The changing importance of key factors associated with anaemia in 6- to 59-month-old children in a sub-Saharan African setting where malaria is on the decline

Analysis of the Rwanda Demographic and Health Survey 2010

Richard Nkulikiyinka, Agnes Binagwaho, Katie Palmer

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Abstract

Objective: To estimate the relative contribution of malaria and other potential determinants to current anaemia prevalence in Rwanda. Methods: The database for this study was the Rwanda Demographic and Health Survey 2010. Haemoglobin and malaria test results, and additional exposures ascertained through mothers' interviews, were analysed for all eligible children age 6-59 months (n = 4068), in addition to diet data available for the youngest under 5-year-old per household. We examined anaemia-exposure associations through forward logistic regression, first for the overall population (n = 3685), and second, for the subpopulation with diet data (n = 1934). Results: In the overall study population, malaria was strongly associated with anaemia (OR = 6.83, 95% CI: 2.90-16.05), but population impact was modest (population-attributable fraction = 2.5%). Factors associated with lower odds of anaemia were recent de-worming medication (six months; OR = 0.60, 95% CI: 0.49-0.74), female sex (OR = 0.76, 95% CI: 0.66-0.87), increasing age, residence in North Province and educated mother. Being underweight and recent fever (two weeks) were associated with higher odds. In the subpopulation with diet data, odds were lower with consumption of vitamin A-rich foods (OR = 0.66, 95% CI: 0.50-0.88); and higher in households with many young children. Conclusions: Malaria remains a strong determinant of anaemia for the individual child: transmission control efforts must be maintained. At population level, to further reduce anaemia prevalence, promoting regular vitamin A intake from natural sources and reducing intestinal helminths burden appear the most promising strategies to explore; exploring potential hitherto unidentified sex-linked factors is warranted.

Original languageEnglish
Pages (from-to)1722-1732
Number of pages11
JournalTropical Medicine and International Health
Volume20
Issue number12
DOIs
Publication statusPublished - Dec 1 2015

Fingerprint

Rwanda
Malaria
Anemia
Demography
Population
Diet
Vitamin A
Mothers
Sex Factors
Thinness
Helminths
Hemoglobins
Fever
Logistic Models
Databases
Interviews
Food

Keywords

  • Africa
  • Anaemia
  • Child
  • Malaria
  • Nutrition
  • Rwanda

ASJC Scopus subject areas

  • Parasitology
  • Medicine(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

@article{92c642ee611f4509a4eed77ffaec6d7b,
title = "The changing importance of key factors associated with anaemia in 6- to 59-month-old children in a sub-Saharan African setting where malaria is on the decline: Analysis of the Rwanda Demographic and Health Survey 2010",
abstract = "Objective: To estimate the relative contribution of malaria and other potential determinants to current anaemia prevalence in Rwanda. Methods: The database for this study was the Rwanda Demographic and Health Survey 2010. Haemoglobin and malaria test results, and additional exposures ascertained through mothers' interviews, were analysed for all eligible children age 6-59 months (n = 4068), in addition to diet data available for the youngest under 5-year-old per household. We examined anaemia-exposure associations through forward logistic regression, first for the overall population (n = 3685), and second, for the subpopulation with diet data (n = 1934). Results: In the overall study population, malaria was strongly associated with anaemia (OR = 6.83, 95{\%} CI: 2.90-16.05), but population impact was modest (population-attributable fraction = 2.5{\%}). Factors associated with lower odds of anaemia were recent de-worming medication (six months; OR = 0.60, 95{\%} CI: 0.49-0.74), female sex (OR = 0.76, 95{\%} CI: 0.66-0.87), increasing age, residence in North Province and educated mother. Being underweight and recent fever (two weeks) were associated with higher odds. In the subpopulation with diet data, odds were lower with consumption of vitamin A-rich foods (OR = 0.66, 95{\%} CI: 0.50-0.88); and higher in households with many young children. Conclusions: Malaria remains a strong determinant of anaemia for the individual child: transmission control efforts must be maintained. At population level, to further reduce anaemia prevalence, promoting regular vitamin A intake from natural sources and reducing intestinal helminths burden appear the most promising strategies to explore; exploring potential hitherto unidentified sex-linked factors is warranted.",
keywords = "Africa, Anaemia, Child, Malaria, Nutrition, Rwanda",
author = "Richard Nkulikiyinka and Agnes Binagwaho and Katie Palmer",
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doi = "10.1111/tmi.12604",
language = "English",
volume = "20",
pages = "1722--1732",
journal = "Tropical Medicine and International Health",
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T1 - The changing importance of key factors associated with anaemia in 6- to 59-month-old children in a sub-Saharan African setting where malaria is on the decline

