Anemia among school children in eastern Nepal

Social and ecological disparities in anaemia among adolescent girls 15-19 years old in Nepal

OBJECTIVE

Adolescent girls are at risk of anaemia due to increased nutrient demands because of growth, menstrual blood loss and possible pregnancies. Sociocultural and household conditions influence their anaemia risk. We aimed to identify the sociocultural and economic factors associated with anaemia among adolescent girls in Nepal.

DESIGN

The Nepal Demographic and Health Surveys (NDHS) conducted in 2006, 2011 and 2016 were pooled for secondary analysis. We used data on haemoglobin measurements for anaemia and conducted bivariate and multivariable logistic regression analyses to identify factors associated with anaemia.

SETTING

Nationally representative NDHS households with adolescent girls 15-19 years of age.

PARTICIPANTS

Non-pregnant adolescent girls 15-19 years, with a haemoglobin measurement (n = 3731).

RESULTS

The overall prevalence of anaemia among adolescent girls was 39·6 %. Adolescents from socially disadvantaged caste/ethnicity groups were 1·42 times (95 % CI: 1·13, 1·78) more likely to have anaemia compared with those from Brahmin/Chhetri households. We found a counter-intuitive association between socio-economic status and anaemia where adolescents from the middle (adjusted OR (aOR) 1·37, 95 % CI: 1·01, 1·85) and highest (aOR 1·74, 95 % CI: 1·18, 2·56) quintiles were at increased odds of anaemia. Relative geographical inequality was observed where adolescents from the Terai region had 3·5 times (95 % CI: 2·32, 5·33) higher odds of anaemia.

CONCLUSIONS

The disparities in the distribution of anaemia among adolescents by caste/ethnicity groups, wealth quintiles and geographical regions are evident. Reducing the anaemia burden will require addressing the social determinants of anaemia by allocating resources and expanding anaemia prevention programmes to target adolescents at higher risk.

Effect of an Integrated School Garden and Home Garden Intervention on Anemia Among School-Aged Children in Nepal: Evidence From a Cluster Randomised Controlled Trial

BACKGROUND

Integrated school and home garden interventions can improve health outcomes in low-income countries, but rigorous evidence remains scarce, particularly for school-aged children and to reduce anemia.

OBJECTIVE

We test if an integrated school and home garden intervention, implemented at pilot stage, improves hemoglobin levels among school children (aged 9-13 years) in a rural district in the mid-hills of Nepal.

METHODS

We use a cluster randomized controlled trial with 15 schools each in the control and treatment groups (n = 680 school children). To test if nutritional improvements translate into a reduction of anemia prevalence, hemoglobin data were collected 6 months after intervention support had ended. Using structural equation modeling, we estimate the direct and indirect effects of the treatment through several pathways, including nutritional knowledge, good food and hygiene practices, and dietary diversity.

RESULTS

The integrated school and home garden intervention did not lead to a direct significant reduction in anemia. Causal positive changes of the treatment on nutritional outcomes, although significant, are not strong enough to impact hemoglobin levels. The program improved hemoglobin levels indirectly for children below 12 by increasing the use of good food and hygiene practices at home. These practices are associated with higher hemoglobin levels, particularly for girls, young children, and in households where caregivers are literate.

CONCLUSIONS

Even integrated school and home garden interventions are not sufficient to reduce anemia among school children. Incorporating behavioral change components around food and hygiene practices into integrated garden interventions is important to unlocking their health impacts.

Magnitude of Anemia and Undernutrition Among Primary School Children in a Setting of Mass Deworming in Central Ethiopia

Background

Undernutrition and anemia in children continue to be a public health problem in developing countries. Besides, intestinal parasitic infection among school children is common in developing countries. World Health Organization (WHO) recommends periodic deworming of children who live in endemic areas. The aim of this study was to determine the magnitude of anemia and undernutrition among school children in a setting of mass deworming.

