Dietary intake, intestinal infection, and safe drinking water among children with anemia in Peru: a cross-sectional analysis

Springer Science and Business Media LLC - Tập 7 Số 1 - 2021
Christopher Westgard1, Luis A. Orrego-Ferreyros1, Liz Franco Calderón1, Alexandra M. Rogers2
1Department of Research and Innovation, Elementos, Lima, Peru
2Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

Tóm tắt

Abstract Background Anemia is a major public health concern that is present in 41.7% of children under 5 worldwide. The prevalence of anemia in Peru was 43.6% in 2017, a decrease by only 6.8% in 8 years. Despite great efforts made by the government to reduce anemia by distributing free multi-micronutrient supplements and promote the consumption of iron rich foods, progress has been slow. The current study sought to better understand why the prevalence remains high by analyzing the dietary intake, incidence of intestinal infectious disease, and access to safe drinking water by children with anemia in Peru. Methods A cross-sectional analysis was conducted using data from two national surveys that were combined by child ID. Descriptive statistics was analyzed to understand the experience of children with anemia in comparison to child without anemia. Logistic multivariate regression analyses were conducted to test the associations between anemia and dietary intake, intestinal infection, and access to safe drinking water. Results The sample included 586 children between 6 and 35 months. The prevalence of anemia in this population was 53%. The portion of children that consumed sufficient iron to meet the recommendation for their age was 62%. Of the children with anemia, 52% consumed sufficient iron to meet their recommendation, vs. 72% of children without anemia (p < 0.001). The children with anemia were more likely to have an intestinal infection during the previous year (35% vs. 26%, p = 0.057) and less likely to have access to safe drinking water (77% vs. 86%, p = 0.002) than those without anemia. The logistic analysis revealed that having an intestinal infection increased the odds of having anemia (OR = 1.64, CI 95% [1.041–2.584]), and having access to safe drinking waters decreased the odds of having anemia (OR = 0.578, [0.334–0.998]). Conclusions More than half of the children with anemia in Peru already consume sufficient iron to meet their daily requirement. However, they continue to have anemia, likely due to intestinal infection, such as diarrhea and parasites, from a lack of access to safe drinking water and hygienic practices.

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Tài liệu tham khảo

Black MM, Walker SP, Fernald LCH, et al. Early childhood development coming of age: science through the life course. Lancet. 2017;389(10064):77–90. https://doi.org/10.1016/S0140-6736(16)31389-7.

Grantham-McGregor S, Cheung YB, Cueto S, et al. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369(9555):60. https://doi.org/10.1016/S0140-6736(07)60032-4.

Engle PL, Fernald LC, Alderman H, et al. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet. 2011;378(9799):1339–53. https://doi.org/10.1016/S0140-6736(11)60889-1.

Walker SP, Wachs TD, Grantham-McGregor S, et al. Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011;378(9799):1325–38. https://doi.org/10.1016/S0140-6736(11)60555-2.

Prevalence of Anemia among Children (% of Children under 5) | Data. The World Bank; 2016. Accessed September 27, 2019. https://data.worldbank.org/indicator/SH.ANM.CHLD.ZS

World Health Organization; Nutritional Anaemias: Tools for effective prevention and control. 2017.

Desforges JF, Oski FA. Iron deficiency in infancy and childhood. New England J Med. 1993;329(3):190–3.

Carter RC, Jacobson JL, Burden MJ, et al. Iron deficiency anemia and cognitive function in infancy. Pediatrics. 2010;126(2):e427–34. https://doi.org/10.1542/peds.2009-2097.

Westgard C, Alnasser Y. Developmental delay in the Amazon: the social determinants and prevalence among rural communities in Peru. PLoS One. 2017;12(10):e0186263. https://doi.org/10.1371/journal.pone.0186263.

Camaschella C. Iron-deficiency Anemia. N Engl J Med. 2015;372(19):1832–43. https://doi.org/10.1056/NEJMra1401038.

Osório MM. Determinant factors of anemia in children. J Pediatr. 2002;78(4):269–78. https://doi.org/10.2223/jped.860.

Subramaniam G, Girish M. Iron deficiency anemia in children. Indian J Pediatr. 2015;82(6):558–64. https://doi.org/10.1007/s12098-014-1643-9.

Solar O, Irwin A. A Conceptual Framework for Action on the Social Determinants of Health. Social Determinants of Health Discussion Paper 2: World Health Organization; 2010.

Sobrino M, Gutierrez Villafuerte C, Ledo Alves Da Cunha AJ, Alarcon J. Desnutrición infantil en menores de cinco años en Perú: Tendencias y Factores Determinantes. Rev Panam Salud Publica. 2014;35(2):104–12.

Encuesta Demográfica y de Salud Familiar 2019 - Nacional y Regional. Instituto Nacional de Estadística e Informática, Peru; 2019. https://proyectos.inei.gob.pe/endes/2019/ppr/Indicadores_de_Resultados_de_los_Programas_Presupuestales_ENDES_Primer_Semestre_2019.pdf

Ministerio de Desarrollo e Inclusion Social, Peru. Plan Multisectorial de Lucha Contra La Anemia. 2018.

Anemia En La Población Infantil Del Perú: Aspectos Clave Para Su Afronte. Instituto Nacional de Salud, Peru; 2017. http://www.ins.gob.pe/repositorioaps/0/4/jer/evidencias/ANEMIAFINAL_v.03mayo2015.pdf.

