Abstract
Background: Various studies have reported the coexistence of undernutrition and anemia. This study aims to determine the correlation between prolonged undernutrition and the occurrence of anemia in Indonesian children.
Methods: This retrospective cohort study examined 2,296 under-five children in the 2007 Indonesian Family Life Survey (IFLS) and its follow-up in 2014 to observe the association between children’s prolonged undernutrition (stunted and wasted) and anemia status.
Results: Children who had prolonged wasting had increased risk of remaining anemic (relative risk (RR): 2.02, 95% CI 1.00 – 4.08) but after adjustment for the confounding variables, the association was less clear (adjusted RR (aRR): 3.02, 95% CI 0.82 – 11.12. p=0.097). Meanwhile, children who had prolonged stunting from 2007 to 2014 had 2.80 times greater risk of remaining anemic compared to children who were normal (RR: 1.47, 95% CI 1.05–2.06), but the relationship between prolonged stunting and anemia becomes no longer significant after adjustment for potential confounding variables (aRR: 1.78, 95% CI 0.78–4.10). Nevertheless, prolonged stunting was a predictor of anemia risk in children with lower meat consumption (aRR: 2.44, 95% CI 1.42–4.19).
Conclusion: Chronic undernutrition, i.e., stunting, in children is closely associated with anemia. Public health interventions and approaches with combined effects can be effective in preventing undernutrition and anemia in both children and adolescents.
Keywords: Anemia, Growth disorders, Stunting, Wasted, Child, Indonesia
Recommended Citation
Sartika R, Sari S, Ningsih W, Wirawan F.
Prolonged Undernutrition and the Risk of Anemia in Indonesian Children.
J Health Res.
2024;
38(3):-.
DOI: https://doi.org/10.56808/2586-940X.1076
References
[1] Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data. Lancet Glob Health. 2022;10(5):e627-39. doi: 10.1016/S2214-109X(22)00084-5
[2] Indonesia, Ministry of Health. Basic Health Research 2013. Jakarta: Ministry of Health; 2013.
[3] Indonesia, Ministry of Health. Basic Health Research 2018. Jakarta: Ministry of Health; 2018.
[4] World Health Organization [WHO]. The Global Prevalence of Anaemia in 2011. Geneva: WHO; 2015.
[5] Heesemann E, Mahler C, Subramanyam MA, Vollmer S. Pregnancy anaemia, child health and development: a cohort study in rural India. BMJ Open. 2021;11(11):e046802. doi: 10.1136/bmjopen-2020-046802
[6] Abu-Ouf NM, Jan MM. The impact of maternal iron deficiency and iron deficiency anemia on child's health. Saudi Med J. 2015;36(2):146-9. doi: 10.15537/smj.2015.2.10289
[7] Putri TA, Salsabilla DA, Saputra RK. The Effect of Low Birth Weight on Stunting in Children Under Five: A Meta Analysis. Journal of Maternal and Child Health. 2021; 6(4):496-506.
[8] Abbas F, Kumar R, Mahmood T, Somrongthong R. Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach. Sci Rep. 2021;11(1):19932. doi: 10.1038/s41598-021-98924-7
[9] Dhokar A, Ray S. Prevalence of anemia among urban and rural adolescents. International Journal of Applied Research. 2016;2(6):965-7.
[10] Jauregui-Lobera I. Iron deficiency and cognitive functions. Neuropsychiatr Dis Treat. 2014;10:2087-95. doi: 10.2147/NDT.S72491
[11] Kim JY, Shin S, Han K, Lee KC, Kim JH, Choi YS, et al. Relationship between socioeconomic status and anemia prevalence in adolescent girls based on the fourth and fifth Korea National Health and Nutrition Examination Surveys. Eur J Clin Nutr. 2014;68(2):253-8. doi: 10.1038/ejcn.2013.241
[12] Yang W, Li X, Li Y, Zhang S, Liu L, Wang X, et al. Anemia, malnutrition and their correlations with socio-demographic characteristics and feeding practices among infants aged 0-18 months in rural areas of Shaanxi province in northwestern China: a cross-sectional study. BMC Public Health. 2012;12:1127. doi: 10.1186/1471-2458-12-1127
[13] Agustina R, Wirawan F, Sadariskar AA, Setianingsing AA, Nadiya K, Prafiantini E, et al. Associations of Knowledge, Attitude, and Practices toward Anemia with Anemia Prevalence and Height-for-Age Z-Score among Indonesian Adolescent Girls. Food Nutr Bull. 2021;42(1_suppl):S92-S108. doi: 10.1177/03795721211011136
[14] Gosdin L, Martorell R, Bartolini RM, Mehta R, Srikantiah S, Young MF. The co-occurrence of anaemia and stunting in young children. Matern Child Nutr. 2018;14(3):e12597. doi: 10.1111/mcn.12597
[15] United States Agency for International Development [USAID]. Conceptual Frameworks for Anemia. Washington, DC: USAID; 2013.
