title: Factors associated with hemoglobin concentrations in pre-school children in Western Kenya: cross-sectional studies.
abstract: In sub-Saharan Africa, the etiology of anemia in early childhood is complex and multifactorial. Three community-based cross-sectional surveys were used to determine the prevalence and severity of anemia. Regression methods were used to compare mean hemoglobin (Hb) concentrations across covariate levels to identify children at risk of low Hb levels in an area with intense malaria transmission. In a random sample of 2,774 children < 36 months old, the prevalence of anemia (Hb < 11g/dL) was 76.1% and 71%, respectively, in villages without and with insecticide-treated bed nets (ITNs); severe-moderate anemia (Hb < 7 g/dL) was observed in 11% (non-ITN) and 8.3% (ITN). The prevalence of anemia, high-density malaria parasitemia (21.7%), microcytosis (34.9%), underweight (21.9%), and diarrhea (54.8%) increased rapidly from age three months onwards and remained high until 35 months of age. Multivariate analyses showed that family size, history of fever, pale body, general body weakness, diarrhea, soil-eating, concurrent fever, stunting, and malaria parasitemia were associated with mean Hb levels. Prevention of severe anemia should start early in infancy and include a combination of micronutrient supplementation, malaria control, and possibly interventions against diarrheal illness.
authors.affiliation: Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mdesai@cdc.gov
authors.forename: Meghna R
authors.initials: MR
authors.lastname: Desai
authors.forename: Dianne J
authors.initials: DJ
authors.lastname: Terlouw
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Kwena
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.forename: Simon K
authors.initials: SK
authors.lastname: Kariuki
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.forename: Amos
authors.initials: A
authors.lastname: Odhacha
authors.forename: William A
authors.initials: WA
authors.lastname: Hawley
authors.forename: Ya Ping
authors.initials: YP
authors.lastname: Shi
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Nahlen
authors.forename: Feiko O
authors.initials: FO
authors.lastname: Ter Kuile
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000378:metabolism* / Q000469:parasitology; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006454:Hemoglobins / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology / Q000378:metabolism* / Q000635:transmission; D008297:Male; D008487:Medical History Taking; D009017:Morbidity; D015995:Prevalence
chemical_list: D006454:Hemoglobins