Prevalence and correlates of childhood anemia in the MINA-Brazil birth cohort study

Authors

DOI:

https://doi.org/10.11606/s1518-8787.2023057005637

Keywords:

Anemia, Iron Deficiency, Malaria, Risk Factors, Cohort Studies

Abstract

OBJECTIVE: To describe the prevalence and predictors of childhood anemia in an Amazonian population-based birth cohort study.

METHODS: We estimated the prevalence of maternal anemia at delivery (hemoglobin [Hb] concentration < 110 g/L) in women participating in the MINA-Brazil birth cohort study and in their children examined at 1 and 2 years (Hb < 110 g/L) and at 5 years of age (Hb < 115 g/L). We measured ferritin, soluble transferrin receptor, and C-reactive protein concentrations in mothers at delivery and in their 1- and 2-year old children to estimate the prevalence of iron deficiency and its contribution to anemia, while adjusting for potential confounders by multiple Poisson regression analysis (adjusted relative risk [RRa]).

RESULTS: The prevalence 95% confidence interval (CI) of maternal anemia, iron deficiency, and iron-deficiency anemia at delivery were 17.3% (14.0–21.0%), 42.6% (38.0–47.2%), and 8.7% (6.3–11.6)%, respectively (n = 462). At age 1 year (n = 646), 42.2% (38.7–45.8%) of the study children were anemic, 38.4% (34.6–42.3%) were iron-deficient, and 26.3 (23.0–29.9) had iron-deficiency anemia. Prevalence had decreased to 12.8% (10.6–15.2%), 18.1% (15.5–21.1%), and 4.1% (2.8–5.7%), respectively, at 2 years (n = 761); at 5 years of age, 5.2% (3.6–7.2%) children were anemic (n = 655). Iron deficiency (RRa = 2.19; 95%CI: 1.84–2.60) and consumption of ultraprocessed foods (UPF) (RRa = 1.56; 95%CI: 1.14–2.13) were significant contributors to anemia at 1 year, after adjusting for maternal schooling. At 2 years, anemia was significantly associated with maternal anemia at delivery (RRa: 1.67; 95%CI: 1.17–2.39), malaria since birth (2.25; 1.30–3.87), and iron deficiency (2.15; 1.47–3.15), after adjusting for child ’s age and household’s wealth index.

CONCLUSIONS: Anemia continues to be highly prevalent during pregnancy and early childhood in the Amazon. Public health policies should address iron deficiency, UPF intake, maternal anemia, and malaria in order to prevent and treat anemia in Amazonian children.

References

Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019 Aug;1450(1):15-31. https://doi.org/10.1111/nyas.14092

Hess SY, Owais A, Jefferds ME, Young MF, Cahill A, Rogers LM. Accelerating action to reduce anemia: review of causes and risk factors and related data needs. Ann N Y Acad Sci. 2023 May;1523(1):11-23. https://doi.org/10.1111/nyas.14985

Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data. Lancet Glob Health. 2022 May;10(5):e627-39. https://doi.org/10.1016/S2214-109X(22)00084-5

Ferreira HS, Vieira RC, Livramento AR, Dourado BL, Silva GF, Calheiros MS. Prevalence of anaemia in Brazilian children in different epidemiological scenarios: an updated meta-analysis. Public Health Nutr. 2021 Jun;24(8):2171-84.

https://doi.org/10.1017/S1368980019005287

Nogueira-de-Almeida CA, Ued FD, Del Ciampo LA, Martinez EZ, Ferraz IS, Contini AA, et al. Prevalence of childhood anaemia in Brazil: still a serious health problem: a systematic review and meta-analysis. Public Health Nutr. 2021 Dec;24(18):6450-65. https://doi.org/10.1017/S136898002100286X

Castro IR, Normando P, Farias DR, Berti TL, Schincaglia RM, Andrade PG, et al. Factors associated with anemia and vitamin A deficiency in Brazilian children under 5 years old: Brazilian National Survey on Child Nutrition (ENANI-2019). Cad Saude Publica. 2023 Sep;25(39 Suppl 2):e00194922. https://doi.org/10.1590/0102-311xen194922

Victora CG, Christian P, Vidaletti LP, Gatica-Domínguez G, Menon P, Black RE. Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda. Lancet. 2021 Apr;397(10282):1388-99. https://doi.org/10.1016/S0140-6736(21)00394-9

Brown KH, Moore SE, Hess SY, McDonald CM, Jones KS, Meadows SR, et al. Increasing the availability and utilization of reliable data on population micronutrient (MN) status globally: the MN Data Generation Initiative. Am J Clin Nutr. 2021 Sep;114(3):862-70. https://doi.org/10.1093/ajcn/nqab173

World Health Organization. Global strategy for infant and young child feeding. Geneva: World Health Organization; 2003 [cited 2023 May 22]. Available from: https://www.who.int/publications/i/item/9241562218

Cardoso MA, Matijasevich A, Malta MB, Lourenco BH, Gimeno SG, Ferreira MU, et al.; MINA-Brazil Study Group. Cohort profile: the maternal and child health and nutrition in Acre, Brazil, birth cohort study (MINA-Brazil). BMJ Open. 2020 Feb;10(2):e034513. https://doi.org/10.1136/bmjopen-2019-034513

Instituto Brasileiro de Geografia e Estatística. Cities and states. Brazil. Rio de Janeiro: Instituto Brasileiro de Geografia e Estatística; 2022 [cited 2023 May 22]. Available from: https://ibge.gov.br/cidades-e-estados/ac/cruzeiro-do-sul.html

