The Demographic and Health Surveys Program, ICF, Rockville, MD, United States of America.
Public Health Institute/ USAID Sustaining Technical and Analytical Resources, Washington, DC, United States of America.
PLoS One. 2024 Feb 28;19(2):e0298967. doi: 10.1371/journal.pone.0298967. eCollection 2024.
Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36-59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p < 0.05) and physical development in Maldives (AORs = 0.97 p < 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.
贫血是许多中低收入国家（LMICs）的一个重大公共卫生问题，幼儿尤其容易受到影响。缺铁是贫血的主要原因，先前的研究表明，铁含量低/缺铁性贫血与儿童发育不良结果之间存在关联。在 LMICs 中，有 43%的五岁以下儿童面临无法发挥其发展潜力的风险。然而，很少有研究在大型基于人群的调查中检查贫血状况与儿童早期发展（ECD）之间的关联。我们研究了严重或中度贫血与 ECD 领域（读写算数、身体、社会情感和学习）以及 36-59 个月儿童整体 ECD 指数之间的关联。使用了来自 DHS 计划第七阶段（DHS-7）的 9 项人口与健康调查（DHS），其中包括儿童五岁以下的 ECD 模块和血红蛋白检测。对五个结果中的每一个进行了二元和多元逻辑回归分析。多元模型控制了早期学习/互动变量、儿童、母婴和父亲特征以及社会经济和家庭特征。结果表明，除了贝宁的社会情感发展（AOR = 1.00，p < 0.05）和马尔代夫的身体发育（AORs = 0.97，p < 0.05）外，贫血与 ECD 领域或整体 ECD 指数之间几乎没有显著关联。参加幼儿教育计划也与许多国家的结果显著相关。我们的研究结果强调了培育关怀框架的重要性，该框架描述了促进 LMICs 中 ECD 的多部门方法。
