Determinants of anemia among 6–59 months aged children in Bangladesh: evidence from nationally representative data
Khan et al. BMC Pediatrics
Determinants of anemia among 6-59 months aged children in Bangladesh: evidence from nationally representative data
Jahidur Rahman Khan 2
Nabil Awan 1
Farjana Misu 0
0 Department of Agricultural Statistics, Bangladesh Agricultural University , Mymensingh , Bangladesh
1 Institute of Statistical Research and Training, University of Dhaka , Dhaka , Bangladesh
2 Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research , Bangladesh (icddr, b), Dhaka , Bangladesh
Background: Anemia is a global public health problem but the burden of anemia is disproportionately borne among children in developing countries. Anemia in early stages of life has serious consequences on the growth and development of the children. We examine the prevalence of anemia, possible association between anemia and different socio-economic, demographic, health and other factors among children with ages from 6 to 59 months from the nationally representative 2011 Bangladesh Demographic and Health Survey (BDHS). Methods: Data on hemoglobin (Hb) concentration among the children aged 6-59 months from the most recent BDHS (2011) were used. This nationally representative survey allowed a multistage stratified cluster sampling design and provided data on a wide range of indicators such as fertility, mortality, women and child health, nutrition and other background characteristics. Anemia status was determined using hemoglobin level (<11.0 g/dl), and weighted prevalence of childhood anemia along with 95 % confidence intervals were provided. We also examined the distribution of weighted anemia prevalence across different groups and performed logistic regression to assess the association of anemia with different factors. Results: A total of 2171 children aged 6-59 months were identified for this analysis, with weighted prevalence of anemia being 51.9 % overall- 47.4 % in urban and 53.1 % in rural regions. Results of a multivariable logistic regression analysis showed that, children below 24 months of age (odds ratio, [OR] 3.01; 95 % confidence interval [CI] 2.38-3.81), and those from an anemic mother (OR 1.80; 95 % CI 1.49-2.18) were at higher risk of anemia. Childhood anemia was significantly associated with chronic malnutrition of child, source of drinking water, household wealth and geographical location (defined by division). Conclusions: A high prevalence of anemia among 6-59 months aged children was observed in Bangladesh. Given the negative impact of anemia on the development of children in future, there is an urgent need for effective and efficient remedial public health interventions.
Anemia; 6-59 months; Children; Determinants; Bangladesh
Background
Anemia is a prevalent public health problem which
affects about a quarter of the world population [
1
], notably
pre-school aged (PreSAC) children with global
prevalence in the 0–5 year-old age group rising to 47.4 % [
2
].
According to World Health Organization (WHO)
criteria, anemia ranks as a severe public health problem
(defined as a prevalence of ≥ 40 %). Anemia can
adversely affect cognitive advancement, performance in
school, physical and behavioral growth, and
immunization ability of children against disease [
3–6
]. It
remains a major cause of mortality and morbidity in
developing countries where resources to determine the
underlying etiology remain poor [3]. According to
WHO, Africa has the highest anemia prevalence overall
for PreSAC, non-pregnant and pregnant women, where
the Asian region shows the highest number of people
being affected with 58 % of the anemia burden exists for
PreSAC [
2
]. According to recent information from the
South Asian region, the prevalence of anemia among
children 6–35 months aged was about 79 % in India. In
Nepal, the prevalence among children <5 years was
46 %. The national overall prevalence of Anemia in
Bangladesh was approximately 51 % in 2011 [
7
].
Anemia in children is of particular interest since it can
negatively and irreversibly impact their future
development. Although the etiology of anemia among children
is multi-factorial, the most significant correlates to the
onset of childhood anemia is iron deficiency with a
smaller proportion due to deficiencies of such
micronutrients as folate, Vitamin A and B12 [
8–10
]. Prevalence
of iron deficiency anemia in developing countries varies;
Villalpando notes it is frequently four times higher than
in developed countries [
8
].
Several surveys in the past have shown that anemia is
a severe problem in Bangladesh among children. In
Bangladesh, prevalence of anemia varied across the
different surveys which were focused on slightly different
populations. According to the Nutritional Surveillance
Project (NSP), prevalence of anemia was 47 % in 2001
and 68 % in 2004 among 6–59 months aged children
[
11
]. Anemia tends to reduce with age, and another
study notes 64 % prevalence in children aged 6–23
months, and 42 % in children aged (...truncated)