title: Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011-2012.
abstract: Iron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey.
  
  
  
  Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011-2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of <110 g/L and ferritin levels of < 12 μg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS.
  
  
  
  A total of 7138 children aged between 6-59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age < 24 months (AOR 1.40, 95% CI 1.18-1.55 p <0.05), stunting (AOR 1.42 CI 1.23-1.63 p<0.05), presence of clinical anemia (AOR 5.69 CI 4.93-6.56 p<0.05), having a mother with IDA (AOR 1.72 CI 1.47-2.01 p<0.05) and household food insecurity (AOR 1.20 CI 1.10-1.40 P<0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65-0.90 p<0.05) and being a female child (AOR 0.87 CI 0.76-0.98 p<0.05) were associated with reduced odds of IDA.
  
  
  
  The prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification.
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.|Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
authors.forename: Muhammad Atif
authors.initials: MA
authors.lastname: Habib
authors.affiliation: Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Black
authors.affiliation: Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
authors.forename: Sajid Bashir
authors.initials: SB
authors.lastname: Soofi
authors.affiliation: Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
authors.forename: Imtiaz
authors.initials: I
authors.lastname: Hussain
authors.affiliation: Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Bhatti
authors.affiliation: Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Sydney Medical School, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Camille
authors.initials: C
authors.lastname: Raynes-Greenow
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000453:epidemiology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009749:Nutrition Surveys / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D013223:Statistics as Topic