Date Published: September 25, 2018
Publisher: Public Library of Science
Author(s): Lara Livia Santos da Silva, Wafaie Wahib Fawzi, Marly Augusto Cardoso, James R. Connor.
Anemia is recognized as a major public health problem in childhood, especially in children under 24 months of age. Despite improvements in public health strategies to prevent and control anemia in Brazilian young children in the last decade, few studies have assessed the predictors for this condition in primary health care. Thus, this study aimed to assess the associated factors of anemia in young children who visited primary public health care facilities in Brazil.
A cross-sectional study was conducted with 520 children aged 11 to 15 months who visited the primary health care in four Brazilian cities. Anemia was defined as hemoglobin concentration < 110 g/L in venous blood samples. Multilevel Poisson regression models were used to describe the associations between anemia and independent variables. The frequency of anemia was 23.1%. A higher frequency was observed in children who live with more than one other child younger than 5 years in the house (Prevalence Ratio [PR] 1.47; 95% Confidence Interval [CI] 1.01–2.14), who started to receive fruits and vegetables after 8 months of age (PR 1.92; 95% CI 1.19–3.10), who were stunted (PR 2.44; 95% CI 1.32–4.50), who were hospitalized at least once in their life (PR 1.55; 95% CI 1.03–2.33) and who were in the lower tertile of serum folate concentration (PR 2.24; 95% CI 1.30–3.85). Inadequate complementary feeding practices and morbidity were the main predictors for anemia in early childhood in this population. Improvements in current strategies to promote healthy complementary feeding along with better control of morbidities are recommended to reduce anemia in Brazilian young children.
Anemia refers to a condition in which the blood hemoglobin concentration is lower than normal , resulting in poor cognitive and motor development in children and loss of work productivity in adulthood [2, 3].
A total of 520 children aged 11 to 15 months were included in this study. The characteristics of the children are shown in Table 1. The mean (standard deviation) age of the participants was 13.5 (1.0) months, 50.6% were male and 76.5% were classified as mixed ethnicity. The mothers of almost 80% of the children had more than 7 years of education. About 5% of the study children were stunted and 14.6% had signs of inflammation.
In this study, 23.1% of children aged 11–15 months who visited primary health care facilities in Brazil were anemic. The main associated factors of anemia in this study were children who lived with more than one child younger than 5 years in the house, those who started to receive fruits and/or vegetables after 8 months of age, were hospitalized at least once in their life, were stunted and those in the lowest tertile of folate concentration.
Anemia was found to be a moderate public health problem in Brazilian young children who visited primary health care facilities. More than one child younger than 5 years in the house, introduction of fruits and/or vegetables after 8 months of age, stunting, previous hospitalization and the lowest tertile of folate concentration were associated with high risk for anemia. Improvements to the current strategies for preventing and controlling anemia in Brazil, along with better control of morbidity, are recommended for reducing anemia in children who visit primary health care in this country.