Anaemia in low-income and middle-income countries

Maternal anaemia and risk of mortality: a call for action

Anemia remains a major challenge for women's and children's health in low- and middle-income countries (LMICs). To assess the socioeconomic inequalities and prevalence of anemia among children and nonpregnant girls and women in LMICs over time. This cross-sectional and repeated cross-sectional analysis used data from the Demographic and Health Surveys collected from January 1, 2000, through December 31, 2014. Initial cross-sectional data sets constructed from the most recent surveys included 163 419 children aged 6 to 59 months and 304 202 nonpregnant girls and women aged 15 to 49 years (hereinafter referred to as nonpregnant women) from 45 LMICs. Repeated cross-sectional data sets from the most recent and the earliest surveys consisted of 322 088 nonpregnant women from 25 LMICs and 182 273 children from 24 LMICs. Analyses were conducted from June 1, 2016, through July 3, 2018. Total and severe anemia for children aged 6 to 59 months (hemoglobin level, <11 and <7 g/dL, respectively) and nonpregnant women aged 15 to 49 years (<12 and <8 g/dL, respectively) were defined according to the World Health Organization hemoglobin cutoff levels. The slope index of inequality (SII) and the relative index of inequality (RII) were calculated to determine anemia inequalities. Among the 163 419 children aged 6 to 59 months and the 304 202 nonpregnant women aged 15 to 49 years in the initial cross-sectional data sets, 34 of 45 countries had anemia prevalence levels for children greater than 40% and 37 of 45 had anemia prevalence levels greater than 20% for nonpregnant women. Among the 182 273 children from 24 LMICs and 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.67 to 3.98 percentage points in 16 of the 24 LMICs; for cases of severe anemia, the decrease was 0.03 to 0.82 percentage points in 15 LMICs. Among 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.49 to 2.59 percentage points in 17 of 25 LMICs; for severe anemia, the decrease was 0.03 to 0.29 percentage points in 15 LMICs. The SII was significantly negative and the RII was significantly less than 1 in 37 of the 45 LMICs among children and in 26 of the 45 LMICs for nonpregnant women. The annualized changes in the SII approached 0 in 16 of the 24 LMICs among children and in 11 of 25 LMICs among nonpregnant women. Most LMICs continue to exhibit a high prevalence of anemia among children and nonpregnant women, although the prevalence of total and severe anemia have decreased in many LMICs. Anemia inequalities among children and nonpregnant women persist in most LMICs.

A renaissance in primary health care

Anemia affects millions of pregnant women and their children worldwide, particularly in low- and middle-income countries. Although anemia in pregnancy is a well-described risk factor for cognitive development, the association with child brain structure is poorly understood. To explore the association of anemia during pregnancy and postnatal child anemia with brain structure in early life. This neuroimaging nested cohort study was embedded within the Drakenstein Child Health Study (DCHS), a population-based birth cohort in South Africa. Pregnant individuals were enrolled into the DCHS between 2012 and 2015 from 2 clinics in a periurban setting. Mother-child pairs were assessed prospectively; follow-up is ongoing. A subgroup of children had brain magnetic resonance imaging (MRI) at age 2 to 3 years from 2015 to 2018. This study focused on the 147 pairs with structural neuroimaging and available hemoglobin data. Data analyses were conducted in 2021 and 2022. Mothers had hemoglobin measurements during pregnancy, and a subgroup of children had hemoglobin measurements during early life. Anemia was classified as hemoglobin levels less than 11 g/dL based on World Health Organization guidelines; children younger than 6 months were classified using local guidelines. Child brain volumes of global, subcortical, and corpus callosum structures were quantified using T1-weighted MRI. Linear regression models were used to analyze the associations between maternal and child anemia with child brain volumes, accounting for potential confounders. Of 147 children (mean [SD] age at MRI, 34 [2] months; 83 [56.5%] male) with high-resolution MRI scans, prevalence of maternal anemia in pregnancy was 31.3% (46 of 147; median [IQR] gestation of measurement: 13 [9-20] weeks). Maternal anemia during pregnancy was significantly associated with smaller volumes of the child caudate bilaterally (adjusted percentage difference, -5.30% [95% CI, -7.01 to -3.59]), putamen (left hemisphere: -4.33% [95% CI, -5.74 to -2.92]), and corpus callosum (-7.75% [95% CI, -11.24 to -4.26]). Furthermore, antenatal maternal hemoglobin levels were also associated with brain volumes in the caudate (left hemisphere: standardized β = 0.15 [95% CI, 0.02 to 0.28]; right hemisphere: β = 0.15 [95% CI, 0.02 to 0.27]), putamen left hemisphere (β = 0.21 [95% CI, 0.07 to 0.35]), and corpus callosum (β = 0.24 [95% CI, 0.09 to 0.39]). Prevalence of child anemia was 52.5% (42 of 80; median [IQR] age of measurement: 8.0 [2.7 to 14.8] months). Child anemia was not associated with brain volumes, nor did it mediate the association of maternal anemia during pregnancy with brain volumes. In this cohort study, anemia in pregnancy was associated with altered child brain structural development. Given the high prevalence of antenatal maternal anemia worldwide, these findings suggest that optimizing interventions during pregnancy may improve child brain outcomes.

