Determinants of Anemia and Hemoglobin Concentration in Haitian School-Aged Children.
Anemia diminishes oxygen transport in the body, resulting in potentially irreversible growth and developmental consequences for children. Limited evidence for determinants of anemia exists for school-aged children. We conducted a cluster randomized controlled trial in Haiti from 2012 to 2013 to test the efficacy of a fortified school snack. Children (N = 1,047) aged 3-13 years were followed longitudinally at three time points for hemoglobin (Hb) concentrations, anthropometry, and bioelectrical impedance measures. Dietary intakes, infectious disease morbidities, and socioeconomic and demographic factors were collected at baseline and endline. Longitudinal regression modeling with generalized least squares and logit models with random effects identified anemia risk factors beyond the intervention effect. At baseline, 70.6% of children were anemic and 2.6% were severely anemic. Stunting increased the odds of developing anemia (adjusted odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.05-2.08) and severe anemia (adjusted OR: 2.47, 95% CI: 1.30-4.71). Parent-reported vitamin A supplementation and deworming were positively associated with Hb concentrations, whereas fever and poultry ownership showed a negative relationship with Hb concentration and increased odds of severe anemia, respectively. Further research should explore the full spectrum of anemia etiologies in school children, including genetic causes.
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri liannotti@wustl.edu.
Lora L
LL
Iannotti
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri.
Jacques R
JR
Delnatus
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri.
Audrey R
AR
Odom
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri.
Jacob C
JC
Eaton
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri.
Jennifer J
JJ
Griggs
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri.
Sarah
S
Brown
Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri.
Patricia B
PB
Wolff
D000293:Adolescent; D000740:Anemia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D000886:Anthropometry; D001823:Body Composition; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D004035:Diet Therapy; D019587:Dietary Supplements; D017097:Electric Impedance; D005260:Female; D005527:Food, Fortified; D006130:Growth Disorders / Q000150:complications; D006205:Haiti / Q000453:epidemiology; D006454:Hemoglobins / Q000032:analysis* / Q000187:drug effects; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009752:Nutritional Status; D012307:Risk Factors; D014801:Vitamin A / Q000008:administration & dosage
D006454:Hemoglobins; D014801:Vitamin A