Is Infant/Toddler Anemia a Problem across Rural China? A Mixed-Methods Analysis

Abstract

In the past, iron-deficiency anemia in children has had a widespread presence in rural China. Given the recent economic growth in China, it is unclear if anemia among infants/toddlers remains a problem. The objective of this study is to measure the anemia rate in rural Chinese infants/toddlers across four major subpopulations and attempt to discover the sources of anemia. We use a mixed-methods approach combining quantitative data on 2909 rural Chinese infants/toddlers and their families with qualitative interviews with 84 caregivers of infants aged 6 to 30 months. Quantitative analysis indicates that the overall prevalence of anemia (43%) within sampled infants/toddlers was high, especially in comparison to the low rates of stunting (2–5%), being underweight (2%), and wasting (2–4%). These findings suggest that in rural China, anemia stems from the poor quality of the diets of infants/toddlers, rather than insufficient quantities of food being consumed. Qualitative analysis illustrates the factors that are contributing to anemia. Caregivers do not understand the causes of this condition, the symptoms that would lead one to recognize this condition, or the steps needed to treat their child with this condition. The findings offer a comprehensive understanding of the limited awareness of anemia among rural Chinese caregivers.

Dynamic Anemia Status from Infancy to Preschool-Age: Evidence from Rural China

“…The results demonstrate that the prevalence of anemia is high among rural infants (51%) and toddlers (24%). Such findings are consistent with previous studies in rural China, which have similarly found high rates of anemia among children under age three [13,14,15,21]. As the children in our sample reached preschool age, hemoglobin concentrations gradually rose, and the prevalence of anemia decreased slightly to 19%.…”

“…In contrast, the results find no associations between dynamic anemia status and any household socioeconomic characteristics, including maternal age, maternal educational level and family asset index. This finding is similar to the quantitative results of a mixed-methods study of children in rural China, which found no significant relationships between socioeconomic variables and the prevalence of anemia [21]. According to the qualitative results of the study, the reason for this lack of significant correlation is that, regardless of socioeconomic status, most rural caregivers have a poor understanding of anemia and of how to prevent or treat anemia in children [21].…”

“…The majority of sample mothers (85%) had completed 9 years of schooling or less, which means only 15% of sample mothers had attained any high school education. The mean of family asset index was −0.07, which is slightly higher than that found in previous studies of western rural areas in China (−0.19) [21].…”

“…Additionally, although international studies have found a natural downward trend in anemia rates as children grow older [17,18,19,20], the prevalence of anemia remains high among China’s rural toddlers. A study of China’s major rural sub-populations, which altogether represent 69% of rural families in China, found that 30% of toddlers aged 18–30 months suffered from anemia [21]. Another nationally-representative study found that 32% of toddlers aged 12–23 months and 18% of toddlers aged 24–35 months in poor rural areas suffered from anemia [13].…”

Dietary pattern and its’ association with anemia among infants aged 6-23 months in central-south China. 

“…The hemoglobin concentration was detected by using hemoglobin machine which made from Hemocue AB Company of Sweden with model hemocue 301.The result was expressed in g/dL. The cut off points for anemia were: for children aged 6 to 23 months, normal Hb levels≥11.0 g/dL, anemia<11.0 g/dL [18].…”