Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T11:14:40.902Z Has data issue: false hasContentIssue false

Factors associated with Hb concentration in children aged 6–59 months in the State of Pernambuco, Brazil

Published online by Cambridge University Press:  09 March 2007

Mônica M. Osório
Affiliation:
Departamento de Nutrição, Universidade Federal de Pernambuco, 50670-860 Campus Universitário – Cidade Universitária, Recife – PE, Brazil Public Health Nutrition Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
Pedro I. C. Lira
Affiliation:
Departamento de Nutrição, Universidade Federal de Pernambuco, 50670-860 Campus Universitário – Cidade Universitária, Recife – PE, Brazil
Ann Ashworth*
Affiliation:
Public Health Nutrition Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
*
*Corresponding author: Professor Ann Ashworth, fax +44 207 299 4666, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

In 1997, the prevalence of anaemia was 40·9 % among children aged 6–59 months in the State of Pernambuco, north-east Brazil. Using the same sample of children, we have investigated possible reasons for this high prevalence. A representative sample was selected through a three-stage process: proportional systematic random sampling of municipalities in the State, systematic random sampling of census sectors within these municipalities, and finally, simple random sampling of households with children aged 6–59 months to obtain the sample of 650 children. Data collection included demographic, environmental, socio-economic and maternal variables, and nutritional status and dietary intakes of the children. Multiple linear regression analysis was based on a hierarchical model of factors associated with Hb concentration. The mean Hb concentration of children aged 6–23 months was 10 g/l lower than that of older children. In the regression analysis, child age explained 8·3 % of the variance in Hb concentration. The intake of bioavailable Fe explained a further 3·3, serum retinol 2·7, diarrhoea 2·4, water treatment 1·7, sanitation 1·3 and low birth-weight 0·5 %. The final model explained 23·4 % of the variance in Hb concentration. We conclude that child age, bioavailable-Fe intake, serum retinol concentration, diarrhoea, water treatment, sanitation and low birth-weight are independently associated with Hb concentration. In north-east Brazil, anaemia prevention programmes among children should focus on those aged <2 years and should consider feasible strategies to improve intakes of bioavailable Fe and vitamin A, and reduce infection. Supplemental Fe should be given to low birth-weight infants.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2004

