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ORIGINAL ARTICLE PREVALENCE AND DETERMINING FACTORS OF ANEMIA AND MALNUTRITION AMONG EGYPTIAN CHILDREN ABEER ABDOU BARAKAT, KHALED HASSAN NADA1, DINA AHMED EZZAT2
ABSTRACT BACKGROUND: The first Millennium Development Goal to "eradicate extreme poverty and hunger" implied reducing by 50% the prevalence of underweight status among children younger than five years between 1990 and 2015. AIM OF WORK: This study investigates the prevalence and determining factors of anemia and malnutrition among children of Albasra village, one of the Egyptian villages, to produce directives for a management program. MATERIALS AND METHODS: All inhabitants aged between six months and15 years (397 children) were subjected to a structured interview, clinical assessment, anthropometric assessment, and laboratory examination. A complete blood picture analysis and a hemoglobin percentage assessment were done. RESULTS: The main prevailing symptom in the two weeks preceding the survey was diarrhea (55%). Complete weaning before the age of 18 months occurred in 20.5% of the below‑six children. The children more likely to be anemic were those under the age of two years, children having the first or more than the fourth order among their siblings, and those who suffered a diarrheal attack, vomiting, grunting, or chest indrawing within two weeks preceding the survey, among children completely weaned after the age of 24 months and those from a low socioeconomic level. Stunting was highest among younger children from extended families. Children who suffered a chronic disease were more likely to be wasted (13.2%). CONCLUSION: An understanding of the risk factors for anemia and malnutrition among a population is fundamental to provide efficient preventive and control measures. Key words: Anemia, children, Egypt, malnutrition
INTRODUCTION Each year, more than 10 million children in low and middle‑income countries die before Department of Public Health, Faculty of Medicine, Cairo University, 1International Population Council, 2 Department of Pediatrics, Faculty of Medicine, Beni Suef University, Egypt
they reach their fifth birthday.[1] Although often an invisible phenomenon, malnutrition casts long shadows, affecting close to 800 million people, 20% of all people in the developing Access this article online Quick Response Code:
Address for correspondence: Dr. Dina Ahmed Ezzat, Assisstant Professor of Pediatrics, Faculty of Medicine, Beni Suef University, Egypt. E‑mail: [email protected]
Indian Journal of Medical Sciences, Vol. 67, No. 7 and 8, July and August 2013
Website: www.indianjmedsci.org DOI: 10.4103/0019-5359.125878
ANEMIA AND MALNUTRITION IN EGYPTIAN CHILDREN
world.[2] The data obtained by the Egyptian Demographic Health Survey (EDHS) 2003 indicated that 16% of Egyptian under five children are stunted, 4% are wasted, and 8% are underweight.[3] In the National Population Council (NPC) study[4] conducted by choosing a nationally representative sample of adolescents (10‑19 years old), 17% were stunted, 9% were thin, and 46.6% were anemic. The first Millennium Development Goal to ،، eradicate extreme poverty and hunger’’ [5] implied reducing by 50% the prevalence of underweight status among children younger than five years between 1990 and 2015. Underweight status in children is internationally recognized as an important public healthcare problem and its devastating effects on human performance, health, and survival are well established.[6] Several studies have shown a clear correlation between iron deficiency anemia (IDA) and a series of determinants such as age of the child, [7] a high number of coinhabitants, [8] low per capita family income,[9] poor general socioeconomic conditions,[10] breast feeding pattern,[11] and worm infections.[2] The present study investigates the area‑specific prevalence and determining factors of anemia and malnutrition among children of Albasra village, one of the Egyptian villages, to produce directives for a management program that can be directed at populations with similar characteristics.