Methods

A cross-sectional study was conducted among 510 school children aged 5-14 years from three randomly selected governmental schools in Sululta town, central Ethiopia. Socio-demographic variables were assessed using interviewer administered structured questionnaire. Anthropometric data were obtained and analyzed using WHO Anthroplusv1.0.4. Venous blood samples were collected using EDTA vacutainers. Hemoglobin level was determined by Sysmex KX-21N automated hematology analyzer and stool samples were processed using direct wet mount, formol-ether concentration and Kato-Katz methods. Data were entered and analyzed using SPSS version 21. Logistic regression analysis was performed to determine the association of anemia and undernutrition with the independent variables.

Results

The overall magnitude of anemia was 3.7%. Among anemic individuals, 84.2% and 15.8% of participants had mild and moderate anemia, respectively. The magnitude of stunting and thinness was 16.9% and 10.8%, respectively. Of them, 18.6% of stunting and 14.5% of thinness were severe. Of factors related to undernutrition, children from large families (≥5) were less likely to be stunted (AOR=0.38, 95% CI=0.2-0.7, P=0.002) compared to small families.

Conclusion

The magnitude of anemia in the study area was considered as an insignificant public health problem and none of the socio-demographic variables of participants were significantly associated with anemia and likewise with undernutrition except for family size. Further studies are required to clearly understand the impact of mass deworming on the magnitude of anemia and undernutrition.

Evaluation of radial peripapillary capillary density in patients with newly diagnosed iron deficiency anemia

PURPOSE

To investigate the effects of iron deficiency anemia (IDA) on radial peripapillary capillary vessel density (RPCvd) and retinal nerve fiber layer (RNFL) thickness.

METHODS

Forty patients with IDA, and 46 healthy participants, were enrolled in this study. Optical coherence tomography angiography was used to determine RNFL thickness and RPCvd measurements. In addition, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and ferritin laboratory values were evaluated.

RESULTS

Analysis of retinal regions (whole images, peripapillary, superior-hemi, inferior-hemi, inferior-nasal, inferior-temporal, temporal-inferior, temporal-superior, superior-nasal) showed that RPCvd values were significantly lower in patients with IDA compared to the control group values (p < 0.05 for all). However, there were no significant differences in RNFL thickness values between the IDA patient group and the control group (p > 0.05 for all). In addition, there were significant positive correlations between RPCvd values and hematological values for Hb, HCT, MCV, MCH, MCHC, and ferritin.

CONCLUSION

It is important to identify changes in retinal vascularity to prevent possible ocular problems in patients with IDA. Specifically, the significant positive correlations between RPCvd values and hematological values suggest that anemia treatment is important for optic nerve perfusion.

Associations among Soil-Transmitted Helminths, G6PD Deficiency and Asymptomatic Malaria Parasitemia, and Anemia in Schoolchildren from a Conflict Zone of Northeast Myanmar

In tropical areas of developing countries, the interactions among parasitic diseases such as soil-transmitted helminths (STHs) and malaria, and glucose-6-phosphate dehydrogenase deficiency (G6PDd), are complex. Here, we investigated their interactions and impact on anemia in school students residing in a conflict zone of northeast Myanmar. A cross-sectional survey was conducted between July and December 2015 in two schools located along the China-Myanmar border. Stool samples from the schoolchildren were analyzed for STH infections, whereas finger-prick blood samples were analyzed for G6PDd, hemoglobin concentrations, and Plasmodium infections. Among 988 enrolled children, Plasmodium vivax, Plasmodium falciparum, hookworm, Ascaris lumbricoides, and Trichuris trichiura infections occurred in 3.3%, 0.8%, 31.5%, 1.2%, and 0.3%, respectively. Glucose-6-phosphate dehydrogenase deficiency was present in 16.9% of the children, and there was a very high prevalence of anemia (73%). Anthropometric measures performed on all children showed that 50% of the children were stunted and 25% wasted. Moderate to severe anemia was associated with STH infections, stunting, and wasting. In addition, children had increasing odds of anemia with increasing burden of infections. This study revealed a high prevalence of G6PDd, STHs, and anemia in schools located in a conflict zone. In areas where malnutrition and STH infections are rampant, testing for both glucose-6-phosphate dehydrogenase and anemia should be considered before treating vivax malaria with 8-aminoquinolines.

