title: Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0-18 months in rural areas of Shaanxi province in northwestern China: a cross-sectional study.
abstract: BACKGROUND
  The first 18 months of life are the most important for long-term childhood well-being. Anemia and malnutrition occurring in this key period have serious implications for individuals and societies, especially in rural areas in developing country. We conducted a cross-sectional study as the baseline survey to provide data for developing a policy-based approach to controlling infant anemia and malnutrition in rural areas of Shaanxi province in northwestern China.
  
  
  METHODS
  We randomly sampled 336 infants aged 0-18 months in 28 rural villages from 2 counties of Shaanxi province. Anthropometric measurements and household interviews were carried out by well-trained researchers. The hemoglobin concentration was measured for 336 infants and serum concentrations of iron, zinc, and retinol (vitamin A) were measured for a stratified subsample of 55 infants. Anemia was defined using World Health Organization (WHO) standards combined with the Chinese standard for infants<6 months old. Logistic regression modeling was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for anemia with non-anemic group as a reference.
  
  
  RESULTS
  We found that 35.12% of infants in rural Shaanxi suffered from anemia, and the malnutrition prevalence rates were 32.14% for underweight, 39.58% for stunting, and 11.31% for wasting. Anemia was significantly associated with malnutrition (underweight, OR: 2.42, 95%CI: 1.50-3.88; stunting, OR: 1.65, 95%CI: 1.05-2.61; wasting, OR: 2.89, 95%CI: 1.45-5.76). Low birth weight, more siblings, less maternal education, low family income, crowded living conditions, and inappropriate complementary food introduction significantly increased the risk for infant anemia. Serum concentrations of iron, zinc, and retinol (vitamin A) were significantly lower in anemic infants compared with non-anemic infants.
  
  
  CONCLUSIONS
  Specific socio-demographic characteristics and feeding patterns were highly associated with infant anemia in rural areas of Shaanxi province. Health education focusing on feeding practices and nutrition education could be a practical strategy for preventing anemia and malnutrition in young children.
authors.affiliation: Maternal and Child Health Center, The First Affiliated Hospital of Medical College in Xi'an Jiaotong University, No, 277, Yanta West Road, Xi'an City, Shaanxi Province 710061, PR China. yangwenfang2008@gmail.com
authors.forename: Wenfang
authors.initials: W
authors.lastname: Yang
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.forename: Shuiping
authors.initials: S
authors.lastname: Zhang
authors.forename: Liming
authors.initials: L
authors.lastname: Liu
authors.forename: Xiang
authors.initials: X
authors.lastname: Wang
authors.forename: Weimin
authors.initials: W
authors.lastname: Li
mesh_terms: D000740:Anemia / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors