Differences in factors associated with anemia in Haitian children from urban and rural areas

Ana M Palacios, Jeanne H Freeland-Graves, Sherlie Jean-Louis Dulience, Jacques Raymond Delnatus, Lora L Iannotti, Ana M Palacios, Jeanne H Freeland-Graves, Sherlie Jean-Louis Dulience, Jacques Raymond Delnatus, Lora L Iannotti

Abstract

Background: In Haiti, differences in the prevalence of anemia between urban and rural areas have been observed.

Objective: To identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti.

Methods: This cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5-13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect.

Results: In rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, ([Formula: see text] = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32-3.18)], age [AOR = 0.89; 95%CI (0.85-0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67-0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed.

Conclusions: In this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Map of Haiti that shows…
Fig 1. Map of Haiti that shows school locations in urban and rural areas.
Modified from Worldatlas.com.

References

    1. Central Intelligence Agency. The world factbook 2016–17 Washington, DC: Central Intelligence Agency; [cited 2016]. Available from:
    1. World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva, Switzerland: WHO/NMH/NHD/MNM; 2011.
    1. Institut Haïtien de l’Enfance, ICF. Enquête mortalité, morbidité et utilisation des services (EMMUS-VI 2016–2017) Pétion-Ville, Haïti, et Rockville, Maryland, USA: IHE et ICF; 2018. Available from: .
    1. Mujica-Coopman MF, Brito A, Lopez de Romana D, Rios-Castillo I, Coris H, Olivares M. Prevalence of anemia in Latin America and the Caribbean. Food Nutr Bull. 2015;36(2 Suppl):S119–28. Epub 2015/07/01. 10.1177/0379572115585775 .
    1. Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, et al.. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382:525–34. 10.1016/S0140-6736(13)60103-8
    1. Perignon M, Fiorentino M, Kuong K, Burja K, Parker M, Sisokhom S, et al.. Stunting, poor iron status and parasite infection are significant risk factors for lower cognitive performance in Cambodian school-aged children. PLoS One. 2014;9(11):e112605. Epub 2014/11/19. 10.1371/journal.pone.0112605
    1. Halterman JS, Kaczorowski JM, Aligne CA, Auinger P, Szilagyi PG. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. 2001;107(6):1381–6. Epub 2001/06/05. 10.1542/peds.107.6.1381 .
    1. de Benoist B, McLean E, Egli I, Cogswell M. Worldwide prevalence of anaemia 1993–2005. World Health Organization, Centers for Disease Control and Prevention, 2008.
    1. Lam LF, Lawlis TR. Feeding the brain—The effects of micronutrient interventions on cognitive performance among school-aged children: A systematic review of randomized controlled trials. Clin Nutr. 2017;36(4):1007–14. Epub 2016/07/11. 10.1016/j.clnu.2016.06.013 .
    1. Van de Poel E, O’Donnell O, Van Doorslaer E. Are urban children really healthier? Evidence from 47 developing countries. Soc Sci Med. 2007;65(10):1986–2003. Epub 2007/08/19. 10.1016/j.socscimed.2007.06.032 .
    1. Paciorek CJ, Stevens GA, Finucane MM, Ezzati M, Nutrition Impact Model Study G. Children’s height and weight in rural and urban populations in low-income and middle-income countries: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(5):e300–9. Epub 2014/08/12. 10.1016/S2214-109X(13)70109-8
    1. Heidkamp RA, Ngnie-Teta I, Ayoya MA, Stoltzfus RJ, Mamadoultaibou A, Durandisse EB, et al.. Predictors of anemia among haitian children aged 6 to 59 months and women of childbearing age and their implications for programming. Food Nutr Bull. 2013;34(4):462–79. 10.1177/156482651303400411 .
