Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011

Abstract

Background Bangladesh is one of the most anemia prone countries in South Asia. Children of age under five years and women of reproductive age are particularly vulnerable in this region. Although several studies have investigated the risk factors of anemia, only few have explored its association with malnutrition, despite its high prevalence in the same group. The objective of this paper is to investigate the association of malnutrition with anemia by conducting separate analyses for under-five children and women of reproductive age using data from the nationally representative 2011 Bangladesh Demographic and Health Survey. Methods Two binary outcome variables are considered separately: presence of anemia in children under five years of age (Hb<11.0 g/dl) and presence of anemia in women of childbearing age (Hb<12.0 g/dl). The exposures of interest corresponding to these two outcomes are stunting (low height-for-age) and low BMI (<18.5 kg/m 2 ), respectively. Preliminary analysis involves estimating the association between exposure and outcome while controlling for a single confounder by computing adjusted odds ratios (adjOR) using the Cochran-Mantel-Haenszel approach in stratified analysis. Later, associations between the exposures and outcomes are estimated separately for under-five children and women of reproductive age by fitting multivariable regression models that adjust simultaneously for several confounders. Results The prevalence of anemia is found to be higher among both the stunted children and women with low BMI compared to their healthy counterparts (Children: 56% vs 48%; women: 50% vs 43%). Furthermore, stunted children and women with low BMI have significantly increased odds of developing anemia, as reflected by the adjusted ORs of 1.76 (95% CI:1.10–2.83) and 1.81 (95% CI: 1.11–3.48), respectively. The association of stunting with anemia in children was modified by their age and socio-economic condition, where risk of being anemic decreases with increasing age but with a lower rate for stunted children from richest family. In addition, stunted children of anemic mothers are at greater risk of being anemic compared to non-stunted children of anemic or non-anemic mothers. Again the association between BMI and anemia in women is modified by the level of education, with risk of anemia being lowest among women with low BMI and higher education. Conclusion Evidence–based policies targeting the vulnerable groups are required to combat anemia and nutritional deficiencies simultaneously under the same program.

<p>Hematological Abnormalities and Associated Factors Among Undernourished Under-Five Children Attending University of Gondar Specialized Referral Hospital, Northwest Ethiopia</p>

“…30,31 In this study, a child whose ages between 6 and 23 months was found to be 5.45 times more prone to anemia as compared to an older age counterpart (AOR= 5.45; 95% CI (2.13-13.93)). This is in line with studies done in Bangladesh 43 and Sri Lanka. 42 The possible reason for the high magnitude of anemia in this age group may be related to the low concentration of iron in breast milk which is insufficient to meet the daily iron requirements of the child.…”

Blood Lead alters the anemia status of malaria infected children in Katanga Kampala Uganda.

“…Since red cells are at the Centre of anemia pathogenesis, elevated malaria parasite density and BLL could produce severe anemia among children. The severity of anemia status is dependent on the host's age and nutrition status [18]. The combined aftermath of these two processes in malaria-endemic regions may result in severe anemia.…”

Relationship between blood Lead status and anemia in Ugandan children with malaria infection

“…High malaria burden, overproduction of protoporphyrin, iron deficiency, inhibited ALAD and impaired ferro chelatase activity accounts for anemia pathogenesis. During malaria infection, intrinsic and extrinsic challenges are elevated and they induce iron deficiency anemia whose persistence elevates the rate at which Lead is absorbed [17][18][19]. In addition to other symptoms, malaria infection becomes fatal with severe anemia.…”