Anaemia and Its Relation to Demographic, Socio-economic and Anthropometric Factors in Rural Primary School Children in Hai Phong City, Vietnam

Little is known about the prevalence of anaemia and associated factors in school children in Vietnam. In this cross-sectional study, we aimed to determine the prevalence of anaemia and its subtypes, and the associations of types of anaemia with demographic, socio-economic and anthropometric factors among 6-9-year-old primary school children in rural areas of Hai Phong City, Vietnam. Haemoglobin (Hb) and mean corpuscular volume (MCV) were measured, and demographic, socio-economic and anthropometric data were collected in 893 children from eight primary schools. The prevalence of anaemia (Hb < 115 g/L) was 12.9% (95% CI: 8.1%, 19.9%), microcytic anaemia (Hb < 115 g/L and MCV < 80 fL) was 7.9% (95% CI: 5.3%, 11.6%) and normocytic anaemia (Hb < 115 g/L and MCV 80-90 fL) was 5.3% (95% CI: 2.9%, 9.5%). No child presented with macrocytic anaemia (Hb < 115 g/L and MCV > 90 fL). Children who were underweight, wasted, or in anthropometric failure (either underweight, stunted or wasted) were more likely to be anaemic (all p ≤ 0.004), and specifically, to have normocytic anaemia (all p ≤ 0.006), than those who were not underweight, wasted or in anthropometric failure. Stunted children were more likely to be anaemic (p = 0.018) than those who were not stunted. Overweight/obese children were less likely to be anaemic (p = 0.026) or have normocytic anaemia (p = 0.038) compared with children who were not overweight/obese. No anthropometric status indicator was associated with the risk of microcytic anaemia. No demographic or socio-economic factor was associated with any type of anaemia. Anaemia remains a public health issue in rural areas in Hai Phong City, Vietnam, and future approaches for its prevention and control should target undernourished primary school children.

Prevalence of iron deficiency anemia in Iranian children under 6 years of age: a systematic review and meta-analysis

Background: Iron deficiency anemia is a prevalent condition among children in developing and developed countries that leads to impaired development, activity intolerance, behavioral changes, irritability, and reduced learning ability. The studies conducted in Iran have reported different prevalence rates for this condition. This systematic review and meta-analysis were aimed at estimating the prevalence of iron deficiency anemia in Iranian children under 6 years of age.

Methodology: Persian and English articles published from 2001 to 2018 were collected. The search process was conducted in national and internationals databases, including SID, MagIran, PubMed, Scopus, and Web of Science, using the following keywords and their combinations: Iron, Iron deficiency, Iron deficiency anemia, Ferritin, Child, Children, and Iran. The data were analyzed using the meta-analysis and random effects model. Heterogeneity was assessed using the I² statistic. All analyses were performed using the STATA software, version 12.

Results: Analysis of six selected articles with a total sample size of 1,700 showed that the prevalence rates of iron deficiency and iron deficiency anemia in the Iranian children under 6 years of age were 27.7% (95% CI: 11.9–43.5) and 18.2% (95% CI: 14.3–22), respectively. In addition, the prevalence of iron deficiency anemia was higher in boys (17.7% with 95% CI: 5.9–29.5) than in girls (14.4% with 95% CI: 4.5–24.2).

Conclusion: About one-fifth of Iranian children under the age of 6 years suffer from iron deficiency anemia. Identification of those at risk of developing this condition with the goal of prevention, diagnosis, and treatment seems to be an important and necessary task.

