The Co-occurrence of Anemia and Stunting in Young Children Open Access

Abstract

ABSTRACT

The Co-occurrence of Anemia and Stunting in Young Children

Background and objectives: Anemia and stunting are prevalent nutritional problems among children of low- and middle-income countries that have profound effects on child development, morbidity, and mortality. A single conceptual framework is used often to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co-occur in effected communities and individuals to a greater degree than by chance. We know from ecological analyses that stunting and anemia cluster across types of countries and their regions but is this also the case at the level of individuals, a question seldom asked and which we address.

Methods: In two separate populations of children - ages 6-18 months in Bihar, India (n=5664) and 0-36 months in Lambayeque, Peru (n=840) - we measured the frequency of the co-occurrence of anemia and stunting. We compared this value to the value expected by chance, the product of the prevalence of anemia and stunting using a chi-square test. Using an iterative model selection process, we built explanatory logistic regression models for each condition.

Results: The frequency of co-occurrence in the Indian population was 21.5%, and in the Peruvian population it was 27.1%, which are similar to frequencies expected by chance, 21.3% (p=0.97) and 28.0% (p=0.87) respectively. In both populations, anemia was associated with sex, while stunting was associated with age, sex, wealth, and social standing (caste or indigenous). In the Peruvian population, anemia was also associated with age, while stunting was associated with dietary diversity over the past month. In the Indian population, anemia was also associated with caste, dietary diversity over one day, and household hunger, while stunting was associated with maternal illiteracy

Conclusion: There was no statistically significant difference in the co-occurrence of anemia and stunting compared to what was expected by chance. Despite some basic shared factors (sex, age, caste), anemia and stunting appear are more independent than commonly assumed.

Implications: Anemia and stunting should be treated as independent and addressed according to their context-specific causes. Additional research into these context-specific determinants is needed.

Table of Contents

Table of Contents

LITERATURE REVIEW ----------------------------------------------------------------------------------- 1

Global Burden of Anemia and Stunting -------------------------------------------------------------------- 1

Dual Burden of Malnutrition --------------------------------------------------------------------------------- 2

METHODS -------------------------------------------------------------------------------------------------- 5

Sample -------------------------------------------------------------------------------------------------------------- 5

Analytic Strategy ------------------------------------------------------------------------------------------------- 7

RESULTS ---------------------------------------------------------------------------------------------------- 8

Table 1: Basic characteristics and nutritional status -------------------------------------------------- 9

Table 2: Comparison of the observed co-occurrence of anemia and stunting to the

expected chance co-occurrence ------------------------------------------------------------------------------ 9

Table 3: Bivariate association between nutritional deficiencies and related variables ---- 11

Table 4: Multivariate regression model of underlying variables associated with anemia

and stunting ----------------------------------------------------------------------------------------------------- 13

DISCUSSION --------------------------------------------------------------------------------------------- 14

IMPLICATIONS FOR PUBLIC HEALTH ------------------------------------------------------------- 17

REFERENCES -------------------------------------------------------------------------------------------- 19

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Keyword	co-occurrence Peru anemia infant nutrition India stunting
Committee Chair / Thesis Advisor	Martorell, Reynaldo, Emory University
Committee Members	Young, Melissa Fox, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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