Ocks Lindsey M, Paudyal Naveen, Lundsgaard Sabrina, Thapa Lila Bikram, Joshi Nira, Mei LZuguo, Whitehead Ralph D, Jefferds Maria Elena D
Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, United States.
Department of Global Health, School of Public Health, Boston University, Boston, MA, United States.
Curr Dev Nutr. 2023 Mar 3;7(5):100063. doi: 10.1016/j.cdnut.2023.100063. eCollection 2023 May.
Analyses of predictors of anemia or malnutrition often pool national or regional data, which may hide variability at subnational levels.
We sought to identify the risk factors for anemia in young Nepali children aged 6-23 mo in 2 districts: Kapilvastu and Achham.
This is an analysis of two cross-sectional surveys that were conducted as part of a program evaluation of an infant and young child feeding and micronutrient powder intervention that included anemia as a primary outcome. Baseline and endline surveys in each district (in 2013 and 2016) included hemoglobin assessments in = 4709 children who were representative of children 6-23 mo in each district. Log-binomial regression models accounting for the survey design were used to estimate univariable and multivariable prevalence ratios for risk factors at multiple levels-underlying, direct, and biological causes. Average attributable fractions (AFs) for the population were calculated for significant predictor biomarkers of anemia in multivariable models.
In Accham, the prevalence of anemia was 31.4%; significant predictors included child's age, household asset ownership, length-for-age -score, inflammation (CRP concentration > 0.5 mg/L; α-1 acid glycoprotein concentration > 1 mg/mL), and iron deficiency (serum ferritin concentration < 12 μg/L with BRINDA-inflammation adjustment). In Kapilvastu, the prevalence of anemia was 48.1%; significant predictors included child's sex and ethnicity, wasting and weight-for-length z-score, any morbidity in the previous 2 wk, consumption of fortified foods, receipt of multiple micronutrient powder distributions, iron deficiency, zinc deficiency (nonfasting serum zinc concentration of <65 μg/dL in the morning and that of <57 μg/dL in the afternoon), and inflammation. In Achham, average AFs were 28.2% and 19.8% for iron deficiency and inflammation, respectively. Average AFs for anemia in Kapilvastu were 32.1%, 4.2%, and 4.9% for iron deficiency, zinc deficiency, and inflammation, respectively.
The prevalence of anemia and its risk factors varied between districts, with inflammation contributing to a greater share of anemia in Achham than in Kapilvastu. The estimated AF for iron deficiency was around 30% in both districts; iron-delivering interventions and multisectoral approaches to anemia are warranted.
对贫血或营养不良预测因素的分析通常汇总国家或地区数据，这可能掩盖国家以下层面的差异。
我们试图确定尼泊尔卡皮拉瓦斯图和阿昌两个地区6至23个月大幼儿贫血的危险因素。
这是一项对两项横断面调查的分析，该调查是一项婴幼儿喂养和微量营养素粉干预项目评估的一部分，贫血是主要结果。每个地区（2013年和2016年）的基线和终线调查包括对4709名儿童的血红蛋白评估，这些儿童代表了每个地区6至23个月大的儿童。使用考虑调查设计的对数二项回归模型来估计多个层面（潜在、直接和生物学原因）危险因素的单变量和多变量患病率比。在多变量模型中，计算了贫血显著预测生物标志物在人群中的平均归因分数（AFs）。
在阿昌，贫血患病率为31.4%；显著预测因素包括儿童年龄、家庭资产拥有情况、年龄别身长评分、炎症（CRP浓度>0.5mg/L；α-1酸性糖蛋白浓度>1mg/mL）和缺铁（经BRINDA炎症调整后血清铁蛋白浓度<12μg/L）。在卡皮拉瓦斯图，贫血患病率为48.1%；显著预测因素包括儿童性别和种族、消瘦和身长别体重z评分、过去2周内的任何疾病、食用强化食品、接受多次微量营养素粉分发、缺铁、缺锌（上午非空腹血清锌浓度<65μg/dL，下午<57μg/dL）和炎症。在阿昌，缺铁和炎症的平均AFs分别为28.2%和19.8%。在卡皮拉瓦斯图，贫血的缺铁、缺锌和炎症平均AFs分别为32.1%、4.2%和4.9%。
贫血患病率及其危险因素在不同地区有所不同，炎症在阿昌导致的贫血比例高于卡皮拉瓦斯图。两个地区缺铁的估计AF约为30%；有必要采取提供铁的干预措施和多部门方法来应对贫血。