    1. Iannotti LL, Delnatus JR, Odom AR, Eaton JC, Griggs JJ, Brown S, et al.. Determinants of anemia and hemoglobin concentration in haitian school-aged children. Am J Trop Med Hyg. 2015;93(5):1092–8. Epub 2015/09/08. 10.4269/ajtmh.15-0073
    1. Iannotti L, Dulience SJ, Joseph S, Cooley C, Tufte T, Cox K, et al.. Fortified snack reduced anemia in rural school-aged children of Haiti: a cluster-randomized, controlled trial. PLoS One. 2016;11(12):e0168121. Epub 2016/12/22. 10.1371/journal.pone.0168121
    1. Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006;64(5 Pt 2):S34–43; discussion S72-91. 10.1301/nr.2006.may.s34-s43
    1. Grantham-McGregor S, Cheung YB, Cueto S, Glewwe P, Richter L, Strupp B, et al.. Developmental potential in the first 5 years for children in developing countries. Lancet. 2007;369(9555):60–70. 10.1016/S0140-6736(07)60032-4
    1. Iannotti LL, Henretty NM, Delnatus JR, Previl W, Stehl T, Vorkoper S, et al.. Ready-to-use supplementary food increases fat mass and BMI in Haitian school-aged children. J Nutr. 2015;145(4):813–22. Epub 2015/02/11. 10.3945/jn.114.203182 .
    1. Institut Haitien de Statistique et d’Informatique (IHSI). Population totale, population de 18 ans et plus ménages et densités estimés en 2015, French, (Total population, population of 18 years and older, plus households and densities estimated in 2015) 2015 [updated March]. Available from:
    1. World Bank. Guatemala—nutrition at a glance. Washington DC: World Bank; 2011. Available from: .
    1. Household Dietary Diversity Score (HDDS) for Measurement of Household Food Access: Indicator Guide (v.2). [Internet]. Washington, D.C.; 2006
    1. Cohen AR, Seidl-Friedman J. HemoCue system for hemoglobin measurement. Evaluation in anemic and nonanemic children. Am J Clin Pathol. 1988;90(3):302–5. 10.1093/ajcp/90.3.302 .
    1. Cogill B, Food and Nutrition Technical Assistance Project. Anthropometric indicators measurement guide. Rev. ed. Washington, D.C.: Food and Nutritional Technical Assistance Project, Academy for Educational Development; 2003. 92 p. p.
    1. de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–7. Epub 2007/11/21. 10.2471/blt.07.043497
    1. World Health Organization. Multicentre Growth Reference Study Group. WHO child growth standards: growth velocity based on weight, length and head circumference: methods and development. Geneva2009
    1. Golzarri-Arroyo L, Oakes JM, Brown AW, Allison DB. Incorrect Analyses of Cluster-Randomized Trials that Do Not Take Clustering and Nesting into Account Likely Lead to p-Values that Are Too Small. Childhood obesity (Print). 2020;16(2):65–6. Epub 2020/02/23. 10.1089/chi.2019.0142
    1. Iglesias Vazquez L, Valera E, Villalobos M, Tous M, Arija V. Prevalence of anemia in children from Latin America and the Caribbean and effectiveness of nutritional interventions: systematic review and meta-analysis. Nutrients. 2019;11(1). Epub 2019/01/19. 10.3390/nu11010183
    1. Leininger LJ, Ziol-Guest KM. Reexamining the effects of family structure on children’s access to care: the single-father family. Health Serv Res. 2008;43(1 Pt 1):117–33. 10.1111/j.1475-6773.2007.00758.x .
    1. Ntshebe O, Channon AA, Hosegood V. Household composition and child health in Botswana. BMC Public Health. 2019;19(1):1621. Epub 2019/12/05. 10.1186/s12889-019-7963-y
    1. Esteve A, Florez-Paredes E. Families in Latin America: Dimensions, Diverging Trends, and Paradoxes. In: Carbone J, DeRose LF, Cahn NR, Wilcox WB, editors. Unequal Family Lives: Causes and Consequences in Europe and the Americas. Cambridge: Cambridge University Press; 2018. p. 40–65.