Pincelli A, Cardoso MA, Malta MB, Johansen IC, Corder RM, Nicolete VC, et al.; MINA-Brazil Study Working Group. Low-level Plasmodium vivax exposure, maternal antibodies, and anemia in early childhood: population-based birth cohort study in Amazonian Brazil. PLoS Negl Trop Dis. 2021 Jul;15(7):e0009568. https://doi.org/10.1371/journal.pntd.0009568

Institute of Medicine and National Research Council. Implementing guidelines on weight gain and pregnancy: Washington, DC: National Academy Press; 2013 [cited 2023 May 22]. Available from: https://www.nap.edu/catalog/18292/implementing-guidelines-on-weight-gainand-pregnancy

Onis M; WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006 Apr;450 S450:76-85. https://doi.org/10.1111/j.1651-2227.2006.tb02378.x

Nogueira MB, Mazzucchetti L, Mosquera PS, Cardoso MA, Malta MB. Consumption of ultra-processed foods during the first year of life and associated factors in Cruzeiro do Sul, Brazil. Cien Saude Colet. 2022;27(2):725-36. https://doi: 10.1590/1413-81232022272.47072020

World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization; 2011 [cited 2023 May 22]. Available from: http://www.who.int/vmnis/indicators/haemoglobin.pdf

Neves PA, Lourenço BH, Pincelli A, Malta MB, Souza RM, Ferreira MU, et al.; MINA-Brazil Study Group. High prevalence of gestational night blindness and maternal anemia in a population-based survey of Brazilian Amazonian postpartum women. PLoS One. 2019 Jul;14(7):e0219203. https://doi.org/10.1371/journal.pone.0219203

World Health Organization. Global prevalence of vitamin A defciency in populations at risk: Geneva: World Health Organization; 2009 [cited 2023 May 22]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44110/9789241598019_eng.pdf

World Health Organization. Serum and red blood cell folate concentrations for assessing folate status in populations. Geneva: World Health Organization; 2012 [cited 2023 May 22]. Available from: http://apps.who.int/iris/bitstream/handle/10665/75584/WHO_NMH_NHD_EPG_12.1_eng.pdf;jsessionid=EE15CBE23687EB40C896BB4D3FF41B28?sequence=1

World Health Organization. WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations. Geneva: World Health Organization; 2020 [cited 2023 May 22]. Available from: https://www.who.int/publications/i/item/9789240000124

Baroni L, Pedroso M, Barcellos C, Salles R, Salles S, Paixão B, et al. An integrated dataset of malaria notifications in the Legal Amazon. BMC Res Notes. 2020 Jun;13(1):274. https://doi.org/10.1186/s13104-020-05109-y

Cardoso MA, Scopel KK, Muniz PT, Villamor E, Ferreira MU. Underlying factors associated with anemia in Amazonian children: a population-based, cross-sectional study. PLoS One. 2012;7(5):e36341. https://doi.org/10.1371/journal.pone.0036341

Davidson EM, Simpson JA, Fowkes FJ. The interplay between maternal-infant anemia and iron deficiency. Nutr Rev. 2023 Mar;81(4):480-91. https://doi.org/10.1093/nutrit/nuac066

Assunção MC, Santos IS, Barros AJ, Gigante DP, Victora CG. Effect of iron fortification of flour on anemia in preschool children in Pelotas, Brazil]. Rev Saude Publica. 2007 Aug;41(4):539-48. https://doi.org/10.1590/S0034-89102006005000031

Cardoso MA, Augusto RA, Bortolini GA, Oliveira CS, Tietzman DC, Sequeira LA, et al. Effect of providing multiple micronutrients in powder through primary healthcare on anemia in young brazilian children: a multicentre pragmatic controlled trial. PLoS One. 2016 Mar;11(3):e0151097. https://doi.org/10.1371/journal.pone.0151097

Pincelli A, Cardoso MA, Malta MB, Nicolete VC, Soares IS, Castro MC, et al.; MINA-Brazil Study Working Group. Prolonged breastfeeding and the risk of plasmodium vivax infection and clinical malaria in early childhood: a birth cohort study. Pediatr Infect Dis J. 2022 Oct;41(10):793-9. https://doi.org/10.1097/INF.0000000000003618

Oliveira PG, Sousa JM, Assunção DG, Araujo EK, Bezerra DS, Dametto JF, et al. Impacts of consumption of ultra-processed foods on the maternal-child health: a systematic review. Front Nutr. 2022 May;9:821657. https://doi.org/10.3389/fnut.2022.821657

Monteiro CA, Cannon G, Lawrence M, Costa Louzada MD, Pereira Machado P. Ultra-processed foods, diet quality, and health using the NOVA Classification System. Rome: FAO; 2019 [cited 2023 May 22]. Available from: https://www.fao.org/3/ca5644en/ca5644en.pdf

Soares MM, Juvanhol LL, Ribeiro SA, Franceschini SD, Araújo RM. Prevalence of processed and ultra-processed food intake in Brazilian children (6-24 months) is associated with maternal consumption and breastfeeding practices. Int J Food Sci Nutr. 2021 Nov;72(7):978-88. https://doi.org/10.1080/09637486.2021.1885016

Nascimento JR, Brito-Sousa JD, Almeida AC, Melo MM, Costa MR, Barbosa LR, et al. Prevalence of glucose 6-phosphate dehydrogenase deficiency in highly malaria-endemic municipalities in the Brazilian Amazon: a region-wide screening study. Lancet Reg Health Am. 2022 May;12:100273. https://doi.org/10.1016/j.lana.2022.100273

Published

2023-11-30

How to Cite

Cardoso, M. A., Lourenço, B. H., Matijasevich, A., Castro, M. C., & Ferreira, M. U. (2023). Prevalence and correlates of childhood anemia in the MINA-Brazil birth cohort study. Revista De Saúde Pública, 57(Supl.2), 1-15. https://doi.org/10.11606/s1518-8787.2023057005637