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Determinants of Anemia and Hemoglobin Concentration in Haitian School-Aged Children

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  • Institute for Public Health, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri; Meds and Food for Kids, Cap Haitien, Haiti; Department of Pediatrics Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri

Anemia diminishes oxygen transport in the body, resulting in potentially irreversible growth and developmental consequences for children. Limited evidence for determinants of anemia exists for school-aged children. We conducted a cluster randomized controlled trial in Haiti from 2012 to 2013 to test the efficacy of a fortified school snack. Children (N = 1,047) aged 3–13 years were followed longitudinally at three time points for hemoglobin (Hb) concentrations, anthropometry, and bioelectrical impedance measures. Dietary intakes, infectious disease morbidities, and socioeconomic and demographic factors were collected at baseline and endline. Longitudinal regression modeling with generalized least squares and logit models with random effects identified anemia risk factors beyond the intervention effect. At baseline, 70.6% of children were anemic and 2.6% were severely anemic. Stunting increased the odds of developing anemia (adjusted odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.05–2.08) and severe anemia (adjusted OR: 2.47, 95% CI: 1.30–4.71). Parent-reported vitamin A supplementation and deworming were positively associated with Hb concentrations, whereas fever and poultry ownership showed a negative relationship with Hb concentration and increased odds of severe anemia, respectively. Further research should explore the full spectrum of anemia etiologies in school children, including genetic causes.

Author Notes

* Address correspondence to Lora L. Iannotti, Washington University in St. Louis, Campus Box 1196, St. Louis, MO 63130. E-mail: liannotti@wustl.edu

Financial support: This study was funded by the United States Department of Agriculture (USDA) Foreign Agricultural Service Micronutrient Fortified Food Aid Products program FFE-521-2012/034-00.

Authors' addresses: Lora L. Iannotti and Jacob C. Eaton, Brown School/Institute for Public Health, Washington University, St. Louis, MO, E-mails: liannotti@wustl.edu and jake.eaton@wustl.edu. Jacques R. Delnatus, Meds and Food for Kids, Cap Haitien, Haiti, E-mail: rdelnatus@mfkhaiti.org. Audrey R. Odom, Departments of Pediatrics and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO, E-mail: odom_a@kids.wustl.edu. Jennifer J. Griggs, Department of Medicine, Division of Hematology/Oncology and Health Management and Policy, University of Michigan, Ann Arbor, MI, E-mail: jengrigg@umich.edu. Sarah Brown, Departments of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, E-mail: brown_sa@kids.wustl.edu. Patricia B. Wolff, Meds and Food for Kids, Washington University School of Medicine, St. Louis, MO, E-mail: pwolff@mfkhaiti.org.

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