    1. Legason ID, Atiku A, Ssenyonga R, Olupot-Olupot P, Barugahare JB. Prevalence of anaemia and associated risk factors among children in north-western Uganda: a cross sectional study. BMC Hematol. 2017;17:10. Epub 2017/07/03. 10.1186/s12878-017-0081-0
    1. Palacios AM, Hurley KM, De-Ponce S, Alfonso V, Tilton N, Lambden KB, et al.. Zinc deficiency associated with anaemia among young children in rural Guatemala. Matern Child Nutr. 2020;16(1):e12885. Epub 2019/10/09. 10.1111/mcn.12885 .
    1. Heard HE. The Family Structure Trajectory and Adolescent School Performance: Differential Effects by Race and Ethnicity. Journal of Family Issues. 2007;28(3):319–54. 10.1177/0192513X06296307
    1. Bester S, Malan-Van Rooyen M. Emotional Development, Effects of Parenting and Family Structure on. In: Wright JD, editor. International Encyclopedia of the Social & Behavioral Sciences (Second Edition). Oxford: Elsevier; 2015. p. 438–44.
    1. Fay M. The urban poor in Latin America. Washington, D.C.: World Bank; 2005. xiii, 266 p. p.
    1. Smith JL, Brooker S. Impact of hookworm infection and deworming on anaemia in non-pregnant populations: a systematic review. Trop Med Int Health. 2010;15(7):776–95. Epub 2010/05/27. 10.1111/j.1365-3156.2010.02542.x
    1. Engle-Stone R, Aaron GJ, Huang J, Wirth JP, Namaste SM, Williams AM, et al.. Predictors of anemia in preschool children: biomarkers reflecting inflammation and nutritional determinants of Anemia (BRINDA) project. Am J Clin Nutr. 2017;106(Suppl 1):402S–15S. Epub 2017/06/16. 10.3945/ajcn.116.142323
    1. Kabaria CW, Gilbert M, Noor AM, Snow RW, Linard C. The impact of urbanization and population density on childhood Plasmodium falciparum parasite prevalence rates in Africa. Malar J. 2017;16(1):49. Epub 2017/01/28. 10.1186/s12936-017-1694-2
    1. Neiderud C-J. How urbanization affects the epidemiology of emerging infectious diseases. Infect Ecol Epidemiol. 2015;5(1):27060-. 10.3402/iee.v5.27060 .
    1. Lienhardt C. From exposure to disease: the role of environmental factors in susceptibility to and development of tuberculosis. Epidemiologic reviews. 2001;23(2):288–301. Epub 2002/08/24. 10.1093/oxfordjournals.epirev.a000807 .
    1. Penrose K, de Castro MC, Werema J, Ryan ET. Informal urban settlements and cholera risk in Dar es Salaam, Tanzania. PLoS Negl Trop Dis. 2010;4(3):e631. Epub 2010/03/20. 10.1371/journal.pntd.0000631
    1. WHO. WHO Housing and Health Guidelines. Geneva: World Health Organization; 2018.
    1. Shirley DT, Farr L, Watanabe K, Moonah S. A review of the global burden, new diagnostics, and current therapeutics for amebiasis. Open Forum Infect Dis. 2018;5(7):ofy161. Epub 2018/07/27. 10.1093/ofid/ofy161
    1. Champetier de Ribes G, Fline M, Desormeaux AM, Eyma E, Montagut P, Champagne C, et al.. [Intestinal helminthiasis in school children in Haiti in 2002]. Bull Soc Pathol Exot. 2005;98(2):127–32. Epub 2005/07/30. .
    1. Donohue RE, Cross ZK, Michael E. The extent, nature, and pathogenic consequences of helminth polyparasitism in humans: A meta-analysis. PLoS Negl Trop Dis. 2019;13(6):e0007455. Epub 2019/06/19. 10.1371/journal.pntd.0007455
    1. Vaumourin E, Vourc’h G, Gasqui P, Vayssier-Taussat M. The importance of multiparasitism: examining the consequences of co-infections for human and animal health. Parasit Vectors. 2015;8:545. Epub 2015/10/21. 10.1186/s13071-015-1167-9
    1. Rogawski ET, Guerrant RL. The burden of enteropathy and "subclinical" infections. Pediatr Clin North Am. 2017;64(4):815–36. Epub 2017/07/25. 10.1016/j.pcl.2017.03.003
    1. Ganz T. Anemia of Inflammation. N Engl J Med. 2019;381(12):1148–57. Epub 2019/09/19. 10.1056/NEJMra1804281 .
    1. Murphy SP, Allen LH. Nutritional importance of animal source foods. The Journal of Nutrition. 2003;133(11):3932S–5S. 10.1093/jn/133.11.3932S
