Association between water source and sanitation with anemia in preschool children: Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project Open Access

Abstract

Purpose: We aimed to assess the associations between water source and sanitation with anemia in preschool children (PSC; age: 6-59 months) using population-based surveys from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anemia (BRINDA) project.

Methods: We analyzed nationally and subnationally representative data from the BRINDA project. Fourteen surveys, representing 13 countries with PSC (N = 32,549) included measures of hemoglobin, household water source and sanitation, type of residence, and socioeconomic status (SES) and were included in analysis. Anemia was defined as hemoglobin concentration < 110 g/L, adjusting for altitude when this information was available. The household water source and sanitation were classified as either “improved” or “unimproved”. Univariable analyses were done using Rao-Scott chi-square test. Multivariable analyses were done using logistic regressions.

Results: The percentage of participants with access to an improved household water source ranged from 44.2% in Laos to 96% in Bangladesh (2012) whereas the percentage of participants with access to improved household sanitation ranged from 0.2% in Kenya (2007) to 94.7% in Philippines. The country-level prevalence of anemia across these 14 surveys ranged from a low of 24.6% in Azerbaijan to a high of 71.7% in Kenya (2010). In the multivariable logistic regression models, access to improved sanitation source was associated with decreased odds of anemia in 5 out of 6 surveys assessed. However, none of these associations was significant at a significance level of 0.05.

Conclusions: Improved household water source and sanitation was not consistently associated with anemia across surveys. Further research is warranted to explore potential links between water source and sanitation with anemia from a clinical perspective.

Table of Contents

INTRODUCTION.. 1

METHODS. 7

RESULTS. 9

Descriptive statistics 9

Univariable associations 10

Multivariable logistic regression models 10

DISCUSSION.. 11

Competing interests 13

Ethical approval 13

Funding. 13

References 14

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Environmental Health
Keyword	anemia
Committee Chair / Thesis Advisor	Melissa Young, Emory University
Committee Members	William Michael Caudle, Emory University

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