ABSTRACT
INTRODUCTION: Anemia is the main nutritional problem in Cuban preschool children, prompting several interventions to prevent and control it. An enhanced national strategy was established in 2008, and particular attention paid to the eastern provinces, the region with greatest challenges in social determinants of health. OBJECTIVE: Determine anemia prevalence in children aged 6-59 months in Cuba's five eastern provinces in three separate years within a decade, as well as association of anemia with epidemiological and nutritional factors, to assess impact of Cuba's Comprehensive Plan for Prevention and Control of Iron-Deficiency Anemia in Cuba. METHODS: Cross-sectional studies of children aged 6-59 months (completed) were conducted in 2005, 2008 and 2011. Hemoglobin levels were measured to diagnose anemia (hemoglobin <110 g/L) and data were collected on independent variables such as age, sex, area of residence (urban or rural), daycare center enrollment, birth weight, breastfeeding history, and maternal anemia during pregnancy. Frequency distributions were created and comparisons tested with the chi square, and odds ratios calculated with 95% confidence intervals. RESULTS: Anemia prevalence in the region fell from 31.8% in 2005 to 26% in 2011; most of cases were mild (hemoglobin: 100-109 g/L). Prevalence was higher in children aged 6-23 months than in those aged 24-59 months throughout. No significant differences were found in anemia prevalence between boys and girls. Prevalence was higher in rural than in urban areas in 2005 (p = 0.026) and 2011 (p = 0.012). Daycare enrollment emerged as a protective factor in all three years. Low birth weight was associated with anemia only in 2011 (OR 1.74, CI 1.04-2.92). Prevalence of exclusive breastfeeding for six months increased over the study period; lack of breastfeeding was found to be associated with anemia in 2005 (OR 1.57, CI 1.05-2.34). Maternal anemia at onset of and during pregnancy was a significant risk factor in 2005 (OR 1.98, CI 1.27-3.10) and 2011 (OR 1.43, CI 1.05-1.94). CONCLUSIONS: Although anemia prevalence steadily decreased over the study period, it continues to be a public health problem in Cuba and anemia prevention and control measures should be maintained and strengthened: interventions for women of childbearing age, fostering exclusive breastfeeding of infants through their sixth month, and encouraging compliance with recommendations on complementary feeding per Cuba's nutritional guidelines for children aged <2 years. Further evaluation is needed to identify the causes of anemia in the population of preschool children.
Subject(s)
Anemia/epidemiology , Breast Feeding , Child, Preschool , Confidence Intervals , Cross-Sectional Studies , Cuba/epidemiology , Female , Humans , Infant , Male , PrevalenceABSTRACT
Fundamentos: Se realizó un estudio transversal en elsegundo semestre del año 2002 con el objetivo de estimarla prevalencia de anemia por deficiencia de hierro enniños de 6 a 24 meses y de 6 a 12 años de edad residentesen las provincias orientales de Cuba.Métodos: La muestra estuvo compuesta por 1708 niños.La concentración de hemoglobina se determinó porel método de la cianometahemoglobina, la ferritina séricapor enzimoinmunoensayo y el retinol sérico por el métodoespectrofotométrico de inactivación ultravioleta deBessey.Resultados: La prevalencia de anemia en los niñoshasta 2 años de edad fue del 29,1%. Fue más frecuentela anemia en niños de 6 a 12 meses de edad. Segúnlas concentraciones de ferritina sérica la prevalenciade deficiencia de hierro fue del 38,6 %. Para los niñosde 6 a 12 años de edad la prevalencia de anemia fuedel 14,6%. Los niveles de vitamina A hallados no estuvieronasociados a la anemia encontrada en niñosde 6 a 12 años de edad. Para este grupo, el consumode alimentos portadores importantes de hierro hem espoco frecuente y bastante similar entre las provincias.El consumo de portadores de hierro no hem es superiory muy diferente entre las provincias. Se encontróuna disminución de la prevalencia de anemia en niñosde 6 a 24 meses de edad al compararlos con los resultadosde finales de 1999 en una muestra derepresentatividad nacional.Conclusiones: Para combatir con efectividad estas deficienciasse hace necesario incrementar la fortificación dealimentos dirigidos a estos grupos de edades, actividadesde educación nutricional, así como mejorar los patronesde ingestión de alimentos ricos en hierro
Study Objective: Prevalence of iron deficiency anemia inchildren aged 6-24 months and 6-12 years in easternprovinces of Cuba was estimated by a cross-sectionalstudy carried out in the second semester of 2002.Desing: The sample included 1708 children. Hemoglobinconcentration was determined by cyanomethemoglobinmethod, serum ferritin by enzymoimmunoassay andserum retinol by Bessey ultraviolet inactivationspectrophotometric method.Results: Prevalence of anemia in children aged 6-24months was 29,1 %. Anemia was more frequent inchildren 6-12 months of age. According to serum ferritinvalues, iron deficiency was 38,6 %. Prevalence of anemiawas 14,6 % for children 6-12 years of age. Serumvitamin A values were not associated to anemia inchildren 6 to 12 years of age. Intake of foods rich in hemeiron was infrequent; conversely, intake of non heme ironwas much higher. Prevalence of anemia in children 6-24months of age was lower in this study in comparison withthe result found in a nation-wide representative sample in1999.Conclusions: In order to combat iron deficiency it isnecessary to increase the fortification of foods targeted tothese age groups as well as implement nutrition education,food diversification and other actions aimed at improvingiron dietary patterns, all of them included in the NationalProgram for the Prevention and Control of Anemia andIron Deficiency in Cuba
