Background: Child anaemia continues to represent a major public health challenge in lower-and-middle income countries. It has serious long-term consequences for child growth and development. In Indonesia, there was a 10% increase in the national prevalence of child anaemia between 2013 and 2018. Aim: This study aims to assess the prevalence of, and factors associated with anaemia among children aged one to three years in eight districts in Aceh Province, Indonesia. Methods: A cross-sectional study was conducted on a sample of 1148 mother-child dyads aged one to three years between November and December 2018. The sampling process involved a three-stage cluster sampling design using the probability proportionate to size methodology. Anaemia status was determined using haemoglobin level (Hb < 11.0 g/dL). Data were analysed using multivariable logistic regression to estimate adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI) for associated factors. Results: The overall prevalence of anaemia was 76.1% (869/1142). 44.7% (510/1142) and 28.6% (327/1142) had moderate and mild anaemia, respectively. Child aged 12–24 months (aOR: 2.00, 95% CI: 1.26–3.17), not receiving routine immunisation (aOR: 2.62, 95% CI: 1.34–5.10), and maternal anaemia (aOR: 2.15, 95% CI: 1.59–2.90) were significantly associated with anaemia. Conclusion: The prevalence of anaemia among the children in this study was high, and was associated with child age, immunisation status, and maternal anaemia. These findings provide further insight into anaemia as a public health issue at a sub-national level in Indonesia and for development of targeted programmes to address associated risk factors of child anaemia.
AhmadARidwandiMutiawati, et al. (2020) Anemia, stunting, and wasting in school-age children: A cross-sectional study in Pidie district, Aceh Indonesia. Malaysian Journal of Medicine and Health Sciences16: 73–74.
2.
AhmadASitiMDwirianiCM, et al. (2018) Iron deficiency risk factors in undernourished children aged 6–23 months in Aceh, Indonesia. Journal of Nutrition and Food13(3): 145–156.
3.
AndriastutiMIlmanaGNawangwulanSA, et al. (2019) Prevalence of anemia and iron profile among children and adolescent with low socio-economic status. International Journal of Pediatrics and Adolescent Medicine. DOI: https://doi.org/10.1016/j.ijpam.2019.11.001.
4.
BaldiAJClucasDPasrichaS-R (2020) Anemia and water, sanitation, and hygiene (WASH)-is there really a link?The American Journal of Clinical Nutrition112(5): 1145–1146.
5.
BarffourMAHinnouhoG-MKounnavongS, et al. (2019) Effects of daily zinc, daily multiple micronutrient powder, or therapeutic zinc supplementation for diarrhea prevention on physical growth, anemia, and micronutrient status in rural laotian children: A randomized controlled trial. The Journal of Pediatrics207: 80–89. e82.
6.
BealTTumilowiczASutrisnaA, et al. (2018) A review of child stunting determinants in Indonesia. Maternal & Child Nutrition14(4): e12617.
7.
BelachewATewabeT (2020) Under-five anemia and its associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia: Systematic review and meta-analysis. Systematic Reviews9(1): 31.
8.
BuduESeiduA-AOpoku AhinkorahB, et al. (2020) Determinants of complete immunizations coverage among children aged 12–23 months in Papua New Guinea. Children and Youth Services Review118: 105394.
9.
BukhariAHamidFMinhajatR, et al. (2020) Non-nutritional and disease-related anemia in Indonesia: A systematic review. Asia Pacific Journal of Clinical Nutrition29(S1): s41–s54.
10.
BursacZGaussCHWilliamsDK, et al. (2008) Purposeful selection of variables in logistic regression. Source Code for Biology and Medicine3: 17–17.
DemirchyanAPetrosyanVSargsyanV, et al. (2016) Prevalence and determinants of anaemia among children aged 0–59 months in a rural region of Armenia: A case–control study. Public Health Nutrition19(7): 1260–1269.
13.
DeySRaheemE (2016) Multilevel multinomial logistic regression model for identifying factors associated with anemia in children 6–59 months in northeastern states of India. Cogent Mathematics3.
14.
DjuardiYLazarusGStefanieD, et al. (2021) Soil-transmitted helminth infection, anemia, and malnutrition among preschool-age children in Nangapanda subdistrict, Indonesia. PLOS Neglected Tropical Diseases15(6): e0009506.
15.
EngidayeGMelkuMYalewA, et al. (2019) Under nutrition, maternal anemia and household food insecurity are risk factors of anemia among preschool aged children in Menz Gera Midir district, Eastern Amhara, Ethiopia: A community based cross-sectional study. BMC Public Health19(1): 968.
16.
FahmidaUHtetMKFergusonE, et al. (2020) Effect of an integrated package of nutrition behavior change interventions on infant and young child feeding practices and child growth from birth to 18 months: cohort evaluation of the baduta cluster randomized controlled trial in East Java, Indonesia. Nutrients12(12): 3851–3867.
17.
FerdiJBardosonoSMediseBE (2021) Iron intake and its correlation to ferritin and hemoglobin level among children aged 24–36 months in Jakarta in 2020. World Nutrition Journal5(1): 106–112.