    1. Hurrell RF, Reddy MB, Juillerat M, Cook JD. Meat protein fractions enhance nonheme iron absorption in humans. J Nutr. 2006;136(11):2808–12. Epub 2006/10/24. 10.1093/jn/136.11.2808 .
    1. Herrero M, Grace D, Njuki J, Johnson N, Enahoro D, Silvestri S, et al.. The roles of livestock in developing countries. Animal. 2013;7 Suppl 1:3–18. Epub 2012/11/06. 10.1017/S1751731112001954 .
    1. Leroy JL, Frongillo EA. Can interventions to promote animal production ameliorate undernutrition? J Nutr. 2007;137(10):2311–6. Epub 2007/09/22. 10.1093/jn/137.10.2311 .
    1. Jin M, Iannotti LL. Livestock production, animal source food intake, and young child growth: the role of gender for ensuring nutrition impacts. Soc Sci Med. 2014;105:16–21. Epub 2014/03/13. 10.1016/j.socscimed.2014.01.001 .
    1. Jones AD, Colecraft EK, Awuah RB, Boatemaa S, Lambrecht NJ, Adjorlolo LK, et al.. Livestock ownership is associated with higher odds of anaemia among preschool-aged children, but not women of reproductive age in Ghana. Matern Child Nutr. 2018;14(3):e12604. Epub 2018/04/03. 10.1111/mcn.12604
    1. Engle PL. Influences of mothers’ and fathers’ income on children’s nutritional status in Guatemala. Soc Sci Med. 1993;37(11):1303–12. 10.1016/0277-9536(93)90160-6 .
    1. Fischer Walker CL, Black RE. Functional indicators for assessing zinc deficiency. Food Nutr Bull. 2007;28(3 Suppl):S454–79. Epub 2007/11/09. 10.1177/15648265070283s305 .
    1. Harper KM, Mutasa M, Prendergast AJ, Humphrey J, Manges AR. Environmental enteric dysfunction pathways and child stunting: A systematic review. PLoS Negl Trop Dis. 2018;12(1):e0006205. Epub 2018/01/20. 10.1371/journal.pntd.0006205
    1. Nutritional Anemia. Kraemer K, Zimmermann M, editors. Basel, Switzerland: Sight and Life Press; 2007.
    1. Tran TD, Biggs B-A, Holton S, Nguyen HTM, Hanieh S, Fisher J. Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: a syndemic. Public Health Nutrition. 2019;22(1):35–43. Epub 2018/09/24. 10.1017/S136898001800232X
    1. Malako BG, Asamoah BO, Tadesse M, Hussen R, Gebre MT. Stunting and anemia among children 6–23 months old in Damot Sore district, Southern Ethiopia. BMC Nutrition. 2019;5(1):3. 10.1186/s40795-018-0268-1
    1. Galicia L, Grajeda R, de Romana DL. Nutrition situation in Latin America and the Caribbean: current scenario, past trends, and data gaps. Rev Panam Salud Publica. 2016;40(2):104–13. Epub 2016/12/17. .
    1. Akram R, Sultana M, Ali N, Sheikh N, Sarker AR. Prevalence and Determinants of Stunting Among Preschool Children and Its Urban–Rural Disparities in Bangladesh. Food and Nutrition Bulletin. 2018;39(4):521–35. 10.1177/0379572118794770
    1. Gosdin L, Martorell R, Bartolini RM, Mehta R, Srikantiah S, Young MF. The co-occurrence of anaemia and stunting in young children. Matern Child Nutr. 2018;14(3):e12597. Epub 2018/02/23. 10.1111/mcn.12597 .
    1. Rotz S, Arty G, Dall’Amico R, De Zen L, Zanolli F, Bodas P. Prevalence of sickle cell disease, hemoglobin S, and hemoglobin C among Haitian newborns. Am J Hematol. 2013;88(9):827–8. Epub 2013/06/13. 10.1002/ajh.23510 .
    1. Simms TM, Rodriguez CE, Rodriguez R, Herrera RJ. The genetic structure of populations from Haiti and Jamaica reflect divergent demographic histories. Am J Phys Anthropol. 2010;142(1):49–66. Epub 2009/11/18. 10.1002/ajpa.21194 .
    1. Weppelmann TA, von Fricken ME, Wilfong TD, Aguenza E, Philippe TT, Okech BA. Field trial of the CareStart Biosensor Analyzer for the determination of glucose-6-phosphate dehydrogenase activity in Haiti. Am J Trop Med Hyg. 2017;97(4):1262–70. Epub 2017/08/19. 10.4269/ajtmh.16-0714

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel