Yadav Kapil, Ramaswamy Gomathi, Puri Surabhi, Vohra Kashish, Achary Thejas, Jaiswal Abhishek, Kaur Ravneet, Bairwa Mohan, Singh Archana, Sethi Vani
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
National Centre of Excellence and Advanced Research on Anemia Control, All India Institute of Medical Sciences, New Delhi, India.
PLOS Glob Public Health. 2024 Jan 18;4(1):e0002095. doi: 10.1371/journal.pgph.0002095. eCollection 2024.
The present study aimed to estimate the prevalence of anemia, and anemia with micronutrient deficiencies (iron/ vitamin B12/ folic acid) and their determinants among children aged 12-59 months in India. Comprehensive National Nutritional Survey (2016-2018) is Asia's largest nutrition survey conducted among 0-19 years aged children in India. We used generalised linear model (modified Poisson) with adjusted prevalence ratio (aPR) to assess the socio-economic and biochemical factors associated with anemia and anemia with micronutrient deficiencies amongst children aged 12 to 59 months. Out of the total of 11,237 children included in the study, 40.5% (95%CI:38·6-42·6) were anemic, 30.0% (95%CI:27·8-32·4) had anemia with micronutrient deficiencies and 60.9% (95%CI:58·2-63·5) had micronutrient deficiencies with or without anemia. Younger age (aPR(95%CI) for one year old: 1.9(1.5-2.4), two year old: 1.8(1.5-2.2), three year old: 1.4(1.2-1.7) compared to four year old children) and lower educational status of the mother (mothers without formal schooling aPR(95%CI):1.4(1.1-1.8); 1-9 standards: 1.4(1.2-1.7)) vs mother educated with high school and above, consumption of less than 100 iron-folic acid tablets during pregnancy (aPR(95%CI):1.3(1.0-1.7) vs consumption of ≥ 180 tablets, any self-reported illness among children within two weeks preceding the interview (aPR(95%CI):1.2(1.1-1.4) vs no-illnesses, iron deficiency (aPR(95%CI):2.2(2.0-2.6)) and zinc deficiency (aPR(95%CI):1.3(1.1-1.4)) were associated with anemia in children. Among anemic, the children from scheduled tribe (aPR(95%CI):1.4(1.1-1.8)) vs other caste categories, and those following unsafe child faeces disposal practices (aPR(95%CI):1.2(1.0-1.4)) vs those who follow safe faeces disposal practices had higher chance of having micronutrient deficiency. One third of children aged 12-59 months had anemia with micronutrient deficiency (iron/ folic acid/ vitamin B12). More than half of children had micronutrient deficiencies irrespective of anemia. Micronutrient deficiencies, antenatal IFA intake, safe hygiene practices need to be strengthened to leave no stone unturned in control of anemia among under-five children in India.
本研究旨在估算印度12至59个月大儿童中贫血、伴有微量营养素缺乏（铁/维生素B12/叶酸）的贫血情况及其决定因素。综合全国营养调查（2016 - 2018年）是在印度0至19岁儿童中开展的亚洲最大规模营养调查。我们使用广义线性模型（修正泊松模型）及调整患病率比（aPR）来评估12至59个月大儿童中与贫血及伴有微量营养素缺乏的贫血相关的社会经济和生化因素。在纳入研究的11237名儿童中，40.5%（95%置信区间：38.6 - 42.6）患有贫血，30.0%（95%置信区间：27.8 - 32.4）患有伴有微量营养素缺乏的贫血，60.9%（95%置信区间：58.2 - 63.5）患有伴有或不伴有贫血的微量营养素缺乏。与4岁儿童相比，年龄较小（1岁儿童的aPR(95%置信区间)：1.9(1.5 - 2.4)，2岁儿童：1.8(1.5 - 2.2)，3岁儿童：1.4(1.2 - 1.7)）以及母亲教育程度较低（未接受正规教育的母亲aPR(95%置信区间)：1.4(1.1 - 1.8)；1 - 9年级：1.4(1.2 - 1.7)）相较于接受高中及以上教育的母亲、孕期服用铁叶酸片少于100片（aPR(95%置信区间)：1.3(1.0 - 1.7) 相较于服用≥180片）、在访谈前两周内儿童有任何自我报告的疾病（aPR(95%置信区间)：1.2(1.1 - 1.4) 相较于无疾病）、缺铁（aPR(95%置信区间)：2.2(2.0 - 2.6)）和缺锌（aPR(95%置信区间)：1.3(1.1 - 1.4)）均与儿童贫血相关。在贫血儿童中，来自在册部落的儿童（aPR(95%置信区间)：1.4(1.1 - 1.8)）相较于其他种姓类别，以及遵循不安全儿童粪便处理方式的儿童（aPR(95%置信区间)：1.2(1.0 - 1.4)）相较于遵循安全粪便处理方式的儿童，有更高的几率患有微量营养素缺乏。三分之一的12至59个月大儿童患有伴有微量营养素缺乏（铁/叶酸/维生素B12）的贫血。超过一半的儿童患有微量营养素缺乏，无论是否贫血。需要加强微量营养素缺乏、产前铁叶酸摄入、安全卫生习惯等方面的措施，以全面控制印度五岁以下儿童的贫血情况。
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