Prevalence and Indicator Anemia in Children Indian

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1. Prevalence and predictors of anemia in a population of North Indian children............................................ 1

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Prevalence and predictors of anemia in a population of North Indian children

Author: Kumar, Tivendra; Taneja, Sunita; Yajnik, Chittaranjan S; Bhandari, Nita; Strand, Tor A

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Abstract: Objective

Anemia is an important health concern worldwide, particularly in poor populations such as in India. The

objective of this study was to determine the prevalence and predictors of anemia and iron status.

Methods

One thousand children ages 6 to 30 mo were included in a study undertaken in low- to middle-income

neighborhoods in New Delhi, India. Children of Tigri and Dakshinpuri were identified through a community

survey. Plasma concentrations of hemoglobin (Hb), soluble transferrin receptor (sTfR), folate, vitamin B12, and

total homocysteine (tHcy) were measured. Predictors for plasma Hb concentration were identified in multiple

linear regression models and considered significant ifP-value


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childhood infections. The results of the study have been published elsewhere[17]

.

Procedures

By means of a door-to-door survey, 1377 children ages 6 to 30 mo of either sex were identified and 1000 were

enrolled in the study between January 2010 and September 2011[17]

. Children with severe systemic illness

requiring hospitalization, severe malnutrition (weight for height z score [WHZ]


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the study design and procedures. Plain-language statements explaining the study were provided to and written

informed consent was obtained from the guardians of all child participants involved in the study. Information

consent forms were translated in a simple local language (Hindi) and those who were unable to read, the staff

obtaining consent read out the information sheet in the presence of an impartial literate witness and those who

were unable to sign, a thumb imprint was taken, witnessed (countersigned) by an impartial literate witness. If

the caregiver wanted to keep a copy of the form to show to other literate family members before consenting, a

copy was left with the caregiver and the caregiver was asked to come on next day for consenting.

Statistical analysis

The forms used for data collection were designed in visual basic.net in computer[26]

. Double data entry by two

data entry clerks followed by validation was completed within 72 h. Range and consistency checks were

incorporated. Continuous variables were reported as means or medians and categorical variables as

proportions in the baseline table. The statistical analyses were performed with Stata, version 12 (StataCorp,

College Station, TX, USA).

Linear regression was used to identify predictors for Hb concentration. The associations were first evaluated in

crude linear regression models and then in multiple-regression models in a stepwise process. Variables were

retained in the multiple regression models if the P-value for their coefficient remained


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3, the most saturated model, the variables that were significantly associated with Hb concentration were as

follow: Plasma sTfR (, -0.49; P


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1000 children in whom we undertook the biochemical analyses (Table 2

). Almost one-third had a folate

concentration


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professionals and workers, as well as caregivers need to be involved.

Conclusion

Improving iron status is probably the most important measure toward reducing the burden of anemia. Improving

the intake of other nutrients such as folate and vitamin B12 is also likely to be important. However, the role of

these nutrients in anemia needs to be verified in other populations within and outside India.

Acknowledgments

We acknowledge the input from Professor Halvor Sommerfelt and Mari Skar Manger at Centre for International

Health, University of Bergen, Norway, as well as from Gagandeep Kang, The Wellcome Trust Research

Laboratory, Department of Gastrointestinal Sciences and Professor Ratnasamy Selvakumar, Department of

Biochemistry from Christian Medical College, Vellore, India, and also from Dattatray S. Bhat from Diabetes Unit,

King Edward Memorial Hospital, Rasta Peth, Pune for biochemical analysis. We also gratefully acknowledge the

participants and their families for their participation in the study. The study was supported by the Thrasher

Research Fund (Project 9144) (USA) and Research Council of Norway (Norway) (Project no. 172226).

Variables n Mean SD

Child characteristics 1000

Age (mo) 16.1 7

6-11 mo (%) 321 32.1

12-23 mo (%) 484 48.4

24-30 mo (%) 195 19.5

Boys (%) 507 50.7

Breastfed (%) 723[low *] 72.3

Family situation

Annual income (median/IQR) (INR) 75500 60 000-144 000

Families who own color TV, scooter, or cooler (%) 882 88.2

Maternal characteristics[dagger]

Age 25.8 4

Years of schooling 6.7 5

Mothers who work (%) 86 8.6

Paternal characteristics

Years of schooling 8.8 4

Fathers who work (%)[dagger] 980 98.1

Household characteristics

Nuclear family (%) 537 53.7

Family size (median/IQR) 5 4-7

Nutritional status

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Weight (kg) 8.5 2

Length (cm) 74.2 7

Z score weight for length (wasted),


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- - -Members in the

householdNumber

- - - Maternal age Years

- - -Maternal working

status-

0 = Not working 1 = Working - Father working status -

0 = Not working 1 = Working -Weight-for-length Z

score (WHZ)Z scores

- - -Length-for-age Z score

(HAZ)Z scores

- - -Weight-for-age Z score

(WAZ)Z scores

- - -Annual family income

(INR)

Log-

transformed

- - - Family type -

3 = Nuclear 4 = Joint -Family assets (color

TV, cooler, or scooter)-

1 = Yes 2 = No -

Diarrheal illness

(prevalence in last 24

h)

-

1 = Yes 2 = No - Hb concentration Unit

- - -Plasma folate

concentration

Log-

transformed

- - -Plasma vitamin B12

concentration

Log-

transformed

- - -Plasma tHcy

concentration

Log-

transformed

- - - Plasma sTfRconcentration

Log-transformed

VariablesMode

l 1

Model

2[low *]

Model

3[low *]Coef 95% CI

P-

valu

e

Coef 95% CI

P-

valu

e

Coef95%

CIP-value

Child

characteri

stics

Age

6-11 mo Ref



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Ref 12-23 mo-

0.48

-0.68 to -

0.28


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Subject:Anemia; Iron; Medical research; Ethics; Studies; Population; Homocysteine; Plasma; Confidence

intervals; Questionnaires; Socioeconomic factors; Preschool children;

Location: India

Corporate institutional author: Study Group

Publication title: Nutrition

Volume: 30

Issue: 5

Pages: 531-7

Publication year: 2014

Publication date: May 2014

Year: 2014

Publisher: Elsevier Science Ltd.

Place of publication: Kidlington

Country of publication: United Kingdom

Publication subject: Nutrition And Dietetics

ISSN: 08999007

Source type: Scholarly Journals

Language of publication: English



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Document type: Journal Article

DOI: http://dx.doi.org/10.1016/j.nut.2013.09.015

Accession number: 24560137

ProQuest document ID: 1511613465

Document URL: http://search.proquest.com/docview/1511613465?accountid=49910

Copyright: Copyright Elsevier Limited May 2014

Last updated: 2014-05-13

Database: ProQuest Medical Library,ProQuest Nursing & Allied Health Source

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Prevalence and Indicator Anemia in Children Indian

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