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Anaemia in infancy in rural Bangladesh: contribution of iron deficiency, infections and poor feeding practices

  • Rahul Rawat (a1), Kuntal Kumar Saha (a2), Andrew Kennedy (a1), Fabian Rohner (a3), Marie Ruel (a1) and Purnima Menon (a4)...

Abstract

Few data exist on the aetiology of anaemia and Fe deficiency (ID) during early infancy in South Asia. The present study aimed to determine the contribution of ID, infections and feeding practices to anaemia in Bangladeshi infants aged 6–11 months. Baseline data from 1600 infants recruited into a cluster-randomised trial testing the effectiveness of micronutrient powder sales by frontline health workers on the prevalence of anaemia were used. Multivariate logistic regression was used to identify risk factors for anaemia and ID, and population attributable fractions (PAF) were computed to estimate the proportion of anaemia that might be prevented by the elimination of individual risk factors. It was found that 68 % of the infants were anaemic, 56 % were Fe deficient, and one-third had evidence of subclinical infections. The prevalence of anaemia and ID increased rapidly, until 8–9 months of age, while that of subclinical infections was constant. ID (adjusted OR (AOR) 2·6–5·0; P< 0·001) and subclinical infections (AOR 1·4–1·5; P< 0·01) were major risk factors for anaemia, in addition to age and male sex. Similarly, subclinical infections, age and male sex were significant risk factors for ID. Previous-day consumption of Fe-rich foods was very low and not associated with anaemia or ID. The PAF of anaemia attributable to ID was 67 % (95 % CI 62, 71) and that of subclinical infections was 16 % (95 % CI 11, 20). These results suggest that a multipronged strategy that combines improvements in dietary Fe intake alongside infection control strategies is needed to prevent anaemia during infancy in Bangladesh.