Iron deficiency anemia (IDA) is a significant global health problem affecting close to 2 billion people worldwide. The prevalence of IDA is higher among children younger than five years and women of reproductive age, indicating an intergenerational correlation between maternal and child anemia. This study aims to analyze the association between maternal and child anemia in The Gambia. A nationally representative dataset comprising 3249 children under the age of five, obtained from The Gambia Demographic and Health Survey (2019-2020), was utilized for empirical analyses. Multivariate linear regression models were employed to assess the association between maternal and child anemia. The multivariate models were adjusted for various confounding variables, including birth order, age, and the gender of the child, as well as maternal education, religion, wealth quintiles, rural residence, and region-fixed effects. Fifty-three percent of children and 52% of mothers are anemic. Children from poorer households show a higher rate of anemia compared to those from wealthier households. Maternal anemia was significantly associated with the anemia status of the children. Children born to anemic mothers were 13.5% more likely to be also anemic (p < 0.001). The correlation coefficient between mother and child hemoglobin levels is 0.165 (p < 0.001). The correlation coefficient between maternal and child anemia is higher among the bottom three wealth quintiles than the top two wealth quintiles. The significant intergenerational association between maternal and child anemia status highlights the need for targeted, multi-pronged strategies to combat the adverse impacts of anemia. Maternal anemia, in general, appears to influence childhood anemia beyond just the pregnancy period. Shared socioeconomic environment, dietary patterns, and exposure to infections likely contribute to this intergenerational association.

Effects of Maternal and Early-Life Anaemia on Child Brain Development: A South African Birth Cohort Study

Anemia is a common nutritional problem, and it has a remarkably high prevalence rate in Southeast Asia. We analyzed a sample of 112,714 mothers aged 15 to 49 years and their children younger than 5 years from the 2005–2006 Indian National Fertility and Health Survey with available data on anemia to determine the anemia statuses and risk factors associated with maternal and childhood anemia. Logistic regression analyses were used to determine factors associated with anemia. The overall prevalence of maternal anemia was 52.0%, while the overall prevalence of childhood anemia was 66.7%. Predictors of maternal anemia are a young age ( p &lt; .001), maternal health practices ( p &lt; .001), and reproductive health-related infections ( p &lt; .001), among others. On the other hand, predictors of childhood anemia included iron deficiency ( p = .007), vitamin deficiency ( p = .003), and common infections ( p = .008). Other predictors of childhood anemia included poor dietary intake ( p &lt; .01) and childcare practices ( p &lt; .001). Childcare practice has the strongest association with childhood anemia with an odds ratio of 1.67 (95% confidence interval [1.55, 1.79]). With respect to maternal anemia, the strongest risk factor was being infected with reproductive health infections with an odds ratio of 1.157 (95% confidence interval [1.11, 1.21]). Interventions designed to address prevalence of childhood and maternal anemia in India should take the risk factors in a holistic manner. A multifactorial framework should guide such interventions.

Not available.

