Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Epidemiology of anemia among 4- to 17-month-old children living in south central Nepal

European Journal of Clinical Nutrition volume 60, pages 228–235 (2006)Cite this article

Abstract

Objective:

To describe the distribution of hemoglobin and prevalence of anemia in Nepali children living in the Terai region by potential risk factors for deficiency.

Design:

This was a cross-sectional, community-based study of baseline characteristics of children enrolled in a randomized, placebo-controlled clinical trial between January and March 2002. Participants were weighed and measured and had their blood drawn. Their mothers contributed demographic, morbidity, and feeding data.

Subjects:

There were 569 4- to 17-month-old children. Statistical models were based on 490 children.

Results:

Anemia was prevalent: 58% of the children had a hemoglobin <105 g/l. Iron-deficiency anemia (anemia with erythrocyte protoporphyrin (EP) ⩾90 μmol/mol heme) was present in 43% of the children. Severe anemia was rare: less than 2% of the children had a hemoglobin <70 g/l. The mean (s.d.) hemoglobin concentration was 101 (12.5) g/l. Stunting and wasting were prevalent: 30.8% were stunted (length-for-age Z-score <−2) and 18.1% were wasted (weight-for-length Z-score <−2). Bivariate analyses revealed that age, caste, socioeconomic status, dietary diversity, stunting, and underweight were associated with hemoglobin concentration and/or anemia. In multivariate models with and without EP, age and caste were found to be strong predictors of both hemoglobin concentration and anemia.

Conclusions:

Anemia and iron deficiency increased strongly with age and low-caste status among the study children. The data reveal the importance of targeting interventions to children in the first year of life before they become anemic and iron deficient.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  • Beard J (2001). Iron biology in immune function, muscle metabolism and neuronal functioning. J Nutr 131, 568S–580S.

    Article  CAS  Google Scholar 

  • Bentley ME, Griffiths PL (2003). The burden of anemia among women in India. Eur J Clin Nutr 57, 52–60.

    Article  CAS  Google Scholar 

  • Brown KH, Peerson JM, Lopez de Romana G, de Kanashiro HC, Black RE (1995). Validity and epidemiology of reported poor appetite among Peruvian infants from a low-income, periurban community. Am J Clin Nutr 61, 26–32.

    Article  CAS  Google Scholar 

  • Christian P, Khatry SK, Katz J, Pradhan EK, LeClerq SC, Shrestha SR et al. (2003). Supplementation with micronutrients in addition to iron and folic acid does not further improve the hematologic status of pregnant women in rural Nepal. J Nutr 133, 3492–3498.

    Article  CAS  Google Scholar 

  • Chronbach LJ (1951). Coefficient alpha and the internal structure of tests. Psychometrika 16, 297–334.

    Article  Google Scholar 

  • Cordaux R, Aunger R, Bentley G, Nasidze I, Sirajuddin SM, Stoneking M (2004). Independent origins of Indian caste and tribal paternal lineages. Curr Biol 14, 231–235.

    Article  CAS  Google Scholar 

  • DeMaeyer E, Adiels-Tegman M (1985). The prevalence of anemia in the world. World Health Stat Q 38 (3), 302–316.

    CAS  PubMed  Google Scholar 

  • Dewey KG (2001). Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am 48, 87–104.

    Article  CAS  Google Scholar 

  • Domellof M, Dewey KG, Lonnerdal B, Cohen RJ, Hernell O (2002a). The diagnostic criteria for iron deficiency in infants should be reevaluated. J Nutr 132, 3680–3686.

    Article  CAS  Google Scholar 

  • Domellof M, Lonnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hernell O (2002b). Sex differences in iron status during infancy. Pediatrics 110, 545–552.

    Article  Google Scholar 

  • Dreyfuss ML, Stoltzfus RJ, Shrestha JB, Pradhan EK, LeClerq SC, Khatry SK et al. (2000). Hookworms, Malaria and Vitamin A Deficiency Contribute to Anemia and Iron Deficiency among Pregnant Women in the Plains of Nepal. J Nutr 130, 2527–2536.

    Article  CAS  Google Scholar 

  • Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, the Comparative Risk Assessment Collaborating Group (2002). Selected major risk factors and global and regional burden of disease. Lancet 360, 1347–1360.

    Article  Google Scholar 

  • Gittelsohn J, Shankar AV, West Jr KP, Ram R, Dhungel C, Dahal B (1997). Infant feeding practices reflect antecedent risk of xerophthalmia in Nepali children. Eur J Clin Nutr 51, 484–490.

    Article  CAS  Google Scholar 

  • Gomber S, Kumar S, Rusia U, Gupta P, Agarwal KN, Sharma S (1998). Prevalence and etiology of nutritional anaemias in early childhood in an urban slum. Indian J Med Res 107, 269–273.

    CAS  PubMed  Google Scholar 

  • James WP, Nelson M, Ralph A, Leather S (1997). Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ 314, 1545–1549.

