Determinants of anemia among 6–59 months aged children in Bangladesh: evidence from nationally representative data

BMC Pediatrics, Jan 2016

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.

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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)


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Jahidur Khan, Nabil Awan, Farjana Misu. Determinants of anemia among 6–59 months aged children in Bangladesh: evidence from nationally representative data, BMC Pediatrics, 2016, pp. 3, 16, DOI: 10.1186/s12887-015-0536-z