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MATERIALS AND METHODS The present study is a cross‑sectional community‑based survey conducted to assess the nutritional status among children in a rural area, with descriptive and analytical components. All inhabitants of the village aged between six months and 15 years were included. The presurvey arrangements lasted for eight weeks including obtaining approvals for conducting the study, designing, revising, and pilot testing the questionnaire, preparation of necessary material, laboratory supplies and equipment, obtaining detailed information about the village necessary for choosing the sample, and training of team members to ensure complete uniformity and standardization of techniques employed in collecting and recording data, as nutritional surveys are specially sensitive to incorrect reporting age or errors in anthropometric measurements.[12] Study tools All the participants were subjected to a structured interview, clinical assessment, anthropometric assessment, and laboratory examination. Structured interviews Two forms were used. The first was used for preschool children (six months to six years). This included demographic, and socioeconomic data,i and history of diarrheal diseases, acute respiratory infection (ARI), breast‑feeding, and vaccination. A standard food frequency sheet was used to provide an idea about the nature of food intake in the preceding week, where the usual frequency of the child’s consumption of each type of food was reported. The food frequency method provided information on
Indian Journal of Medical Sciences, Vol. 67, No. 7 and 8, July and August 2013
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INDIAN JOURNAL OF MEDICAL SCIENCES
the frequency of consumption of a list of foods classified as energy yielding, body building, and protective items. The second was directed toward school‑aged children from above six up to 15 years. This included demographic, and socioeconomic data, history of diseases, operations and medications, history of sun exposure, exercise, school attendance, scholastic achievements, smoking, and eating habits including drinking tea and eating outside home, and the perception of the individual of his own health. The food frequency sheet was also used.
0.1 cm. For older children, height was measured using a vertical measuring scale and was read to the nearest 0.5 cm.[14] • Weight: Young children were weighed on a sensitive scale (beam balance scale) where they were weighed in light clothing and the record was taken to the nearest 0.1 kg.[14] The weight of older children was taken using the ordinary scale. For body mass index (BMI), the cutoff points of Styne[15] were used.
iSince reliable income data are usually difficult to obtain, especially in such cultures, alternative indirect indicators were used. The socioeconomic score adopted is that of Park and Park[13] used by the National Institute of Nutrition in Egypt.
Laboratory investigations After obtaining consent from their parents or caregivers, hemoglobin percentage of all selected children was determined. The Hemo Cue system used in the 2000 EDHS[16] for testing hemoglobin was used. Then, a complete blood picture analysis for those found to be anemic (hemoglobin concentration
ORIGINAL ARTICLE PREVALENCE AND DETERMINING FACTORS OF ANEMIA AND MALNUTRITION AMONG EGYPTIAN CHILDREN ABEER ABDOU BARAKAT, KHALED HASSAN NADA1, DINA AHMED EZZAT2
ABSTRACT BACKGROUND: The first Millennium Development Goal to "eradicate extreme poverty and hunger" implied reducing by 50% the prevalence of underweight status among children younger than five years between 1990 and 2015. AIM OF WORK: This study investigates the prevalence and determining factors of anemia and malnutrition among children of Albasra village, one of the Egyptian villages, to produce directives for a management program. MATERIALS AND METHODS: All inhabitants aged between six months and15 years (397 children) were subjected to a structured interview, clinical assessment, anthropometric assessment, and laboratory examination. A complete blood picture analysis and a hemoglobin percentage assessment were done. RESULTS: The main prevailing symptom in the two weeks preceding the survey was diarrhea (55%). Complete weaning before the age of 18 months occurred in 20.5% of the below‑six children. The children more likely to be anemic were those under the age of two years, children having the first or more than the fourth order among their siblings, and those who suffered a diarrheal attack, vomiting, grunting, or chest indrawing within two weeks preceding the survey, among children completely weaned after the age of 24 months and those from a low socioeconomic level. Stunting was highest among younger children from extended families. Children who suffered a chronic disease were more likely to be wasted (13.2%). CONCLUSION: An understanding of the risk factors for anemia and malnutrition among a population is fundamental to provide efficient preventive and control measures. Key words: Anemia, children, Egypt, malnutrition
INTRODUCTION Each year, more than 10 million children in low and middle‑income countries die before Department of Public Health, Faculty of Medicine, Cairo University, 1International Population Council, 2 Department of Pediatrics, Faculty of Medicine, Beni Suef University, Egypt
