Social Costs of Iron Deficiency Anemia in 6–59-Month-Old Children in India

Plessow, Rafael; Arora, Narendra K.; Brunner, Beatrice; Tzogiou, Christina; Eichler, Klaus; Brügger, Urs; Wieser, Simon

doi:10.1371/journal.pone.0136581

Cited by 54 publications

(51 citation statements)

References 25 publications

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“…Considering that coverage of ICDS preschool beneficiaries in Telangana State is 654,165 (http://wdcw.tg.nic.in/), the additional expenditure for inclusion of guava in the SNP meal would cost about ₹523,332 (∼$7476.17). A more detailed cost–benefit analysis in terms of disability‐adjusted life years lost due to IDA can be done once the impact of the intervention is known.…”

Section: Discussionmentioning

confidence: 99%

A food synergy approach in a national program to improve the micronutrient status of preschoolers: a randomized control trial protocol

Choudhury

Nair

Balakrishna

et al. 2018

Annals of the New York Academy of Sciences

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Iron deficiency anemia (IDA) is a significant public health issue in India affecting nearly all vulnerable segments of the population. Causes of IDA include low consumption of iron-rich foods combined with poor iron bioavailability of nonheme iron sources. To date, interventions aimed at correcting IDA focus on increasing iron intake through iron supplementation or fortification strategies. In contrast, dietary diversification is a long-term sustainable approach to improve bioavailable iron intake. In this context, the inclusion of vitamin C-rich fruits in the regular diet has proven to improve iron absorption, but the effect on iron status is inconclusive. Considering the ongoing national program for preschoolers in India, we designed a cluster randomized controlled trial (RCT) to test the hypothesis that inclusion of vitamin C-rich fruit in a regular meal would improve iron absorption and lead to better child iron and micronutrient status, cognitive development, gut health, and growth while reducing morbidity. This paper illustrates a context-specific framework and activities to design and functionalize an open-label, three-arm cluster RCT to test a specific hypothesis. The results of this designed trial should generate evidence to inform policy on the effect of a food-based intervention on iron status.

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Section: Discussionmentioning

confidence: 99%

A food synergy approach in a national program to improve the micronutrient status of preschoolers: a randomized control trial protocol

Choudhury

Nair

Balakrishna

et al. 2018

Annals of the New York Academy of Sciences

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“…Infants younger than 6 months were excluded due to lack of data. The model is an extension of a previously published model 7,8 to Pakistan and additionally integrates the consequences of IoD and xerophthalmia as a consequence of VAD. Step 1 stratifies 6-to 59-month-old Pakistani children in 20 groups (by age-group and socioeconomic status).…”

Section: Methodsmentioning

confidence: 99%

Societal Costs of Micronutrient Deficiencies in 6- to 59-month-old Children in Pakistan

et al. 2017

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Background: In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development. Objective: To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months. Methods: We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and disability-adjusted life-years (DALYs). The estimation is based on large population surveys, information on the health consequences of micronutrient deficiencies extracted from randomized trials, and a variety of other sources. Results: Total societal costs amount to US$46 million in medical costs, US$3,222 million in production losses, and 3.4 million DALYs. Costs are dominated by the impaired cognitive development induced by iron-deficiency anemia in 6-to 23-month-old children and the mortality caused by vitamin A deficiency. Costs are substantially higher in poorer households. Conclusions: Societal costs amounted to 1.44% of gross domestic product and 4.45% of DALYs in Pakistan in 2013. These costs hinder the country's development. They could be eliminated by improved nutrition of 6-to 59-month-old children and public health measures. Our results may contribute to the design of cost-effective interventions aiming to reduce micronutrient deficiencies in early childhood and their lifetime consequences.

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“…Plessow et al estimated that over one percent of the Indian Gross Domestic Product (GDP) is lost every year due to Iron Deficiency Anemia among 6-59-month-old children. In addition, it causes over 8 million Disability Adjusted Life Years (DALYs) lost and affects disproportionally younger infants from lower wealth households (4). Over 95 % of this economic and 80% of the health burden was linked to children 6 to 23 months of age.…”

Section: Introductionmentioning

confidence: 99%

Association between Anemia in Children 6 to 23 Months Old and Child, Mother, Household and Feeding Indicators

Prieto-Patrón¹,

Horst²,

Hutton³

et al. 2018

Preprint

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In Low and Lower-Middle-Income countries, the prevalence of anemia in infancy remains high. In early childhood anemia cause irreversible cognitive deficits and represents a higher risk of child mortality. The consequences of anemia in infancy are a major barrier to overcome poverty traps. The aim of this study was to analyze based on a multi-level approach, different factors associated with anemia in children 6–23 m old based on recent available Standard Demographic Health Surveys (S-DHS). We identified 52 S-DHS that had complete information in all covariates of interest in our analysis between 2005 and 2015. We performed traditional logistic regressions and multilevel logistic regression analyses to study the association between hemoglobin concentrations and household, child, maternal, socio-demographic variables. In our sample, 70 % of the 6–23 m old children were anemic. Child anemia was strongly associated with maternal anemia, household wealth, maternal education and low birth weight. Children fed with fortified foods, potatoes and other tubers had significantly lower rates of anemia. Improving overall household living conditions, increasing maternal education, delaying childbearing and introducing iron rich foods at six months of age may reduce the likelihood of anemia at in toddlerhood.

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Social Costs of Iron Deficiency Anemia in 6–59-Month-Old Children in India

Cited by 54 publications

References 25 publications

A food synergy approach in a national program to improve the micronutrient status of preschoolers: a randomized control trial protocol

A food synergy approach in a national program to improve the micronutrient status of preschoolers: a randomized control trial protocol

Societal Costs of Micronutrient Deficiencies in 6- to 59-month-old Children in Pakistan

Association between Anemia in Children 6 to 23 Months Old and Child, Mother, Household and Feeding Indicators

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