Amarasinghe Gayani Shashikala, Naottunna Naotunna Palliya Guruge Chamidri Randika, Agampodi Thilini Chanchala, Agampodi Suneth Buddhika
Maternal and Child Health Research Unit, Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka.
BMC Pediatr. 2017 Mar 27;17(1):87. doi: 10.1186/s12887-017-0841-9.
Despite interventions, childhood anemia is still a major public health problem in low and middle income countries. Purpose of the present study is to determine factors associated with anemia among rural primary school children in Sri Lanka, a country undergoing rapid socioeconomic changes.
Multi stage cluster sampling was used to select 100 rural schools in NCP and a maximum of 50 children aged 60-131 months were enrolled from each school. Self-administered questionnaires were sent to parents. Anthropometric measurements and blood samples were obtained by trained investigators. Blood reports were analyzed in a commercial laboratory with external quality control measures.
Total of 4412 children were included in the analysis. A Multiple regression was performed for hemoglobin. Only 4.2% of the change in hemoglobin could be explained by the model. District (p > 0.001), age (p > 0.001), timing of warm treatment(p = 0.026) and BMI for age (p = 0.002) uniquely contributed 1.12%, 1.19%, 0.13% and 0.26% to change in hemoglobin level respectively whereas, sex, monthly family income and frequency of meat and green leaf consumption didn't contribute significantly. Peripheral blood film analyses were available for 146 anemic children. Blood film was reported as normal in 19.9% while evidence of iron deficiency (18.5%), early iron deficiency (32.5%) and thalassemia trait with iron deficiency (29.5%) were reported in the rest. Serum ferritin level was available for 417 children with hemoglobin less than 12 g/dl. Mean ferritin level was 63.7 microgram/l. Only 0.5% had depleted iron stores. A multiple regression was performed for serum ferritin and R was 0.123 (p < 0.001). Area under the curve for serum ferritin and anemia was 0.436.
Anemia among rural primary school children in NCP cannot be well explained by routinely assessed socioeconomic characteristics which mainly provide clues to access for food. Commonly used anemia related investigations have low validity in detecting and explaining anemia in this population. Since behavioral factors have been shown to affect nutrition of younger children in Sri Lanka, studying weather behaviors are related to anemia in primary school children is important. Possible etiologies including but not limited to nutritional deficiencies need to be studied further.
尽管采取了干预措施，但儿童贫血在低收入和中等收入国家仍是一个主要的公共卫生问题。本研究的目的是确定在社会经济快速变化的斯里兰卡农村小学儿童中，与贫血相关的因素。
采用多阶段整群抽样法，在北中央省选择100所农村学校，每所学校最多招募50名年龄在60 - 131个月的儿童。向家长发放自填式问卷。由经过培训的调查人员进行人体测量并采集血样。血样报告在一家有外部质量控制措施的商业实验室进行分析。
共有4412名儿童纳入分析。对血红蛋白进行了多元回归分析。模型仅能解释血红蛋白变化的4.2%。地区（p > 0.001）、年龄（p > 0.001）、温热治疗时间（p = 0.026）和年龄别体重指数（p = 0.002）分别对血红蛋白水平变化的贡献率为1.12%、1.19%、0.13%和0.26%，而性别、家庭月收入以及肉类和绿叶蔬菜的食用频率没有显著贡献。对146名贫血儿童进行了外周血涂片分析。19.9%的血涂片报告为正常，其余报告有缺铁证据（18.5%）、早期缺铁（32.5%）和缺铁性地中海贫血特征（29.5%）。对417名血红蛋白低于12 g/dl的儿童检测了血清铁蛋白水平。平均铁蛋白水平为63.7微克/升。只有0.5%的儿童铁储备耗尽。对血清铁蛋白进行了多元回归分析，R为0.123（p < 0.001）。血清铁蛋白与贫血的曲线下面积为0.436。
北中央省农村小学儿童的贫血情况不能通过常规评估的社会经济特征得到很好的解释，这些特征主要提供获取食物的线索。常用的与贫血相关的检查在检测和解释该人群的贫血方面有效性较低。由于行为因素已被证明会影响斯里兰卡年幼儿童的营养状况，因此研究行为与小学儿童贫血之间的关系很重要。包括但不限于营养缺乏在内的可能病因需要进一步研究。
