Age, Ethnicity, Glucose-6-Phosphate Dehydrogenase Deficiency, Micronutrient Powder Intake, and Biomarkers of Micronutrient Status, Infection, and Inflammation Are Associated with Anemia Among Children 6–59 Months in Nepal

Abstract

Background Anemia is a major concern for children in Nepal; however, little is known about context-specific causes of anemia. Objective We used cross-sectional data from the 2016 Nepal National Micronutrient Status Survey to evaluate factors associated with anemia in a nationally representative, population-based sample of children 6–59 mo (n = 1367). Methods Hemoglobin, biomarkers of iron status and other micronutrients, infection, inflammation, and blood disorders were assessed from venous blood samples. Soil-transmitted helminth (STH) and Helicobacter pylori infections were assessed from stool. Anthropometry was measured with standard procedures. Sociodemographic and household characteristics, diet, micronutrient powder (MNP) intake, pica, and morbidity recall were ascertained by caregiver interview. Multivariable logistic regression that accounted for complex sampling design, determined predictors of anemia (hemoglobin <11.0 g/dL, altitude adjusted); candidate predictors were variables with P < 0.05 in bivariate models. Results Anemia prevalence was 18.6% (95% CI: 15.8, 21.4). MNP intake [adjusted OR (AOR): 0.25, 95% CI: 0.07, 0.86], log (ln) ferritin (μg/L) (AOR: 0.49, 95% CI: 0.38, 0.64), and ln RBP (μmol/L) (AOR: 0.42, 95% CI: 0.18, 0.95) were associated with reduced odds of anemia. Younger age (6–23 mo compared with 24–59 mo; AOR: 2.29, 95% CI: 1.52, 3.46), other Terai ethnicities (AOR: 2.59, 95% CI: 1.25, 5.35) and Muslim ethnicities (AOR: 3.15, 95% CI: 1.30, 7.65) relative to Brahmin/Chhetri ethnicities, recent fever (AOR: 1.68, 95% CI: 1.08, 2.59), ln C-reactive protein (mg/L) (AOR: 1.23, 95% CI: 1.03, 1.45), and glucose-6-phosphate dehydrogenase deficiency (AOR: 2.84, 95% CI: 1.88, 4.30) were associated with increased odds of anemia. Conclusion Both nonmodifiable and potentially modifiable factors were associated with anemia. Thus some but not all anemia might be addressed through effective public health policy, programs, and delivery of nutrition and infection prevention and control.

Anaemia in Indians aged 10–19 years: Prevalence, burden and associated factors at national and regional levels

“…Our findings are consistent with recent studies on school-aged children and adolescents from Nepal (Ford et al, 2020a), Kuwait (Shaban et al, 2020) and Bangladesh (Ahmed et al, 2000), and communitybased studies on adolescent girls in India (Patel et al, 2017;Srivastava et al, 2016;Thomas et al, 2015). Similar associations between anaemia and iron deficiency are well documented in women of reproductive age and children (Engle-Stone et al, 2017;Ford et al, 2020b;George et al, 2012;Petry et al, 2019;.…”

The Prevalence of Anemia in Children Aged 6–23 Months and its Correlates Differ by District in Kapilvastu and Achham Districts in Nepal

“…The prevalence of anemia in Achham in our survey is similar to the 2016 Nepal National Micronutrient Status Survey (NNMSS), which estimated a 33% national prevalence of anemia in children 6–23 mo [ 10 ]; our estimated prevalence in Kapilvastu is higher than that in the NNMSS. The NNMSS, which was not powered for district or regional estimates stratified by age, estimated that among children aged 6–59 mo, 15% of children in the hill’s ecological zone (where Achham is located) and 23% in the Terai (where Kapilvastu is located) had anemia, which corresponds to the district-level patterns that we also observed for higher prevalence in Kapilvastu.…”

“…It has been estimated that ∼50% of the worldwide burden of anemia is due to iron deficiency [ 7 ]; however, the etiology and pathophysiology of anemia are complex and likely vary across contexts [ 8 ]. Analyses of predictors of anemia often pool data on a national or regional level [ 9 , 10 ], which may hide important variability at the subnational level. In the current analysis, we used 2 large surveys that are representative of children aged 6–23 mo in 2 districts in Nepal to evaluate district-specific predictors of anemia.…”

Micronutrients deficiencies and its correlation with the soil-transmitted helminthic infections among children and non-pregnant women in Nepal: findings from Nepal national micronutrient status survey

“…A minimum size of clusters was considered of 100 households and in case of wards having less than 100 households were merged with the adjacent wards whereas the clusters with more than 300 households were divided into the sub wards of 100 households. A total of 180 clusters (75 from the Terai and Hills each, and 30 clusters from the Mountains) were selected from the 15 strata considering the population proportion size 30 where clusters (wards) were used as the primary sampling units (PSUs). A detail table of clusters is presented in the Table 1 .…”