Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011-2012

Muhammad Atif Habib; Kirsten Black; Sajid Bashir Soofi; Imtiaz Hussain; Zaid Bhatti; Zulfiqar A Bhutta; Camille Raynes-Greenow

doi:10.1371/journal.pone.0155051

Prevalence and Predictors of Iron Deficiency Anemia in Children under Five Years of Age in Pakistan, A Secondary Analysis of National Nutrition Survey Data 2011-2012

PLoS One. 2016 May 12;11(5):e0155051. doi: 10.1371/journal.pone.0155051. eCollection 2016.

Authors

Muhammad Atif Habib^{1

2}, Kirsten Black¹, Sajid Bashir Soofi², Imtiaz Hussain², Zaid Bhatti², Zulfiqar A Bhutta², Camille Raynes-Greenow³

Affiliations

¹ Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.
² Women and Child Health Division, Aga Khan University, Karachi, Pakistan.
³ Sydney Medical School, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.

Abstract

Background: Iron deficiency Anemia (IDA) in children is a recognized public health problem that impacts adversely on child morbidity, mortality and impairs cognitive development. In Pakistan information on the true prevalence and predictors of IDA is limited. This study sought to investigate IDA in children under five years of age using data from a nationally representative stratified cross-sectional survey.

Methods: Secondary analysis was performed on the National Nutrition Survey in Pakistan 2011-2012. We used a pre-structured instrument to collect socio demographic and nutritional data on mothers and children. We also collected Anthropometric measurements and blood samples for micronutrient deficiencies. IDA was defined as having both haemoglobin levels of <110 g/L and ferritin levels of < 12 μg/L. Data analysis was performed by applying univariate and multivariate techniques using logistic regression through SPSS.

Findings: A total of 7138 children aged between 6-59 months were included in the analysis. The prevalence of IDA was 33.2%. In multivariate regression analysis adjusted odds ratios (AOR) were calculated. Age < 24 months (AOR 1.40, 95% CI 1.18-1.55 p <0.05), stunting (AOR 1.42 CI 1.23-1.63 p<0.05), presence of clinical anemia (AOR 5.69 CI 4.93-6.56 p<0.05), having a mother with IDA (AOR 1.72 CI 1.47-2.01 p<0.05) and household food insecurity (AOR 1.20 CI 1.10-1.40 P<0.05) were associated with IDA. Living in a rural area (AOR 0.77 CI 0.65-0.90 p<0.05) and being a female child (AOR 0.87 CI 0.76-0.98 p<0.05) were associated with reduced odds of IDA.

Conclusion: The prevalence of IDA amongst Pakistani children represents a moderate burden that disproportionately affects the youngest, growth retarded children, affected children are more likely to have mothers with IDA and live in areas where food security is lacking. National efforts to alleviate the burden of IDA should involve both short term vertical programs such as iron supplementation and long term horizontal programs including wheat flour fortification.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anemia, Iron-Deficiency / epidemiology*
Child, Preschool
Female
Humans
Infant
Male
Multivariate Analysis
Nutrition Surveys / statistics & numerical data*
Pakistan / epidemiology
Prevalence
Risk Factors
Statistics as Topic*

Grants and funding

The National Nutrition Survey was funded by UNICEF. MAH is a PhD Students at University of Sydney and is funded through International Post graduate research scholarship and Australian Post Graduate Award funded by the Commonwealth Department of Industry, Australia; and CRG's funding through an NHMRC career development fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.