    Article  CAS  Google Scholar 

  • Kapoor D, Agarwal KN, Sharma S, Kelo K, Kaur I (2002). Iron status of children aged 9 – 36 months in an urban slum Integrated Child Development Services project in Delhi. Indian Pediatr 39, 136–144.

    PubMed  Google Scholar 

  • Katz J, West Jr KP, LeClerq SC, Thapa MD, Khatry SK, Shresta SR et al. (1998). Agreement between clinical examination and parental morbidity histories for children in Nepal. J Trop Pediatr 44, 225–229.

    Article  CAS  Google Scholar 

  • Lartey A, Manu A, Brown KH, Dewey KG (2000). Predictors of micronutrient status among six- to twelve-month old breast-fed Ghanaian infants. J Nutr 130, 199–207.

    Article  CAS  Google Scholar 

  • Lozoff B, Brittenham GM, Wolf AW, Mclish DK, Kuhnert PM, Jimenez E et al. (1988). Iron deficiency anemia and iron therapy effects on infant development test performance. Pediatrics 79, 981–985. (Published erratum appears in Pediatrics 1988 81: 683).

    Google Scholar 

  • Lutter CK, Rivera JA (2003). Nutritional status of infants and young children and characteristics of their diets. J Nutr 133, 2941S–2949S.

    Article  Google Scholar 

  • Mason JB, Lotfi M, Dalmiya N, Sethuraman K, Deitchler M, Geibel S et al. (2001). The Micronutrient Report: Current Progress and Trends in the Control of Vitamin A, Iron, and Iodine Deficiencies. Micronutrient Initiative, International Development Research Center: Ottawa, Canada.

    Google Scholar 

  • Ruel MT (2003). Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr 133 (11 Suppl 2), 3911S–3926S.

    Article  CAS  Google Scholar 

  • Stoltzfus R, Mullany L, Black RE (2005). Iron deficiency anemia. In: Ezzati M, Lopez AD, Rogers A, Murray CJL (eds.), Comparative Quantification of Health Risks: The Global and Regional Burden of Disease due to 25 Selected Major Risk Factors. World Health Organization: Geneva, 163–209.

    Google Scholar 

  • Sultan AN, Zuberi RW (2003). Late weaning: the most significant risk factor in the development of iron deficiency anemia at 1-2 years of age. J Ayub Med Coll Abbottabad 15, 3–7.

    PubMed  Google Scholar 

  • Underwood BA (1985). Weaning practices in deprived environments: the weaning dilemma. Pediatrics 75 (1 Part 2), 194–198.

    CAS  PubMed  Google Scholar 

  • UNICEF (1997). Malnutrition in South Asia: A regional profile UNICEF Regional Office for South Asia.

  • Wharf SG, Fox TE, Fairweather-Tait ST, Cook JD (1997). Factors affecting iron stores in infants 4–18 months of age. Eur J Clin Nutr 51, 504–509.

    Article  CAS  Google Scholar 

  • WHO/UNICEF (1998). Complementary Feeding of Young Children in Developing Countries: a Review of Current Scientific Knowledge. World Health Organization: Geneva.

Download references

Acknowledgements

The authors wish to acknowledge the Nepal Nutrition Intervention Project – Sarlahi (NNIPS) staff members for their effort, dedication, and enthusiasm in implementing the study, especially Shishir Var Shrestha, Sharada Ram Shrestha, Tirtha Raj Shakya, Gokarna Subedi, Bikram Tamang, Jaybar Shrestha, Kalawati Giri, Chandeswor Nepali, Rajeswori Kafle, and Parvati Malli. This study was conducted by the Center for Human Nutrition and the Sight and Life Institute in the Department of International Health, Bloomberg School of Public Health, Johns Hopkins University (JHU) Baltimore, MD, USA, and was funded by the National Institutes of Health, Bethesda, Maryland (HD 38753), the Bill and Melinda Gates Foundation, Seattle, Washington (810-2054), and a Cooperative Agreement between JHU and the Office of Health and Nutrition, US Agency for International Development, Washington, DC, USA (HRN-A-00-97-00015-00).

Author information

Authors and Affiliations

  1. Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA

    E H Siegel & R J Stoltzfus

  2. Nepal Nutrition Project-Sarlahi, Nepal Netra Jyoti Sangh, Kathmandu, Nepal

    S K Khatry & S C LeClerq

  3. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    J Katz & J M Tielsch

Authors
  1. E H Siegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R J Stoltzfus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S K Khatry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S C LeClerq
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J M Tielsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E H Siegel.

Additional information

Guarantor: EH Siegel.

Contributors: All authors participated in the design and execution of the study. ES conducted the data analysis and wrote the manuscript with substantial contributions from RS, JK, and JT in the formulation of ideas and edits of each draft.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Siegel, E., Stoltzfus, R., Khatry, S. et al. Epidemiology of anemia among 4- to 17-month-old children living in south central Nepal. Eur J Clin Nutr 60, 228–235 (2006). https://doi.org/10.1038/sj.ejcn.1602306

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602306

Keywords

This article is cited by

Search

Advanced search

Quick links