BackgroundSocioeconomic inequalities in overweight and obesity exist in many European countries. A sugar-sweetened beverages (SSB) tax may contribute to a reduction of these inequalities. However, in the Netherlands, the government decided to not (yet) introduce an SSB tax, although the government has acknowledged its potential to be pro-equity. Understanding how various stakeholder groups perceive the potential effects of an SSB tax on different socioeconomic groups may provide useful insights into equity-related considerations in the debate whether or not to implement an SSB tax. This study aims to gain insight into the perceptions of stakeholder groups in the Netherlands on (1) the effects of an SSB tax on the budgets of lower and higher socioeconomic groups and (2) the impact of an SSB tax on socioeconomic inequalities in dietary intake and health.MethodsSemi-structured interviews were conducted in 2019 with 27 participants from various stakeholder groups in the Netherlands (i.e. health and consumer organizations, health professional associations, trade associations, academia, advisory bodies, ministries and parliamentary parties). Data were analyzed using a thematic content approach.ResultsParticipants from all stakeholder groups indicated that an SSB tax would have a larger impact on the budgets of lower socioeconomic groups. Participants from nearly all stakeholder groups (except trade associations) mentioned that an SSB tax could have greater health benefits among lower socioeconomic groups as these often have a higher SSB consumption and are more likely to be overweight or obese. Some participants mentioned that an SSB tax may have no or adverse health effects among lower socioeconomic groups (e.g. compensation of lower SSB consumption with other unhealthy behaviours). Some participants emphasised that an SSB tax should only be introduced when accompanied by other interventions (e.g. offering healthy alternatives), to make it easier for lower socioeconomic groups to lower their SSB consumption in response to an SSB tax, and to prevent adverse health effects.ConclusionsParticipants believed an SSB tax could contribute to a reduction in socioeconomic inequalities in dietary intake and health. However, additional interventions facilitating the reduction of SSB consumption in lower socioeconomic groups were recommended.

Reduction of anaemia.

BackgroundThis study aimed to determine whether associations of antenatal maternal anaemia with smaller corpus callosum, caudate nucleus, and putamen volumes previously described in children at age 2–3 years persisted to age 6–7 years in the Drakenstein Child Health Study (DCHS).MethodsThis neuroimaging sub-study was nested within the DCHS, a South African population-based birth cohort. Pregnant women were enrolled (2012–2015) and mother–child dyads were followed prospectively. A sub-group of children had magnetic resonance imaging at 6–7 years of age (2018–2022). Mothers had haemoglobin measurements during pregnancy and a proportion of children were tested postnatally. Maternal anaemia (haemoglobin < 11 g/dL) and child anaemia were classified using WHO and local guidelines. Linear modeling was used to investigate associations between antenatal maternal anaemia status, maternal haemoglobin concentrations, and regional child brain volumes. Models included potential confounders and were conducted with and without child anaemia to assess the relative roles of antenatal versus postnatal anaemia.ResultsOverall, 157 children (Mean [SD] age of 75.54 [4.77] months; 84 [53.50%] male) were born to mothers with antenatal haemoglobin data. The prevalence of maternal anaemia during pregnancy was 31.85% (50/157). In adjusted models, maternal anaemia status was associated with smaller volumes of the total corpus callosum (adjusted percentage difference, − 6.77%; p = 0.003), left caudate nucleus (adjusted percentage difference, − 5.98%, p = 0.005), and right caudate nucleus (adjusted percentage difference, − 6.12%; p = 0.003). Continuous maternal haemoglobin was positively associated with total corpus callosum (β = 0.239 [CI 0.10 to 0.38]; p < 0.001) and caudate nucleus (β = 0.165 [CI 0.02 to 0.31]; p = 0.027) volumes. In a sub-group (n = 89) with child haemoglobin data (Mean [SD] age of 76.06 [4.84]), the prevalence of antenatal maternal anaemia and postnatal child anaemia was 38.20% (34/89) and 47.19% (42/89), respectively. There was no association between maternal and child anaemia (χ2 = 0.799; p = 0.372), and child anaemia did not contribute to regional brain volume differences associated with maternal anaemia.ConclusionsAssociations between maternal anaemia and regional child brain volumes previously reported at 2–3 years of age were consistent and persisted to 6–7 years of age. Findings support the importance of optimising antenatal maternal health and reinforce these brain regions as a future research focus.