T2 - Analysis of the Rwanda Demographic and Health Survey 2010

AU - Nkulikiyinka, Richard

AU - Binagwaho, Agnes

AU - Palmer, Katie

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objective: To estimate the relative contribution of malaria and other potential determinants to current anaemia prevalence in Rwanda. Methods: The database for this study was the Rwanda Demographic and Health Survey 2010. Haemoglobin and malaria test results, and additional exposures ascertained through mothers' interviews, were analysed for all eligible children age 6-59 months (n = 4068), in addition to diet data available for the youngest under 5-year-old per household. We examined anaemia-exposure associations through forward logistic regression, first for the overall population (n = 3685), and second, for the subpopulation with diet data (n = 1934). Results: In the overall study population, malaria was strongly associated with anaemia (OR = 6.83, 95% CI: 2.90-16.05), but population impact was modest (population-attributable fraction = 2.5%). Factors associated with lower odds of anaemia were recent de-worming medication (six months; OR = 0.60, 95% CI: 0.49-0.74), female sex (OR = 0.76, 95% CI: 0.66-0.87), increasing age, residence in North Province and educated mother. Being underweight and recent fever (two weeks) were associated with higher odds. In the subpopulation with diet data, odds were lower with consumption of vitamin A-rich foods (OR = 0.66, 95% CI: 0.50-0.88); and higher in households with many young children. Conclusions: Malaria remains a strong determinant of anaemia for the individual child: transmission control efforts must be maintained. At population level, to further reduce anaemia prevalence, promoting regular vitamin A intake from natural sources and reducing intestinal helminths burden appear the most promising strategies to explore; exploring potential hitherto unidentified sex-linked factors is warranted.

AB - Objective: To estimate the relative contribution of malaria and other potential determinants to current anaemia prevalence in Rwanda. Methods: The database for this study was the Rwanda Demographic and Health Survey 2010. Haemoglobin and malaria test results, and additional exposures ascertained through mothers' interviews, were analysed for all eligible children age 6-59 months (n = 4068), in addition to diet data available for the youngest under 5-year-old per household. We examined anaemia-exposure associations through forward logistic regression, first for the overall population (n = 3685), and second, for the subpopulation with diet data (n = 1934). Results: In the overall study population, malaria was strongly associated with anaemia (OR = 6.83, 95% CI: 2.90-16.05), but population impact was modest (population-attributable fraction = 2.5%). Factors associated with lower odds of anaemia were recent de-worming medication (six months; OR = 0.60, 95% CI: 0.49-0.74), female sex (OR = 0.76, 95% CI: 0.66-0.87), increasing age, residence in North Province and educated mother. Being underweight and recent fever (two weeks) were associated with higher odds. In the subpopulation with diet data, odds were lower with consumption of vitamin A-rich foods (OR = 0.66, 95% CI: 0.50-0.88); and higher in households with many young children. Conclusions: Malaria remains a strong determinant of anaemia for the individual child: transmission control efforts must be maintained. At population level, to further reduce anaemia prevalence, promoting regular vitamin A intake from natural sources and reducing intestinal helminths burden appear the most promising strategies to explore; exploring potential hitherto unidentified sex-linked factors is warranted.

KW - Africa

KW - Anaemia

KW - Child

KW - Malaria

KW - Nutrition

KW - Rwanda

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