학술논문
The Risk Factors for Child Anemia Are Consistent across 3 National Surveys in Nepal
ORIGINAL RESEARCH
ORIGINAL RESEARCH
Document Type
Report
Author
Source
Current Developments in Nutrition. June 2021, Vol. 5 Issue 6, p1c, 15 p.
Subject
Language
English
ISSN
2475-2991
Abstract
Introduction Although the global prevalence of anemia has declined since the 1990s, it remains a major public health problem affecting 27% of the world's population (1). Moreover, progress made in [...]
Background: Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue. Objectives: This study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013 to 2016 in Nepal. Methods: Same-season national surveys were administered in 2013, 2014, and 2016 in 63 sites across 21 districts, selected using multistage random sampling, representing the mountains, hills, and Tarai (plains). Among consenting households with children aged 6-59 mo, a random sample of capillary blood was selected each year for anemia assessment using an Hb 201 + hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin Results: The national prevalence of child anemia decreased from 63.3% (95% CI: 59.0%, 67.5%) in 2013 to 51.9% (95% CI: 46.5%, 57.2%) in 2014 and increased to 59.3% (95% CI: 54.7%, 63.8%) in 2016. Across years, prevalence was highest in the Tarai (58.4-70.2%), followed by the mountains (53.0-61.1%) and hills (37.5-51.4%). Nationally and across time, child age and maternal anemia were significantly associated with child anemia. Child diarrhea and stunting, maternal thinness, and poor water and sanitation conditions also showed consistent trends toward higher anemia prevalence. Conclusions: Anemia affects more than half of Nepalese children aged 6-59 mo. Although prevalence varies year to year, the stability of observed risk factors suggests the need to focus on reducing gastrointestinal infection, promoting adequate household sanitation, and improving maternal and child health. Curr Dev Nutr 2021;5:nzab079 Keywords: children, anemia, Nepal, risk factors, nutrition C The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the origina work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Manuscript received December 23, 2020. Initial review completed April 8, 2021. Revision accepted May 5, 2021. Published online May 21, 2021. This study was carried out as part of the Feed the Future Innovation Lab for Nutrition, which is funded by the United States Agency for International Development under grant number AID-OAA-L-1-00005, with additional assistance from the Sight and Life Global Nutrition Research Institute, Baltimore, MD and the Bill & Melinda Gates Foundation, Seattle, WA. Design of the study was undertaken by the Johns Hopkins University investigative team; funders did not have any roles in the design, implementation, or analysis of this study. Author disclosures: The authors report no conflicts of interest. Supplemental Tables 1-6 are available from the "Supplementary data" link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/cdn/. Address correspondence to MMP (e-mail: mpasqua2@jhmi.edu). Abbreviations used: APR, adjusted prevalence ratio; DHS, Demographic and Health Surveys; Hb, hemoglobin; LMIC, low- and middle-income countries; MDD-W, Minimum Dietary Diversity for Women; MUAC, midupper arm circumference; NNMS, Nepal National Micronutrient Survey; PoSHAN, Policy and Science for Health, Agriculture and Nutrition; VDC, village development community; WASH, water, sanitation, and hygiene.
Background: Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue. Objectives: This study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013 to 2016 in Nepal. Methods: Same-season national surveys were administered in 2013, 2014, and 2016 in 63 sites across 21 districts, selected using multistage random sampling, representing the mountains, hills, and Tarai (plains). Among consenting households with children aged 6-59 mo, a random sample of capillary blood was selected each year for anemia assessment using an Hb 201 + hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin Results: The national prevalence of child anemia decreased from 63.3% (95% CI: 59.0%, 67.5%) in 2013 to 51.9% (95% CI: 46.5%, 57.2%) in 2014 and increased to 59.3% (95% CI: 54.7%, 63.8%) in 2016. Across years, prevalence was highest in the Tarai (58.4-70.2%), followed by the mountains (53.0-61.1%) and hills (37.5-51.4%). Nationally and across time, child age and maternal anemia were significantly associated with child anemia. Child diarrhea and stunting, maternal thinness, and poor water and sanitation conditions also showed consistent trends toward higher anemia prevalence. Conclusions: Anemia affects more than half of Nepalese children aged 6-59 mo. Although prevalence varies year to year, the stability of observed risk factors suggests the need to focus on reducing gastrointestinal infection, promoting adequate household sanitation, and improving maternal and child health. Curr Dev Nutr 2021;5:nzab079 Keywords: children, anemia, Nepal, risk factors, nutrition C The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the origina work is properly cited. For commercial re-use, please contact journals.permissions@oup.com Manuscript received December 23, 2020. Initial review completed April 8, 2021. Revision accepted May 5, 2021. Published online May 21, 2021. This study was carried out as part of the Feed the Future Innovation Lab for Nutrition, which is funded by the United States Agency for International Development under grant number AID-OAA-L-1-00005, with additional assistance from the Sight and Life Global Nutrition Research Institute, Baltimore, MD and the Bill & Melinda Gates Foundation, Seattle, WA. Design of the study was undertaken by the Johns Hopkins University investigative team; funders did not have any roles in the design, implementation, or analysis of this study. Author disclosures: The authors report no conflicts of interest. Supplemental Tables 1-6 are available from the "Supplementary data" link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/cdn/. Address correspondence to MMP (e-mail: mpasqua2@jhmi.edu). Abbreviations used: APR, adjusted prevalence ratio; DHS, Demographic and Health Surveys; Hb, hemoglobin; LMIC, low- and middle-income countries; MDD-W, Minimum Dietary Diversity for Women; MUAC, midupper arm circumference; NNMS, Nepal National Micronutrient Survey; PoSHAN, Policy and Science for Health, Agriculture and Nutrition; VDC, village development community; WASH, water, sanitation, and hygiene.