18.
GibsonRS (2005) Principles of Nutritional Assessment. New York: Oxford University Press.
19.
GosdinLMartorellRBartoliniRM, et al. (2018) The co-occurrence of anaemia and stunting in young children. Maternal & Child Nutrition14(3): e12597–e12597.
20.
GrantSWHickeyGLHeadSJ (2019) Statistical primer: Multivariable regression considerations and pitfalls. European Journal of Cardio-Thoracic Surgery55(2): 179–185.
21.
HerlianaPDouiriA (2017) Determinants of immunisation coverage of children aged 12–59 months in Indonesia: A cross-sectional study. BMJ Open7(12): e015790.
22.
HoangNTDOrellanaLLeTD, et al. (2019) Anaemia and its relation to demographic, socio-economic and anthropometric factors in rural primary school children in Hai Phong City, Vietnam. Nutrients11(7): 1478.
23.
HuangZJiangF-xLiJ, et al. (2018) Prevalence and risk factors of anemia among children aged 6–23 months in Huaihua, Hunan Province. BMC Public Health18(1): 1267.
24.
IBM Corp (2017) IBM SPSS Statistics for Macintosh, 26.0 ed.Armonk, NY: IBM Corp.
25.
Indonesian Ministry of Health (2019) Basic Health Survey 2018 Report. Jakarta, Indonesia: Indonesian Ministry of Health, Health Research and Development Agency.
26.
JohnDIssacA (2018) Do mass deworming efforts improve the developmental health and well-being of children in low-and middle-income countries? Summary of the evidence and implications for public health programmes. Clinical Epidemiology and Global Health6(4): 220–224.
27.
JonkerFAMBoele van HensbroekM (2014) Anemia, iron deficiency and susceptibility to infections. Journal of Infection69: S23–S27.
28.
KejoDPetruckaPMMartinH, et al. (2018) Prevalence and predictors of anemia among children under 5 years of age in Arusha District, Tanzania. Pediatric Health, Medicine and Therapeutics9: 9–15.
29.
KhanJRAwanNMisuF (2016) Determinants of anemia among 6–59 months aged children in Bangladesh: Evidence from nationally representative data. BMC Pediatrics16: 3–3.
30.
KothariMTCoileAHuestisA, et al. (2019) Exploring associations between water, sanitation, and anemia through 47 nationally representative demographic and health surveys. Annals of the New York Academy of Sciences1450(1): 249–267.
31.
LegasonIDAtikuASsenyongaR, et al. (2017) Prevalence of anemia and associated risk factors among children in North-western Uganda: A cross sectional study. BMC Hematology17(1): 10.
32.
LestariSFujiatiIIKeumalasariD, et al. (2018) The prevalence of anemia in pregnant women and its associated risk factors in North Sumatera, Indonesia. Earth and Evironmental Science125.
33.
National Population Family Planning Board, Statistics Indonesia, Ministry of Health, et al. (2018) Indonesia Demographic and Health Survey 2017. Reportno. Report Number|, Date. Place Published|: Institution|.
34.
MitchinsonCStrobelNMcAullayD, et al. (2019) Anemia in disadvantaged children aged under five years; quality of care in primary practice. BMC Pediatrics19(1): 178.
35.
MulevicieneASestelNStankevicieneS, et al. (2018) Assessment of risk factors for iron deficiency anemia in infants and young children: A case–control study. Breastfeeding Medicine13(7): 493–499.
36.
NambiemaARobertAYayaI (2019) Prevalence and risk factors of anemia in children aged from 6 to 59 months in Togo: Analysis from Togo demographic and health survey data, 2013–2014. BMC Public Health19(1): 215.
37.
NtendaPAMChuangK-YTirunehFN, et al. (2017) Multilevel analysis of the effects of individual- and community-level factors on childhood anemia, severe anemia, and hemoglobin concentration in Malawi. Journal of Tropical Pediatrics64(4): 267–278.
38.
OseiAPandeyPNielsenJ, et al. (2016) Combining home garden, poultry, and nutrition education program targeted to families with young children improved anemia among children and anemia and underweight among nonpregnant women in Nepal. Food and Nutrition Bulletin38(1): 49–64.
39.
PasrichaS-RGheorgheASakr-AshourF, et al. (2020) Net benefit and cost-effectiveness of universal iron-containing multiple micronutrient powders for young children in 78 countries: A microsimulation study. The Lancet Global Health8(8): e1071–e1080.
40.
Prieto-PatronAVan der HorstKHuttonZV, et al. (2018) Association between anemia in children 6 to 23 months old and child, mother, household and feeding indicators. Nutrients10(9): 1269.
41.
RahJHSukotjoSBadgaiyanN, et al. (2020) Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age. Maternal & Child Nutrition16(S2): e12741.
42.
RahmanMMAbeSKRahmanMS, et al. (2016) Maternal anemia and risk of adverse birth and health outcomes in low- and middle-income countries: Systematic review and meta-analysis1,2. The American Journal of Clinical Nutrition103(2): 495–504.
43.
