Factors associated with anemia among Sri Lankan primary school children in rural North Central Province

Abstract

BackgroundDespite interventions, childhood anemia is still a major public health problem in low and middle income countries. Purpose of the present study is to determine factors associated with anemia among rural primary school children in Sri Lanka, a country undergoing rapid socioeconomic changes.MethodsMulti stage cluster sampling was used to select 100 rural schools in NCP and a maximum of 50 children aged 60–131 months were enrolled from each school. Self-administered questionnaires were sent to parents. Anthropometric measurements and blood samples were obtained by trained investigators. Blood reports were analyzed in a commercial laboratory with external quality control measures.ResultsTotal of 4412 children were included in the analysis. A Multiple regression was performed for hemoglobin. Only 4.2% of the change in hemoglobin could be explained by the model. District (p > 0.001), age (p > 0.001), timing of warm treatment(p = 0.026) and BMI for age (p = 0.002) uniquely contributed 1.12%, 1.19%, 0.13% and 0.26% to change in hemoglobin level respectively whereas, sex, monthly family income and frequency of meat and green leaf consumption didn’t contribute significantly.Peripheral blood film analyses were available for 146 anemic children. Blood film was reported as normal in 19.9% while evidence of iron deficiency (18.5%), early iron deficiency (32.5%) and thalassemia trait with iron deficiency (29.5%) were reported in the rest.Serum ferritin level was available for 417 children with hemoglobin less than 12 g/dl. Mean ferritin level was 63.7 microgram/l. Only 0.5% had depleted iron stores. A multiple regression was performed for serum ferritin and R2 was 0.123 (p < 0.001). Area under the curve for serum ferritin and anemia was 0.436.ConclusionAnemia among rural primary school children in NCP cannot be well explained by routinely assessed socioeconomic characteristics which mainly provide clues to access for food. Commonly used anemia related investigations have low validity in detecting and explaining anemia in this population. Since behavioral factors have been shown to affect nutrition of younger children in Sri Lanka, studying weather behaviors are related to anemia in primary school children is important. Possible etiologies including but not limited to nutritional deficiencies need to be studied further.

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

“…In the current study, our initial analysis found a negative association between anaemia (i.e., anaemia and normocytic anaemia) and overweight/obesity in contrast to previous studies, some of which failed to report any association between anaemia and overweight/obesity [43,44,45], whereas others detected a positive association between Hb concentration and BMI [43,44]. To further examine the correlation between Hb concentration and BMI among children in the current study, we performed an additional analysis and also found a significant positive relationship between Hb and BMI-for-age z-score.…”

“…In contrast, we found no association between anaemia and any of the selected socio-economic factors investigated such as maternal employment, maternal education, or household income, findings in accordance with Alelign et al’s study in Ethiopian children [49]. In our additional analyses, we also found no association between Hb and selected socio-economic factors, in contrast to Amarasinghe et al who reported a significant positive relationship between parental education and Hb concentrations of Sri Lankan children [44]. Similarly, although not statistically significant, children of mothers with better education also had higher Hb concentrations in our study.…”

“…Similarly, although not statistically significant, children of mothers with better education also had higher Hb concentrations in our study. However, the lack of statistical significance in our analysis might have resulted from a small number of mothers who reported their education level, i.e., 678 out of 893 mothers compared to 4412 parents from the study by Amarasinghe et al [44], which might have been insufficient to detect the association. Therefore, further research is necessary to understand the relationship between anaemia and socio-economic conditions in Vietnam, which may include other socio-economic factors not investigated in this study.…”

Iron status and prevalence of anaemia among school children in the Jaffna district

“…Overall prevalence of anaemia in this study was 27.9% and Thenmaradchi zone had a significantly higher prevalence than other zones. A similar study in the North Central Province among 4460 primary school children showed an overall prevalence of anaemia of 17.3% 13 . This shows that there is a difference in the prevalence of anaemia between northern and north central province indicating that the demographic factor has a role in the prevalence.…”

“…(Table 4) Mild anaemia was seen in 22.7% and moderate anaemia in 4.1% of the study population. The cross sectional study done in North Central Province found mild and moderate anaemia in 9.4% and 7.6% of children respectively 13 . Prevalence of anaemia among school children aged 5-19 years in Ethiopia in 2017 was 23% and among them 61%, 21% and 11% had mild, moderate, and severe anaemia respectively 16 .…”