Informe Final. Encuesta: Vigilancia Alimentaria y Nutricional Por Etapas de Vida - VIANEV - Niños Menores de 36 Meses - 2015. Ministerio de Salud, Instituto National de Salud, Centro Nacional de Alimentacion y Nutricion; 2016. https://web.ins.gob.pe/sites/default/files/Archivos/cenan/van/vigilacia_poblacion/Informe_VIANEV_Ninos_2015.pdf

Ministerio de Salud de Peru; Seguro Integral de Salud. Base de Datos de Prestaciones de Salud. 2015-2016. 2017.

Software for Intake Distribution Estimation - Iowa State University. Accessed October 4, 2020. http://www.side.stat.iastate.edu/

Fats and Fatty Acids in Human Nutrition -Report of an Expert Consultation. Food and Agriculture Organization of the United Nations.; 2010. http://www.fao.org/3/a-i1953e.pdf

Protein and Amino Acid Requirements in Human Nutrition. Report of a Join FAO/WHO/UNU Expert Consultation. World Health Organization; 2007. http://www.who.int/nutrition/publications/nutrientrequirements/WHO_TRS_935/en/

Human Energy Requirements. Report of Joint FAO/WHO/UNU Expert Consultation.; 2001. http://www.fao.org/3/a-y5686e.pdf

Vitamin and Mineral Requirements in Human Nutrition : Report of a Joint FAO/WHO Expert Consultation. Joint FAO/WHO Expert Consultation on Human Vitamin and Mineral Requirements; 1998.

Prevention and Control of Iron-Deficiency Anaemia in Women and Children. Report of the UNICEF/WHO Regional Consultation. WHO Regional Office for Europe, UNICEF Regional Office for Central and Eastern Europe the Commonwealth of Independence States and the Baltic States; 2001. Accessed October 4, 2020. https://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/e73102/en/

World Health Organization; Iron Deficiency Anaemia Assessment, Prevention, and control a guide for Programme manager. 2001. https://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf

Becker R. International Classification of Diseases: Preparation of Short Lists for Data Tabulation. Epidemiol Bull. 2002;23:4 Accessed April 4, 2020. https://www.paho.org/english/dd/ais/be_v23n4-short_list.htm.

Hernan M, Robins J. Causal inference: what if. Boca Raon: Chapman & Hall/CRC; 2020.

Stata: Software for Statistics and Data Science. Accessed October 2, 2018. https://www.stata.com/

Metodología Para La Medición de La Pobreza En El Perú. Instituto Nacional de Estadistica E Informatica, Peru; 2000. https://www.inei.gob.pe/media/MenuRecursivo/metodologias/pobreza01.pdf

Tarqui Mamani CB, Rosales Pimentel S. informe Technico: Vigilancia de Indicadores Nutricionales. Consumo de Alimentos En Niños Peruanos de 6 a 35 Meses 2013-2014. Ministerio de Salud, Instituto Nacional de Salud, Centro Nacional de Alimentacion y Nutricion; 2015. https://web.ins.gob.pe/sites/default/files/Archivos/cenan/van/vigilacia_poblacion/CONSUMO%20DE%20ALIMENTOS%20EN%20NINOS%20PERUANOS%20DE%206%20A%2035%20MESES%202013-2014.pdf

Larsen DA, Grisham T, Slawsky E, Narine L. An individual-level meta-analysis assessing the impact of community-level sanitation access on child stunting, anemia, and diarrhea: Evidence from DHS and MICS surveys. PLoS Negl Trop Dis. 2017;11(6):e0005591. https://doi.org/10.1371/journal.pntd.0005591.

Wolf J, Prüss-Ustün A, Cumming O, et al. Systematic review: assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression. Tropical Med Int Health. 2014;19(8):928–42. https://doi.org/10.1111/tmi.12331.

Bechir M, Schelling E, Hamit MA, Tanner M, Zinsstag J. Parasitic infections, anemia and malnutrition among rural settled and mobile pastoralist mothers and their children in Chad. Ecohealth. 2012;9(2):122–31. https://doi.org/10.1007/s10393-011-0727-5.

Jonker FAM, Calis JCJ, Phiri K, et al. Real-time PCR demonstrates Ancylostoma duodenale is a key factor in the etiology of severe anemia and iron deficiency in Malawian pre-school children. PLoS Negl Trop Dis. 2012;6(3):e1555. https://doi.org/10.1371/journal.pntd.0001555.

Evaluación Basal de Anemia Por Deficiencia de Hierro y Folatos En Mujeres En Edad Fértil y En Niños y Niñas de 24 a 59 Meses En Lima Metropolitana. Instituto Nacional de Salud; 2006. Accessed August 21, 2019. http://catalog.ihsn.org/index.php/citations/82226

Humphrey JH, Mbuya MNN, Ntozini R, et al. Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: a cluster-randomised trial. Lancet Glob Health. 2019;7(1):e132–47. https://doi.org/10.1016/S2214-109X(18)30374-7.

Westgard CM, Rogers A, Bello G, Rivadeneyra N. Health service utilization, perspectives, and health-seeking behavior for maternal and child health services in the Amazon of Peru, a mixed-methods study. Int J Equity Health. 2019;18(1):155. https://doi.org/10.1186/s12939-019-1056-5.

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