Factors Associated with Anemia among Adolescents Public

Abstract

Background: Anemia is a condition in which the hemoglobin concentration in the blood is lower than normal; anemia affects nearly one third of the world’s population. Anemia in adolescents can lead to impaired physical growth and mental development, resistance to infection, and reduced school performance and work capacity. So, it is important to assess the association between anemia and risk factors for anemia in adolescents.

 

Methods and Materials: Adolescents (age range: 10 to 19 years) who measured hemoglobin from 16 nationally representative cross-sectional surveys were analyzed by each country and pooled by the infection burden and risk in the country (n=20719). From these surveys, the prevalence of anemia was reported and univariate associations between anemia and factors including micronutrient deficiency, inflammation, malaria and demographic factors at every country level and by infection burden as well were examined. Univariate and multivariable logistic regression models were fit to identify key determinants of anemia in adolescents stratified by infection burden group.

 

Results: There was highly significant (P-value<0.0001) association between iron deficiency and anemia among adolescents from most country surveys excluding Mexico (2012) (P-value=0.74). This association was also highly significant among low, moderate, high country infection burden group (P-value <0.0001). In the multivariable analysis, anemia among adolescents who had iron deficiency (OR=6.08, p <0.001), any inflammation (OR=1.88, p-value=0.013), vitamin A-deficiency (OR=13.84, P=0.017), lower socioeconomic status (SES), (OR=2.07, p-value=0.013), lower education (OR=0.30, p-value<0.001) were associated with anemia in low infection burden group. Folate deficiency (OR=2.59, p-value<0.001), iron deficiency (OR=7.20, p-value<0.001) and any inflammation (OR=1.91, p-value<0.001) and with the increasing of age in one year (OR=1.20, p-value<0.001) were associated with anemia in moderate infection group. Folate deficiency (OR=2.48, p-value<0.001), Iron deficiency (OR=2.45, P-value=0.006), any inflammation (OR=2.14, P-value=0.012) were associated with anemia in high infection group.

Conclusion: Risk factors associated with anemia among adolescents vary according to a country’s infection burden. In the multivariable analysis, iron deficiency and inflammation were consistently associated with anemia in low, moderate and high infection burden group. In order to improve anemia prevalence for adolescents, should consider assess both micronutrient deficiencies in different infection burden of the population.

Table of Contents

1.Introduction................................................................................................................................ 1

2.Method..........................................................................................................................................3

2.1 Grouping Countries by Infection Burden.................................................................................3

2.2 Determinants of Anemia and Case Definitions .......................................................................4

2.3 Statistical Method .....................................................................................................................7

2.3.1 Analysis by Country Survey Level .........................................................................................7

2.3.1.1 Descriptive Analysis ..............................................................................................................7

2.3.1.2 Univariate Association Analysis ............................................................................................7

2.3.2 Analysis by Pooled Data .........................................................................................................8

 2.3.2.1 Univariate and Multivariate Logistic Regression Analysis.....................................................8

 2.3.3 Analysis by Infection Burden Group....................................................................................10

 2.3.3.1 Descriptive Analysis.............................................................................................................10

 2.3.3.2 Univariate Association Analysis...........................................................................................10

 2.3.3.3 Univariate and Multivariate Logistic Regression Analysis....................................................11

3.Results...........................................................................................................................................11

3.1 Result of Analysis by Country Level..........................................................................................11

3.1.1 Result of Descriptive Statistics...............................................................................................11

 3.1.2 Result of Univariate Association Analysis.............................................................................12

3.2 Result of analysis by pooled data...............................................................................................13

3.2.1 Result of Univariate and Multivariate Logistic Regression Analysis....................................13

3.3 Result of analysis by infection burden group............................................................................14

3.3.1 Result of Descriptive Statistics...............................................................................................14

3.3.2 Result of univariate association analysis...............................................................................14

3.3.3 Result of Univariate and Multivariate Logistic Regression Analysis....................................15

4.Conclusion.....................................................................................................................................17

5.Discussion......................................................................................................................................17

6.Reference.......................................................................................................................................20

7.Tables.............................................................................................................................................24

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Biology, Biostatistics
Mot-clé	Anemia Biomarker Adolescents
Committee Chair / Thesis Advisor	Moore, Renee, Emory University
Committee Members	Young, Melissa, Emory University

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