Prevalence of Anemia and Hemoglobin Disorders Among School Children in Myanmar

The prevalence of anemia is high in the population of Myanmar and hypochromic microcytic anemia (HMA) is predominant. The objective of our study was to determine the prevalence of anemia and causes of HMA among school children. A cross-sectional study was conducted on 239 children from Thanlyin and Insein Townships, Yangon Region, Myanmar. Complete blood count (CBC) and blood film morphology was examined on venous blood samples. Hypochromic microcytic anemia cases were subsequently analyzed for serum ferritin and cellulose acetate hemoglobin (Hb) electrophoresis. The prevalence of anemia was 46.4%; 27.6% had mild, while 18.8% had moderate anemia, and no case of severe anemia was detected. The mean Hb concentration was 11.7 ± 0.9 g/dL. The younger age group (8-11 years) had a significantly higher prevalence of anemia than the older age group (12-15 years) (p = 0.029). Blood film morphology revealed a 50.6% red blood cell (RBC) disorder; HMA was the most common type (70.2%). Out of 85 children with HMA, three children (3.5%) had iron deficiency and all had comorbidity with Hb AE (β^A/β^E) (Hb E trait). Hemoglobin electrophoresis illustrated that Hb AA (β^A/β^A) (31, 36.5%) and Hb AE (β^A/β^E) trait (31, 36.5%) were the most common types followed by β-thalassemia (β-thal) trait (19, 22.3%) and Hb EE (β^E/β^E) (homozygous Hb E; HBB: c.79G>A) (three, 3.5%). Hematocrit [or packed cell volume (PCV)], mean corpuscular volume (MCV), mean corpuscular Hb (MCH) and mean corpuscular Hb concentration (MCHC), showed a significant difference between Hb AE, Hb EE and β-thal trait (p = 0.029, 0.023, 0.015 and 0.01, respectively). Our findings will provide valuable information for the management of anemia in the Myanmar school-age population.

Prevalence of Anemia among Chinese Rural Residents

This paper presents an analysis of the level of blood hemoglobin and the rates of anemia in Chinese rural residents in the 2010–2012 National Nutrition and Health Survey, and the change in its prevalence in rural residents during the last ten years. Our methodology included data from the Chinese Nutrition and Health Surveillance in 2010–2012, where samples were selected through the method of probability proportion to size. The study objects were from 150 sites in provinces, autonomous regions, or municipalities in China. The concentration of blood hemoglobin was determined using the cyanmethemoglobin method. Anemia was judged by the anemia standard recommended by the World Health Organization (WHO), combined with elevation correction standard. The level of blood hemoglobin, the prevalence of anemia, and the 95% CI (Confidence interval) value were analyzed using complex sampling weighted processing, combined with the population figures released by the National Bureau of Statistics in 2009. Our results indicate that the level of blood hemoglobin of the Chinese rural area population was 145.92 ± 0.83 g/L, with the prevalence of anemia in the Chinese rural population at 9.7% (95% CI: 9.4%–10.0%). The prevalence of anemia in children 6–11 years old was 5.5% (95% CI: 5.0%–6.0%), 8.1% (95% CI: 7.5%–8.7%) for 12–17-year-old teenagers, 10.0% (95% CI: 9.4%–10.6%) for 18–44-year-old adults, 9.6% (95% CI: 9.0%–10.1%) for 45–59-year-old adults, and 12.6% (95% CI: 11.9%–13.3%) for the elderly above 60 years old. Our conclusion shows that the prevalence of anemia in the Chinese rural population in 2010–2012 had obviously decreased compared to the last decade; however, women of reproductive age and the elderly still had a high prevalence of anemia.

Anemia, Iron Deficiency and Iodine Deficiency among Nepalese School Children

OBJECTIVES

To assess iodine and iron nutritional status among Nepalese school children.

METHODS

A cross-sectional, community based study was conducted in the two districts, Ilam (hilly region) and Udayapur (plain region) of eastern Nepal. A total of 759 school children aged 6-13 y from different schools within the study areas were randomly enrolled. A total of 759 urine samples and 316 blood samples were collected. Blood hemoglobin level, serum iron, total iron binding capacity and urinary iodine concentration was measured. Percentage of transferrin saturation was calculated using serum iron and total iron binding capacity values.