RahmanMSMushfiqueeMMasudMS, et al. (2019) Association between malnutrition and anemia in under-five children and women of reproductive age: Evidence from Bangladesh demographic and health survey 2011. PLOS ONE14(7): e0219170–e0219170.
44.
RobertsDJMatthewsGSnowRW, et al. (2020) Investigating the spatial variation and risk factors of childhood anemia in four sub-Saharan African countries. BMC Public Health20(1): 126.
45.
Sanchis-GomarFCortell-BallesterJPareja-GaleanoH, et al. (2012) Hemoglobin point-of-care testing: The HemoCue system. Journal of Laboratory Automation18(3): 198–205.
46.
SarmaHWangdiKTariqujjamanM, et al. (2022) The effects of deworming and multiple micronutrients on anaemia in preschool children in Bangladesh: Analysis of five cross-sectional surveys. Nutrients14(1): 150–163.
47.
SarnaAPorwalARameshS, et al. (2020) Characterisation of the types of anaemia prevalent among children and adolescents aged 1–19 years in India: A population-based study. The Lancet Child & Adolescent Health4(7): 515–525.
48.
Secretariat of the Vice President of the Republic of Indonesia (2020) National Strategy to Accelerate Stunting Prevention 2018–2024 and Implementation Progress. Jakarta: Tim Perceptan Pencegahan Anak Kerdil (Stunting).
49.
SembaRDMoench-PfannerRSunK, et al. (2010) Iron-fortified milk and noodle consumption is associated with lower risk of anemia among children aged 6–59 mo in Indonesia. The American Journal of Clinical Nutrition92(1): 170–176.
50.
ShentonLMJonesADWilsonML (2020) Factors associated with anemia status among children aged 6–59 months in Ghana, 2003–2014. Maternal and Child Health Journal24(4): 483–502.
51.
Solis-SotoMTPaudelDNicoliF (2020) Relationship between vaccination and nutritional status in children: Analysis of recent demographic and health surveys. Demographic Research42: 1–14.
52.
SouganidisESSunKSdP, et al. (2012) Determinants of anemia clustering among mothers and children in Indonesia. Journal of Tropical Paediatrics58(3): 170–177.
53.
SuchdevPSJefferdsMEDOtaE, et al. (2020) Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Cochrane Database of Systematic Reviews. DOI: https://doi.org/10.1002/14651858.CD008959.pub3.(2).
54.
SunardiDBardosonoSBasrowiRW, et al. (2021) Dietary determinants of anemia in children aged 6–36 months: A cross-sectional study in Indonesia. Nutrients13(7): 2397–2407.
55.
Suryana, MadanijahSSukandarD (2016) Prevalence and factors associated with anemia in children aged 12–24 months in Darul Imarah sub-district Aceh Besar District. Pakistan Journal of Nutrition15(8): 708–714.
56.
TamEKeatsECRindF, et al. (2020) Micronutrient supplementation and fortification interventions on health and development outcomes among children under-five in low- and middle-income countries: A systematic review and meta-analysis. Nutrients12(2): 289–319.
57.
TamiratKSSisayMM (2019) Full immunization coverage and its associated factors among children aged 12–23 months in Ethiopia: Further analysis from the 2016 Ethiopia demographic and health survey. BMC Public Health19(1): 1019.
58.
ThayerWMClermontAWalkerN (2017) Effects of deworming on child and maternal health: A literature review and meta-analysis. BMC Public Health17(4): 830.
59.
TranTDBiggsB-AHoltonS, et al. (2019) Co-morbid anaemia and stunting among children of pre-school age in low- and middle-income countries: A syndemic. Public Health Nutrition22(1): 35–43.
60.
VanBuskirkKMOfosuAKennedyA, et al. (2014) Pediatric anemia in rural Ghana: A cross-sectional study of prevalence and risk factors. Journal of Tropical Pediatrics60(4): 308–317.
61.
WestgardCMOrrego-FerreyrosLACalderónLF, et al. (2021) Dietary intake, intestinal infection, and safe drinking water among children with anemia in Peru: A cross-sectional analysis. BMC Nutrition7(1): 11.
WoldieHKebedeYTarikuA (2015) Factors associated with anemia among children aged 6–23 months attending growth monitoring at Tsitsika Health Centre, Wag-Himra zone, Northeast Ethiopia. Journal of Nutrition and Metabolism2015.
64.
World Health Organisation (2006) WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-forheight and body mass index-for-age: methods and development. Reportno. Report Number|, Date. Place Published|: Institution|.
65.
World Health Organisation (2008) Indicators for assessing infant and young child feeding practices: conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C., USA. Reportno. Report Number|, Date. Place Published|: Institution|.
66.
World Health Organisation (2011) Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Reportno. Report Number|, Date. Place Published|: Institution|.
67.
XinQ-QChenB-WYinD-L, et al. (2016) Prevalence of anemia and its risk factors among children under 36 months old in China. Journal of Tropical Pediatrics63(1): 36–42.
68.
YusufAMamunASMAKamruzzamanM, et al. (2019) Factors influencing chilhood anaemia in Bangladesh: A two level regression analysis. BMC Pediatrics19: 213.
