Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, São Paulo, Brazil.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLoS One. 2018 Sep 25;13(9):e0204504. doi: 10.1371/journal.pone.0204504. eCollection 2018.
Anemia is recognized as a major public health problem in childhood, especially in children under 24 months of age. Despite improvements in public health strategies to prevent and control anemia in Brazilian young children in the last decade, few studies have assessed the predictors for this condition in primary health care. Thus, this study aimed to assess the associated factors of anemia in young children who visited primary public health care facilities in Brazil.
A cross-sectional study was conducted with 520 children aged 11 to 15 months who visited the primary health care in four Brazilian cities. Anemia was defined as hemoglobin concentration < 110 g/L in venous blood samples. Multilevel Poisson regression models were used to describe the associations between anemia and independent variables.
The frequency of anemia was 23.1%. A higher frequency was observed in children who live with more than one other child younger than 5 years in the house (Prevalence Ratio [PR] 1.47; 95% Confidence Interval [CI] 1.01-2.14), who started to receive fruits and vegetables after 8 months of age (PR 1.92; 95% CI 1.19-3.10), who were stunted (PR 2.44; 95% CI 1.32-4.50), who were hospitalized at least once in their life (PR 1.55; 95% CI 1.03-2.33) and who were in the lower tertile of serum folate concentration (PR 2.24; 95% CI 1.30-3.85).
Inadequate complementary feeding practices and morbidity were the main predictors for anemia in early childhood in this population. Improvements in current strategies to promote healthy complementary feeding along with better control of morbidities are recommended to reduce anemia in Brazilian young children.
贫血被认为是儿童期的一个主要公共卫生问题，尤其是在 24 个月以下的儿童中。尽管在过去十年中，巴西针对幼儿的公共卫生策略在预防和控制贫血方面有所改善，但很少有研究评估初级保健中该疾病的预测因素。因此，本研究旨在评估巴西初级公共卫生保健机构就诊的幼儿贫血的相关因素。
本研究采用横断面研究设计，共纳入了 520 名年龄在 11 至 15 个月之间的儿童，这些儿童均来自巴西的四个城市的初级卫生保健机构。贫血定义为静脉血样血红蛋白浓度<110g/L。采用多水平泊松回归模型描述贫血与自变量之间的关联。
贫血的发生率为 23.1%。与以下因素相关的儿童贫血发生率较高：家中有 5 岁以下的其他儿童（流行率比 [PR] 1.47；95%置信区间 [CI] 1.01-2.14）、8 个月后开始食用水果和蔬菜（PR 1.92；95% CI 1.19-3.10）、生长迟缓（PR 2.44；95% CI 1.32-4.50）、至少住院一次（PR 1.55；95% CI 1.03-2.33）以及血清叶酸浓度处于较低三分位数（PR 2.24；95% CI 1.30-3.85）。
在该人群中，不适当的补充喂养实践和发病是幼儿期贫血的主要预测因素。建议改善当前促进健康补充喂养的策略，并更好地控制发病，以降低巴西幼儿的贫血发生率。
