological and anthropometric parameters except head circumference (P?=?0.85). Concerning the nutritional indices the two groups were statistically different (P?<?0.001) in the following: the cases were breastfed less, were drinking fresh cow's milk and tea, were eating meat, vegetables and fruit less often, had a bad appetite and were more likely to get sick. In conclusion, the prevalence of IDA in this area of Greece is approximately similar to other areas in the developed world. The application of simple food frequency questionnaires for the detection of the nutritional IDA risk factors could prognose and prevent anaemia.