While child anemia remains an uncontrolled health issue in developing and underdeveloped countries, the public health burden of child anemia is high in Madagascar. Using cross-sectional data from Madagascar Demographic and Health Survey 2021 (Madagascar DHS 2021), this study aims to examine the prevalence and risk factors of child anemia by region and socioeconomic status in the country. A total of 5,048 children aged 6-59 months with hemoglobin (Hb) concentration data were used for the study. First, the associations between child anemia (Hb&lt; 11.0g/dl) and the household, parental, and child characteristics were tested by univariate logistic regression analysis. Variables with a p-value &lt;0.05 in the univariate were included in the multivariate regression analysis, and sub-group analysis was conducted for six provinces. A heatmap was provided to visualize the distribution of common risk factors for the child anemia across six provinces. The prevalence of child anemia was 47 %. Child anemia was negatively associated with older age, and positively associated with maternal anemia in a dose-response manner, maternal younger age (&lt;25 years old), underweight (BMI&lt;18.5), low education level, history of fever or diarrhea in the past two weeks and high birth order (5th or higher, compared to the 1st). There was a regional variation in anemia (3.8% to 56.3%) with a higher prevalence in the Southern provinces compared to Antananarivo province, the capital area. The age of the child and the maternal anemia status consistently determined child anemia status in all six provinces, with certain region-specific factors such as female child, poor wealth, maternal obesity, women’s empowerment, and iron supplementation. The prevalence of child anemia across Madagascar was found to be closely linked to both the age of the child and the maternal status, including health related, and socioeconomic conditions, which need to be more comprehensively examined. Further research is required to explore the pathways by which child anemia is related to maternal anemia and varies by regional location is required. Interventions targeting both anemic mother-child pairs, vulnerable populations, and young children are recommended to strengthen national nutrition programs in the country. Key words: Anemia prevention, anemia control, Madagascar, child health, public health

A new path to mentorship for emerging global health leaders in low-income and middle-income countries

This cross-sectional study investigated the association between maternal and child anemia and development in 2,473 children up to 72 months old in Ceará, Brazil. Hemoglobin was measured using HemoCue Hb 201, and child development was assessed via the Ages and Stages Questionnaires-Brazil (ASQ-BR). In multivariate analyses, neither maternal anemia nor child anemia (overall) was associated with continuous domain z-scores or developmental delays (all p > 0.05). However, when stratified by severity, mild child anemia was associated with a higher prevalence of fine motor delay (Prevalence Ratio = 1.65, 95% CI: 1.18-2.31), while moderate-to-severe child anemia was associated with a higher prevalence of gross motor delay (PR = 1.71, 95% CI: 1.06-2.75). Exploratory analyses revealed effect modification by age; in children aged 49-72 months, mild child anemia was associated with lower gross motor (Standardized Mean Difference = -0.52), fine motor (SMD = -0.91), and problem-solving scores (SMD = -0.33), while moderate-to-severe child anemia was associated with lower gross motor scores (SMD = -0.83). Our findings suggest that the severity and timing of child anemia are associated with specific developmental outcomes, reinforcing the need for targeted interventions.

Aims: Anaemia in children aged 6 - 59 months is an important public health problem associated with increasing hospital costs, lengths of hospital stay, and development of complications later in life. Due to the significant caregiver roles of mothers, the level of mothers’ knowledge, beliefs and practices are important in addressing anaemia in children. This study investigated knowledge, attitudes, beliefs, and practices of select mothers on anaemia and linked these with known factors for anaemia. Methodology: The case study was conducted at Mkuranga District Hospital, Paediatric Ward between December 2014 and April 2015. A cross-sectional design was used to recruit a convenience sample of 40 mothers whose children had a confirmed diagnosis of anaemia (through routine laboratory testing). Results: Within the sample, the majority of children were male (52.5%); aged 6 - 39 months (87.5%); and had a diagnosis of severe anaemia (75.0%) according to the World Health Organization’s definition. Over one third (35%) of mothers reported a prior history of anemia in their other children, and the majority (55%) had heard about anaemia prior to their child’s hospitalization. Maternal anaemia was reported by 67.5% of mothers. Mothers reported that maternal anemia (17.5%) and feeding practices (32.5%) are known contributing factors to anaemia in children. Mothers reported that anemia could be prevented (55.0%) and cured by herbal preparations (47.5%). In addition, some mothers indicated that anaemia was caused by witchcraft (22.5%) and eating lemons (2.5%). Conclusion: Severe anaemia was high among the studied population which aligned with their hospitalization status. Findings suggested potential gaps in control and management of anemia in children possibly related to low awareness or incorrect knowledge of the relationship between maternal and child anaemia. The findings also highlighted important cultural beliefs related to anaemia. There is an imperative for culturally and socially appropriate knowledge translation and exchange with mothers in order to impact on the prevention and control of anaemia in children in Tanzania.