title: Determinants of anemia among preschool children in rural, western Kenya.
abstract: Although anemia in preschool children is most often attributed to iron deficiency, other nutritional, infectious, and genetic contributors are rarely concurrently measured. In a population-based, cross-sectional survey of 858 children 6-35 months of age in western Kenya, we measured hemoglobin, malaria, inflammation, sickle cell, α-thalassemia, iron deficiency, vitamin A deficiency, anthropometry, and socio-demographic characteristics. Anemia (Hb < 11 g/dL) and severe anemia (Hb < 7 g/dL) prevalence ratios (PRs) for each exposure were determined using multivariable modeling. Anemia (71.8%) and severe anemia (8.4%) were common. Characteristics most strongly associated with anemia were malaria (PR: 1.7; 95% confidence interval [CI] = 1.5-1.9), iron deficiency (1.3; 1.2-1.4), and homozygous α-thalassemia (1.3; 1.1-1.4). Characteristics associated with severe anemia were malaria (10.2; 3.5-29.3), inflammation (6.7; 2.3-19.4), and stunting (1.6; 1.0-2.4). Overall 16.8% of anemia cases were associated with malaria, 8.3% with iron deficiency, and 6.1% with inflammation. Interventions should address malaria, iron deficiency, and non-malarial infections to decrease the burden of anemia in this population.
authors: Emory University School of Medicine, Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. efoote@uw.edu
authors: Eric M
authors: EM
authors: Foote
authors: Kevin M
authors: KM
authors: Sullivan
authors: Laird J
authors: LJ
authors: Ruth
authors: Jared
authors: J
authors: Oremo
authors: Ibrahim
authors: I
authors: Sadumah
authors: Thomas N
authors: TN
authors: Williams
authors: Parminder S
authors: PS
authors: Suchdev
mesh_terms: D000740:Anemia / Q000453:epidemiology / Q000209:etiology*; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000150:complications; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000150:complications* / Q000469:parasitology; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D015995:Prevalence; D012424:Rural Population; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D017085:alpha-Thalassemia / Q000150:complications
references: Niger J Clin Pract. 2007 Dec;10(4):272-82
references: 18293634
references: J Nutr. 2011 Dec;141(12):2233-41
references: 22049292
references: Blood Rev. 2009 May;23(3):95-104
references: 18835072
references: Am J Clin Nutr. 2012 May;95(5):1223-30
references: 22492366
references: Clin Nutr. 2008 Dec;27(6):793-9
references: 18718696
references: Lancet. 2009 Sep 19;374(9694):1032-1035
references: 19766883
references: Clin Chem. 2000 Aug;46(8 Pt 2):1284-90
references: 10926923
references: Baillieres Clin Haematol. 1998 Mar;11(1):1-51
references: 10872472
references: Nutr Rev. 2011 Nov;69 Suppl 1:S49-56
references: 22043883
references: Br J Nutr. 2000 May;83(5):513-20
references: 10953676
references: Parasitol Today. 2000 Nov;16(11):469-76
references: 11063857
references: Pediatr Res. 2003 Sep;54(3):306-11
references: 12788978
references: Br J Clin Pharmacol. 1991 Sep;32(3):317-21
references: 1777367
references: J Nutr. 2009 Nov;139(11):2124-31
references: 19741202
references: J Lipid Res. 1996 May;37(5):962-71
references: 8725149
references: Trends Parasitol. 2011 Jul;27(7):315-20
references: 21429801
references: Lancet. 2008 Jan 19;371(9608):243-60
references: 18207566
references: N Engl J Med. 2008 Feb 28;358(9):888-99
references: 18305266
references: BMC Med Res Methodol. 2009 Jan 23;9:7
references: 19166593
references: Trends Parasitol. 2003 Dec;19(12):547-51
references: 14642761
references: Blood. 2005 Jul 1;106(1):368-71
references: 15769889
references: J Infect Dis. 2008 Aug 1;198(3):401-8
references: 18582194
references: Am J Trop Med Hyg. 2005 Dec;73(6):1151-8
references: 16354829
references: Am J Trop Med Hyg. 2012 Nov;87(5):862-7
references: 22987658
references: MMWR Morb Mortal Wkly Rep. 2007 Oct 26;56(42):1109-13
references: 17962803
references: J Gen Intern Med. 1992 Mar-Apr;7(2):145-53
references: 1487761
references: Am J Trop Med Hyg. 2009 Dec;81(6):1062-70
references: 19996438
references: Br J Nutr. 2008 Jul;100(1):174-82
references: 18177514
references: Am J Trop Med Hyg. 1998 Apr;58(4):470-5
references: 9574794
references: Nucleic Acids Res. 2001 Dec 1;29(23):E119
references: 11726702
references: J Nutr. 2001 Feb;131(2S-2):697S-700S; discussion 700S-701S
references: 11160600
references: J Nutr. 2004 Nov;134(11):3127-32
references: 15514286
references: Am J Clin Nutr. 1997 Jan;65(1):153-9
references: 8988928
references: J Infect Dis. 2005 Dec 15;192(12):2160-70
references: 16288383
references: J Nutr. 2012 Apr;142(4):781-7
references: 22378325
references: J Nutr. 2004 Feb;134(2):348-56
references: 14747671
references: Pediatrics. 1989 Sep;84(3):500-8
references: 2671914
references: Food Nutr Bull. 2010 Jun;31(2 Suppl):S168-78
references: 20715601
references: J Nutr. 2012 Jan;142(1):105-11
references: 22157541
references: J Nutr. 2001 Feb;131(2S-2):565S-567S
references: 11160589
references: Trends Parasitol. 2005 Aug;21(8):386-92
references: 15967725