[16] da Silva LLS, Fawzi WW, Cardoso MA, Group EW. Factors associated with anemia in young children in Brazil. PLoS One. 2018;13(9):e0204504. doi: 10.1371/journal.pone.0204504
[17] Woldie H, Kebede Y, Tariku A. Factors Associated with Anemia among Children Aged 6-23 Months Attending Growth Monitoring at Tsitsika Health Center, Wag-Himra Zone, Northeast Ethiopia. J Nutr Metab. 2015;2015:928632. doi: 10.1155/2015/928632
[18] Wang JY, Hu PJ, Luo DM, Dong B, Ma Y, Dai J, et al. Reducing Anemia Among School-Aged Children in China by Eliminating the Geographic Disparity and Ameliorating Stunting: Evidence From a National Survey. Front Pediatr. 2020;8:193. doi: 10.3389/fped.2020.00193
[19] Syed S, Addo OY, De la Cruz-Gongora V, Ashour FA, Ziegler TR, Suchdev PS. Determinants of Anemia among School-Aged Children in Mexico, the United States and Colombia. Nutrients. 2016;8(7). doi: 10.3390/nu8070387
[20] Zhang YX, Chen J, Liu XH. Profiles of anemia among school-aged children categorized by body mass index and waist circumference in Shandong, China. Pediatr Neonatol. 2021;62(2):165-71. doi: 10.1016/j.pedneo.2020.11.002
[21] United Nations [UN]. Transforming our world: the 2030 Agenda for Sustainable Development. New York: UN; 2015.
[22] RAND Cooperation. The IFLS Study Design. [cited 2022 Feb 24]. Available from: https://www.rand.org/well-being/social-and-behavioral-policy/data/FLS/IFLS/study.html.
[23] World Health Organization [WHO]. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: WHO; 2011.
[24] World Health Organizations [WHO]. WHO Child Growth Standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva: WHO; 2006.
[25] Indonesia, Ministry of Health. Basic Health Research 2007. Jakarta: Ministry of Health; 2007.
[26] Rahman MS, Mushfiquee M, Masud MS, Howlader T. Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh Demographic and Health Survey 2011. PLoS One. 2019;14(7):e0219170. doi: 10.1371/journal.pone.0219170
[27] Zanin FH, da Silva CA, Bonomo E, Teixeira RA, Pereira CA, dos Santos KB, et al. Determinants of Iron Deficiency Anemia in a Cohort of Children Aged 6-71 Months Living in the Northeast of Minas Gerais, Brazil. PLoS One. 2015;10(10):e0139555. doi: 10.1371/journal.pone.0139555
[28] Sumarmi S, Puspitasari N, Handajani R, Wirjatmadi B. Underweight as a Risk Factor for Iron Depletion and Iron-Deficient Erythropoiesis among Young Women in Rural Areas of East Java, Indonesia. Mal J Nutr. 2016; 22(2):219-32.
[29] Malako BG, Asamoah BO, Tadesse M, Hussen R, Gebre MT. Stunting and anemia among children 6-23 months old in Damot Sore district, Southern Ethiopia. BMC Nutr. 2019;5:3. doi: 10.1186/s40795-018-0268-1
[30] Endris BS, Dinant GJ, Gebreyesus SH, Spigt M. Risk factors of anemia among preschool children in Ethiopia: a Bayesian geo-statistical model. BMC Nutr. 2022;8(1):2. doi: 10.1186/s40795-021-00495-3
[31] Nounkeu CD, Dharod JM. Integrated Approach in Addressing Undernutrition in Developing Countries: A Scoping Review of Integrated Water Access, Sanitation, and Hygiene (WASH) + Nutrition Interventions. Curr Dev Nutr. 2021;5(7):nzab087. doi: 10.1093/cdn/nzab087
[32] Siekmans K, Receveur O, Haddad S. Can an integrated approach reduce child vulnerability to anaemia? Evidence from three African countries. PLoS One. 2014;9(3):e90108. doi: 10.1371/journal.pone.0090108