RESULTS

The mean level of hemoglobin, serum iron, total iron binding capacity, transferrin saturation and median urinary iodine excretion were 12.29 ± 1.85 g/dl, 70.45 ± 34.46 μg/dl, 386.48 ± 62.48 μg/dl, 19.94 ± 12.07 % and 274.67 μg/L respectively. Anemia, iron deficiency and iodine deficiency (urinary iodine excretion <100 μg/L) were present in 34.5 %, 43.4 % and 12.6 % children respectively. Insufficient urinary iodine excretion (urinary iodine excretion <100 μg/L) was common in anemic and iron deficient children.

CONCLUSIONS

Iron deficiency and anemia are common in Nepalese children, whereas, iodine nutrition is more than adequate. Low urinary iodine excretion was common in iron deficiency and anemia.

Association between iron status and thyroid function in Nepalese children

Background

Deficiencies of iodine and iron may have adverse effect on thyroid function. This study was undertaken to investigate the association between iron status and thyroid function in Nepalese children living in hilly regions.

Methods

A cross-sectional study was conducted among 227 school children aged 6–12 years living in hilly regions of eastern Nepal. Urine and blood samples were analyzed for urinary iodine concentration, free thyroxine, free triiodothyronine, thyroid stimulating hormone, hemoglobin, serum iron and total iron binding capacity, and percentage transferrin saturation was calculated.

Results

The cohort comprised euthyroid (80.6 %, n = 183), overt hypothyroid (1.3 %, n = 3), subclinical hypothyroid (16.3 %, n = 37) and subclinical hyperthyroid (1.8 %, n = 4) children respectively. About 35.2 % (n = 80) children were anemic, 43.6 % (n = 99) were iron deficient and 19.8 % (n = 45) had urinary iodine excretion < 100 μg/L. Hypothyroidism (overt and subclinical) was common in anemic and iron deficient children. The relative risk of having hypothyroidism (overt and subclinical) in anemic and iron deficient children was 5.513 (95 % CI: 2.844−10.685, p < 0.001) and 1.939 (95 % CI: 1.091-3.449, p = 0.023) respectively as compared to non-anemic and iron sufficient children. Thyroid stimulating hormone had significant negative correlation with hemoglobin (r = −0.337, p < 0.001) and transferrin saturation (r = −0.204, p = 0.002).

Conclusions

Thyroid dysfunction, iron deficiency and anemia are common among Nepalese children. In this cohort, anemic and iron deficient children had poor thyroid function.

Potential Contribution of Iron Deficiency and Multiple Factors to Anemia Among 6- to 72-Month-Old Children in the Kokang Area of Myanmar

The prevalence of anemia among children in Myanmar has been reported to be among the highest in the world. This study was conducted to determine 1) the prevalence of anemia in preschool children and 2) risk factors associated with anemia. A total of 138 children aged from 6 to 72 months were recruited through cluster sampling from six villages in Kokang. Hemoglobin (Hb) concentration, blood trace elements, and anthropometric indicators were measured. Feces samples were collected to examine for the presence of ascarid eggs. The overall prevalence of anemia in children was 61.6%, including 10.9% with severe anemia. Meanwhile, high prevalence of stunting (40.0%), underweight (22.4%), wasting (6.3%), and small head circumference (6.7%) was found. Children with anemia were more prone to stunting. Children with severe anemia and moderate anemia had significantly lower blood iron and zinc levels than children without anemia (P < 0.001 and P = 0.007). The prevalence of ascarid infection was 64.9%; however, it was not associated with anemia. Drinking spring water was positively associated with anemia (odds ratio [OR] = 6.368). This study demonstrated that anemia is an important public health problem among children from the Kokang area. Iron deficiency and drinking spring water may be the important causes of anemia among children.