References

Araújo, CRL & Flores, H (1978) Improved spectrophotometric vitamin A assay. Clin Chem 24, 386.CrossRefGoogle ScholarPubMed
Beresford, CH, Neale, RJ & Brooke, OG (1971) Iron absorption and pyrexia. Lancet i, 568572.Google Scholar
Bloem, MW (1995) Interdependence of vitamin A and iron: an important association for programmes of anaemia control?. Proc Nutr Soc 54, 501508.CrossRefGoogle ScholarPubMed
Bloem, MW, Wedel, M, Egger, RJ et al. (1989) Iron metabolism and vitamin A deficiency in children in Northeast Thailand. Lancet 50, 332338.Google ScholarPubMed
Bloem, MW, Wedel, M, Van Agtmaal, EJ et al. (1990) Vitamin A interventions: short-term effects of a single, oral, massive dose on iron metabolism. Am J Clin Nutr 51, 7679.CrossRefGoogle ScholarPubMed
Brault-Dubuc, M, Nadeau, M & Dickie, J (1983) Iron status of French-Canadian children: a three year follow-up study. Human Nutr Appl Nutr 37 210221.Google Scholar
Brazil Ministry of Health (2002) Guia Alimentar para Crianças Menores de Dois Anos. (Feeding Guidelines for Children below Two Years).Secretaria de Políticas de Saúde, Organização Pan-Ama da Saúde Brasília: Ministério da Saúde.Google Scholar
Cook, JD, Skikne, BS & Baynes, RD (1994) Iron deficiency: the global perspective. In Progress in Iron Research: Advances in Experimental Medicine and Biology, pp. 219228 [Hershko, C, Konijn, AM, Aisen, P, editors]. New York: Plenum Press.Google Scholar
De Vizia, B, Poggi, V, Conenna, RFiorillo, A & Scippa, L (1992) Iron absorption and iron deficiency in infants and children with gastrointestinal diseases. J Pediatr Gastroenterol Nutr 14, 2126.Google Scholar
Epi Info version 6.04. (1994) A Word Processing, Database and Statistics Program for Public Health. Centers for Disease Control (CDC). Atlanta, GA, USA.Google Scholar
Food and Agriculture Organization/World Health Organization. (1988) Requirements of Vitamin A Iron. Folate and Vitamin B12. Report of a Joint FAO/WHO Expert Consultation. Food and Nutrition Series 23. Rome: FAO.Google Scholar
Food and Agriculture Organization/World Health Organization (2002) Human Vitamin and Mineral Requirements. Report of a Joint FAO/WHO Expert Consultation. Rome: FAO.Google Scholar
Gonçalves, JF, Tanabe, M & Medeiros, FPM (1990) Parasitological and serological studies on amoebiasis and other intestinal parasitic infections in the rural sector around Recife, Northeast Brazil. Rev Inst Med Trop Sao Paulo 32, 428435.Google Scholar
Guyatt, HL, Brooker, S, Kihamia, CM, Hall, A & Bundy, DA (2001) Evaluation of efficacy of school-based anthelmintic treatments against anaemia in children in the United Republic of Tanzania. Bull World Health Organ 79, 695703.Google ScholarPubMed
Instituto Brasileiro de Geografia e Estatística (1977) Estudo Nacional de Despesa Familiar – ENDEF: Tabela de Composição de Alimentos (National Survey of Household Expenditure: Food Composition Tables). Publicações especiais no.3.Rio de Janeiro: IBGE.Google Scholar
Instituto Brasileiro de Geografia e Estatística (2001) Síntese de Indicadores Sociais 2000. Estudos e Pesquisas. Informação Demográfica e Socioeconômica (Summary of Social Indicators 2000. Demographic and Socioeconomic Information) no. 5. Rio de Janeiro. IBGE.Google Scholar
Instituto de Nutrición de Centro América y Panamá/Comité Interdepartamental de Nutricio´n para la Defensa Nacional. (1970) tabla de Composicion de Alimentos para America Lantina(Food Composition Tables for Latin America). Guatemala City. INCAP.Google Scholar
Instituto Nacional de Alimentação e Nutrição/Ministério da Saúde (1998) II Pesquisa Estadual de Saúde e Nutrição: Saúde, Nutrição, Alimentação e Condições Sócio-econômicas no Estado de Pernambuco (Health and Nutrition Research: Health, Nutrition, Diet and Socioeconomic Conditions in Pernambuco State). Recife: Secretaria Estadual de Saúde, Pernambuco.Google Scholar
Kohlmeier, LMendez, MShalnova, S, (1998) Deficient dietary iron intake among women and children in Russia: evidence from the Russian Longitudinal Monitoring Survey. Am J Public Health 88, 576580.Google Scholar
Lynch, SR (1997) Interaction of iron with other nutrients Nutr Rev 55, 102110.Google Scholar
Mejía, LAChew, F (1988) Hematological effect of supplementing anemic children with vitamin A alone and in combination with iron. Am JClin Nutr 48, 595600.Google Scholar
Mejía, LA, Hodges, RE, Arroyave, G, Viteri, F & Torún, B (1977) Vitamin A deficiency and anemia in Central American children. Am J Clin Nutr 30, 11751184.CrossRefGoogle Scholar
Monsen, ER, Balinfy, JL, (1982) Calculating dietary iron bioavailability: refinement and computerization J Am Diet Assoc 80, 307311.Google Scholar
Monsen, ER, Hallberg, L, Layrisse, M et al. (1978) Estimation of available dietary iron. Am J Clin Nutr 31, 134141.Google Scholar
Monte, CMG Sá MLB (1998) Guias Alimentares para Crianças de 6–23 meses no Nordeste do Brasil (Feeding Guidelines for Children aged 6–23 months in Northeast Brazil). Fortaleza: The British Council.Google Scholar
Monteiro, CA, Szarfarc, SC & Mondini, L (2000) Tendência secular da anemia na infância na cidade de São Paulo (1984–1996) (Secular trend of infant anaemia in São Paulo city) (1984–1996). Rev de Saúde Pública 34, Suppl. 6, 6272.CrossRefGoogle Scholar
Osório, MMLira, PICAshworth, A (2001) Prevalence of anemia in children 6–59 months old in the state of Pernambuco, Brazil Pan Am J Public Health 10, 101107.Google Scholar
Philippi, ST, Szarfarc, SC & Latterza, AR (1996) Virtual Nutri (software), version 1.0, for Windows. São Paulo: University of São Paulo.Google Scholar
Reeves, JD, Yip, R, Kiley, VA, Dallman, PR, (1984) Iron deficiency in infants: the influence of mild antecedent infection J Pediatr 105, 874879.Google Scholar
Sargent, JD, Stukel, TA, Dalton, MA, Freeman, JL & Brown, MJ (1996) Iron deficiency in Massachusetts communities: socioeconomic and demographic risk factors among children. Am J Public Health 86, 544550.CrossRefGoogle ScholarPubMed
Sherriff, A, Emond, A, Hawkins, N & Golding, J (1999) Haemoglobin and ferritin concentration in children aged 12 and 18 months. Arch Dis Child 80, 153157.CrossRefGoogle ScholarPubMed
Sichieri, R (1987) Anemia nutricional em crianças menores de 5 anos do Município de São Paulo: papel da dieta na determinação de sua prevalência (Nutritional anaemia among the under-fives in São Paulo city: role of diet in determining its prevalence). PhD thesis, University of São Paulo.Google Scholar
Tabachnick, BG & Fidel, LS (1996) Using Multivariate Statistics. 3rd ed. New York: Harper Collins.Google Scholar
Tseng, M, Chakraborty, H, Robinson, DT, Mendez, M & Kohlmeier, L (1997) Adjustment of iron intake for dietary enhancers and inhibitors in population studies: bioavailable iron in rural and urban residing Russian women and children. J Nutr 127, 14561468.Google Scholar
United Nations Interntational Children's Emergency Fund (1998) The State of World's Children. New York: UNICEF.Google Scholar
Victora, CG, Huttly, SR, Fuchs, SC & Olinto, AMT (1997) The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 26, 224227.Google Scholar
Viteri, FE, Tuna, V & Guzman, MA (1972) Normal haematological values in the Central American population. Br J Haematol 23, 89204.Google Scholar
World Health Organization (1983) Measuring Change in Nutritional Status. Guidelines for Assessing the Nutritional Impact of Supplementary Feeding Programmes for Vulnerable Groups. Geneva: WHO.Google Scholar
World Health Organization (2001) Iron Deficiency Anaemia. Assessment, Prevention, and Control. A Guide for Programme Managers. Geneva: WHO/NHD/01.3.Google Scholar
Zive, MM, Taras, HL, Broyles, SL, Frank-Spohrer, GCNader, PR (1995) Vitamin and mineral intakes of Anglo-American and Mexican-American preschoolers. J Am Diet Assoc 95, 329335.Google Scholar