they reach their fifth birthday.[1] Although often an invisible phenomenon, malnutrition casts long shadows, affecting close to 800 million people, 20% of all people in the developing Access this article online Quick Response Code:
Address for correspondence: Dr. Dina Ahmed Ezzat, Assisstant Professor of Pediatrics, Faculty of Medicine, Beni Suef University, Egypt. E‑mail: [email protected]
Indian Journal of Medical Sciences, Vol. 67, No. 7 and 8, July and August 2013
Website: www.indianjmedsci.org DOI: 10.4103/0019-5359.125878
ANEMIA AND MALNUTRITION IN EGYPTIAN CHILDREN
world.[2] The data obtained by the Egyptian Demographic Health Survey (EDHS) 2003 indicated that 16% of Egyptian under five children are stunted, 4% are wasted, and 8% are underweight.[3] In the National Population Council (NPC) study[4] conducted by choosing a nationally representative sample of adolescents (10‑19 years old), 17% were stunted, 9% were thin, and 46.6% were anemic. The first Millennium Development Goal to ،، eradicate extreme poverty and hunger’’ [5] implied reducing by 50% the prevalence of underweight status among children younger than five years between 1990 and 2015. Underweight status in children is internationally recognized as an important public healthcare problem and its devastating effects on human performance, health, and survival are well established.[6] Several studies have shown a clear correlation between iron deficiency anemia (IDA) and a series of determinants such as age of the child, [7] a high number of coinhabitants, [8] low per capita family income,[9] poor general socioeconomic conditions,[10] breast feeding pattern,[11] and worm infections.[2] The present study investigates the area‑specific prevalence and determining factors of anemia and malnutrition among children of Albasra village, one of the Egyptian villages, to produce directives for a management program that can be directed at populations with similar characteristics.
169
MATERIALS AND METHODS The present study is a cross‑sectional community‑based survey conducted to assess the nutritional status among children in a rural area, with descriptive and analytical components. All inhabitants of the village aged between six months and 15 years were included. The presurvey arrangements lasted for eight weeks including obtaining approvals for conducting the study, designing, revising, and pilot testing the questionnaire, preparation of necessary material, laboratory supplies and equipment, obtaining detailed information about the village necessary for choosing the sample, and training of team members to ensure complete uniformity and standardization of techniques employed in collecting and recording data, as nutritional surveys are specially sensitive to incorrect reporting age or errors in anthropometric measurements.[12] Study tools All the participants were subjected to a structured interview, clinical assessment, anthropometric assessment, and laboratory examination. Structured interviews Two forms were used. The first was used for preschool children (six months to six years). This included demographic, and socioeconomic data,i and history of diarrheal diseases, acute respiratory infection (ARI), breast‑feeding, and vaccination. A standard food frequency sheet was used to provide an idea about the nature of food intake in the preceding week, where the usual frequency of the child’s consumption of each type of food was reported. The food frequency method provided information on
Indian Journal of Medical Sciences, Vol. 67, No. 7 and 8, July and August 2013
170
INDIAN JOURNAL OF MEDICAL SCIENCES
the frequency of consumption of a list of foods classified as energy yielding, body building, and protective items. The second was directed toward school‑aged children from above six up to 15 years. This included demographic, and socioeconomic data, history of diseases, operations and medications, history of sun exposure, exercise, school attendance, scholastic achievements, smoking, and eating habits including drinking tea and eating outside home, and the perception of the individual of his own health. The food frequency sheet was also used.
0.1 cm. For older children, height was measured using a vertical measuring scale and was read to the nearest 0.5 cm.[14] • Weight: Young children were weighed on a sensitive scale (beam balance scale) where they were weighed in light clothing and the record was taken to the nearest 0.1 kg.[14] The weight of older children was taken using the ordinary scale. For body mass index (BMI), the cutoff points of Styne[15] were used.
iSince reliable income data are usually difficult to obtain, especially in such cultures, alternative indirect indicators were used. The socioeconomic score adopted is that of Park and Park[13] used by the National Institute of Nutrition in Egypt.
Laboratory investigations After obtaining consent from their parents or caregivers, hemoglobin percentage of all selected children was determined. The Hemo Cue system used in the 2000 EDHS[16] for testing hemoglobin was used. Then, a complete blood picture analysis for those found to be anemic (hemoglobin concentration
