背景:贫血仍然是一个全球性的公共卫生问题,尤其是在发展中国家。它主要影响五岁以下的儿童(CU5),育龄妇女(WRA),和孕妇,因为他们对铁的需求较高。最常见的贫血形式是缺铁性贫血(IDA)。据估计,IDA每年导致全球一半的贫血病例和一百万人死亡。然而,仍然缺乏基于全球和区域代表性人群样本的有据可查和生物化学评估的IDA患病率.在这项研究中,我们旨在评估2018年国家营养调查(NNS),以确定IDA在巴基斯坦CU5和WRA的患病率和危险因素.
方法:对NNS2018进行了二次分析,这是一项横断面调查,它收集了关于饮食习惯的数据,营养不良,和粮食不安全。贫血定义为儿童血红蛋白水平<11.0g/dL,女性血红蛋白水平<12.0g/dL。IDA定义为低血红蛋白和低铁蛋白(<12ng/mL)水平,在CU5和WRA中使用AGP和CRP生物标志物调整炎症。使用Stata统计软件(第16版)进行单变量和多变量逻辑回归。我们还比较了2018年和2011年NNS的IDA率。
结果:共17,814个CU5和22,114个WRA纳入分析。在CU5中,28.9%有IDA,而18.4%的WRA报告有IDA经验。在CU5中,IDA在居住在农村地区的6-23个月大的男性儿童中最普遍,并且在过去2周内出现腹泻和发烧。母亲没有受过教育的孩子,年龄在20-34岁之间,并受雇,IDA患病率较高。已婚WRA,被雇用的人,生活在农村地区,没有受过教育,IDA患病率较高。在多变量逻辑回归中,6-23个月的儿童(AOR=1.19,95%CI[1.08-1.33],p<0.001),并且在最后2周内存在腹泻(AOR=1.32,95%CI[1.13-1.54],p<0.001)或发烧(AOR=1.16,95%CI[1.02-1.32],p=0.02)有更高的IDA几率。在家庭层面,CU5中最贫困家庭发生IDA的几率更高(AOR=1.27,95%CI[1.08-1.50],p=0.005),CU5≥5(AOR=1.99,95%CI[1.28-3.11],p=0.002),并且无法获得改善的卫生设施(AOR=1.17,95%CI[1.02-1.34],p=0.026)。对于WRA,多变量逻辑回归发现,在维生素A缺乏的女性中,IDA的几率更高(严重:AOR=1.26,95%CI[1.05-1.52],p=0.013;轻度:AOR=1.36,95%CI[1.23-1.51],p<0.001),缺锌(AOR=1.42,95%CI[1.28-1.57],p<0.001),没有受过教育(AOR=1.53,95%CI[1.30-1.81],p<0.001),以及来自严重粮食不安全的家庭(AOR=1.20,95%CI[1.07-1.34],p=0.001)。在体重指数超重的女性中,IDA的几率较低(AOR=0.77,95%CI[0.69-0.86],p<0.001)或肥胖(AOR=0.71,95%CI[0.62-0.81],p<0.001)。
结论:孩子的年龄,出现腹泻或发烧,居住地,家庭大小,财富地位,在巴基斯坦CU5中,获得卫生设施与IDA显著相关。对于WRA,教育,身体质量指数,维生素A和锌的状态,家庭粮食安全状况,财富地位,和获得卫生设施与国际开发协会密切相关。大,建立良好,政府资助的方案侧重于补充微量营养素,食物强化,食品供应的多样化,以及需要治疗和预防传染病和寄生虫病,以预防巴基斯坦儿童和妇女的各种贫血。
BACKGROUND: Anemia remains a global public health problem, especially in developing countries. It affects primarily children under five (CU5), women of reproductive age (WRA), and pregnant women due to their higher need for iron. The most common form of anemia is iron-deficiency anemia (IDA). IDA is estimated to cause half of all anemia cases and one million deaths per year worldwide. However, there remains a lack of well-documented and biochemically assessed prevalence of IDA based on the representative population-based samples globally and regionally. In this study, we aimed to assess the National Nutrition Survey (NNS) 2018 to identify the prevalence and risk factors of IDA in Pakistani CU5 and WRA.
METHODS: Secondary analysis was conducted on the NNS 2018, a cross-sectional survey, which collected data on dietary practices, malnutrition, and food insecurity. Anemia was defined as hemoglobin levels < 11.0 g/dL in children and 12.0 g/dL in women. IDA was defined as low hemoglobin and low ferritin (<12 ng/mL) levels, adjusted for inflammation using AGP and CRP biomarkers in CU5 and WRA. Univariate and multivariable logistic regressions were conducted using Stata statistical software (version 16). We also compared the IDA rates of NNS 2018 and 2011.
RESULTS: A total of 17,814 CU5 and 22,114 WRA were included in the analysis. Of the CU5, 28.9% had IDA, while 18.4% of WRA reported to experience IDA. Among the CU5, IDA was most prevalent among male children aged 6-23 months living in rural areas and with the presence of diarrhea and fevers in the last 2 weeks. Children whose mothers had no education, were aged 20-34 years, and employed, had a higher prevalence of IDA. Married WRA, who are employed, living in rural areas, and with no education, had a higher prevalence of IDA. In the multivariable logistic regression, children aged 6-23 months (AOR = 1.19, 95% CI [1.08-1.33], p < 0.001) and with the presence of diarrhea in the last 2 weeks (AOR = 1.32, 95% CI [1.13-1.54], p < 0.001) or fever (AOR = 1.16, 95% CI [1.02-1.32], p = 0.02) had higher odds of IDA. At the household level, the odds of IDA among CU5 were higher in the poorest households (AOR = 1.27, 95% CI [1.08-1.50], p = 0.005), with ≥5 CU5 (AOR = 1.99, 95% CI [1.28-3.11], p = 0.002), and with no access to improved sanitation facilities (AOR = 1.17, 95% CI [1.02-1.34], p = 0.026). For WRA, the multivariable logistic regression found that the odds of IDA were higher among women with vitamin A deficiency (Severe: AOR = 1.26, 95% CI [1.05-1.52], p = 0.013; Mild: AOR = 1.36, 95% CI [1.23-1.51], p < 0.001), zinc deficiency (AOR = 1.42, 95% CI [1.28-1.57], p < 0.001), no education (AOR = 1.53, 95% CI [1.30-1.81], p < 0.001), and from severely food insecure households (AOR = 1.20, 95% CI [1.07-1.34], p = 0.001). The odds of IDA were lower among women whose body mass index was overweight (AOR = 0.77, 95% CI [0.69-0.86], p < 0.001) or obese (AOR = 0.71, 95% CI [0.62-0.81], p < 0.001).
CONCLUSIONS: The child\'s age, presence of diarrhea or fever, place of residence, household size, wealth status, and access to sanitation facilities were significantly associated with IDA among CU5 in Pakistan. For WRA, education, body mass index, vitamin A and zinc status, household food security status, wealth status, and access to sanitation facilities were significantly associated with IDA. Large, well-established, government-funded programmes focused on micronutrient supplementation, food fortification, the diversification of food supplies, and the treatment and prevention of infectious and parasitic diseases are needed to prevent IDA and all forms of anemia among children and women in Pakistan.