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Copyright

COPYRIGHT: © The Authors 2013 

Corresponding author

* Corresponding author: Dr R. Rawat, email r.rawat@cgiar.org

References

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1 WHO (2007) Assessing the Iron Status of Populations: Including Literature Reviews, 2nd ed. Geneva: World Health Organization/Centers for Disease Control and Prevention.
2 WHO (2008) Worldwide Prevalence of Anaemia 1993–2005: WHO Global Database on Anaemia. Geneva: World Health Organization.
3 Stoltzfus, RJ, Chwaya, HM, Montresor, A, et al. (2000) Malaria, hookworms and recent fever are related to anemia and iron status indicators in 0- to 5-y old Zanzibari children and these relationships change with age. J Nutr 130, 1724–1733.
4 Lozoff, B (2007) Iron deficiency and child development. Food Nutr Bull 28, S560–S571.
5 Lozoff, B, Brittenham, GM, Wolf, AW, et al. (1988) Iron deficiency anemia and iron therapy effects on infant developmental test performance. Pediatrics 79, 981–995.
6 Beard, JL (2001) Iron-deficiency anemia: reexamining the nature and magnitude of the public health problem: iron biology in immune function, muscle metabolism and neuronal functioning. J Nutr 131, 568S–580S.
7 Horton, S & Ross, J (2003) The economics of iron deficiency. Food Policy 28, 51–75.
8 Domellöf, M (2011) Iron requirements in infancy. Ann Nutr Metab 59, 59–63.
9 Weiss, G & Goodnough, LT (2005) Anemia of chronic disease. N Engl J Med 352, 1011–1023.
10 Nemeth, E & Ganz, T (2006) Regulation of iron metabolism by hepcidin. Ann Rev Nutr 26, 323–342.
11 Institute of Public Health Nutrition (2007) National Strategy for Anaemia Prevention and Control in Bangladesh. Dhaka: Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh.
12 UNICEF (1990) UNICEF Strategy for Improved Nutrition of Children and Women in Developing Countries. New York, NY: UNICEF.
13 Erhardt, JG, Estes, JE, Pfeiffer, CM, et al. (2004) Combined measurement of ferritin, soluble transferrin receptor, retinol binding protein, and C-reactive protein by an inexpensive, sensitive, and simple sandwich enzyme-linked immunosorbent assay technique. J Nutr 134, 3127–3132.
14 Cogill, B (2003) Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical Assistance Project (FHI 360).
15 WHO (2008) Indicators for Assessing Infant and Young Child Feeding Practices: Conclusions of a Consensus Meeting, 6–8 November 2007, Washington, DC.
16 Thurnham, DI, Mburu, ASW, Mwaniki, DL, et al. (2005) Micronutrients in childhood and the influence of subclinical inflammation. Proc Nutr Soc 64, 502–509.
17 WHO (2011) Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva: World Health Organization.
18 Thurnham, DI, Mccabe, LD, Haldar, S, et al. (2010) Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr 92, 546–555.
19 WHO Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards: Length/height-for-age, Weight-for-age, Weight-for-length, Weight-for-height and Body Mass Index-for-age: Methods and Development. Geneva: World Health Organization.
20 Eneroth, H, Persson, L-Å, El Arifeen, S, et al. (2011) Infant anaemia is associated with infection, low birth weight and iron deficiency in rural Bangladesh. Acta Paediatr 100, 220–225.
21 Shakur, YA, Choudhury, N, Hyder, SMZ, et al. (2009) Unexpectedly high early prevalence of anaemia in 6-month-old breast-fed infants in rural Bangladesh. Public Health Nutr 13, 4–11.
22 Siegel, EH, Stoltzfus, RJ, Khatry, SK, et al. (2006) Epidemiology of anemia among 4- to 17-month children living in south central Nepal. Eur J Clin Nutr 60, 228–235.
23 Dewey, KG (2001) Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am 48, 87–104.
24 Meinzen-derr, JK, Guerrero, ML, Altaye, M, et al. (2006) Risk of infant anemia is associated with exclusive breast-feeding and maternal anemia in a Mexican cohort. J Nutr 136, 452–458.
25 Kimmons, JE, Dewey, KG, Haque, E, et al. (2005) Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr 135, 444–451.
26 Rasheed, S, Haider, R, Hassan, N, et al. (2011) Why does nutrition deteriorate rapidly among children under 2 years of age? Using qualitative methods to understand community perspectives on complementary feeding practices in Bangladesh. Food Nutr Bull 32, 192–200.
27 Domellof, M, Lonnerdal, B, Dewey, KG, et al. (2002) Sex differences in iron status during infancy. Pediatrics 110, 545–552.
28 Miller, MF, Stoltzfus, RJ, Mbuya, NV, et al. (2003) Total body iron in HIV-positive and HIV-negative Zimbabwean newborns strongly predicts anemia throughout infancy and is predicted by maternal hemoglobin concentration. J Nutr 133, 3461–3468.
29 Yang, Z, Lo, B, Adu-Afarwuah, S, et al. (2009) Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: comparison of data from 6 studies. Am J Clin Nutr 89, 1433–1440.
30 Wieringa, FT, Berger, J, Dijkhuizen, MA, et al. (2007) Sex differences in prevalence of anaemia and iron deficiency in infancy in a large multi-country trial in South-East Asia. Br J Nutr 98, 1070–1076.
31 Haddad, L, Pena, C, Nishida, C, et al. (1996) Food Security and Nutrition Implications of Intra-household Bias: A Review of Literature. FCND Discussion Paper no. 19. Washington, DC: International Food Policy Research Institute .
32 Stoltzfus, RJ (2011) Iron interventions for women and children in low-income countries. J Nutr 141, 756S–762S.
33 Stoltzfus, RJ & Dreyfuss, M (1998) Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. Washington, DC: International Nutritional Anemia Consultative Group.
34 Gera, T, Sachdev, HS & Boy, E (2012) Effect of iron-fortified foods on hematologic and biological outcomes: systematic review of randomized controlled trials. Am J Clin Nutr 96, 309–324.
35 Dewey, KG & Adu-afarwuah, S (2008) Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr 4, 24–85.
36 De-Regil, LM, Suchdev, PS, Vist, GE, et al. (2011) Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database of Systematic Reviews 2011, issue 9 CD008959.
37 Olney, DK, Rawat, R & Ruel, MT (2012) Identifying potential programs and platforms to deliver multiple micronutrient interventions. J Nutr 142, 178S–185S.
38 Humphrey, JH (2009) Child undernutrition, tropical enteropathy, toilets, and handwashing. Lancet 19, 1032–1035.
39 Prendergast, A & Kelly, P (2012) Enteropathies in the developing world: neglected effects on global health. Am J Trop Med Hyg 86, 756–763.

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  • Cited by 12

  • Access

Anaemia in infancy in rural Bangladesh: contribution of iron deficiency, infections and poor feeding practices

  • Rahul Rawat (a1), Kuntal Kumar Saha (a2), Andrew Kennedy (a1), Fabian Rohner (a3), Marie Ruel (a1) and Purnima Menon (a4)...

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