The FNSS included 687 participants, with 586 participants between 6 to 35 months that included an indicator for anemia. Therefore, the sample size for our study was 586. The sample was 53% male with an average age of 20 months. The proportion living in Metropolitan Lima was 35%, 27% in Urban areas, and 37% in Rural areas. The demographics, rates of anemia, and nutrient uptake are included in Table 1.
Table 1
Characteristics of study population
Characteristics | N (%) |
Children with anemia1 | |
No | 274 (46.8) |
Yes | 312 (53.2) |
Children that meet recommendation for iron1 | |
No | 218 (38.4) |
Yes | 350 (61.6) |
Children that meet recommendation for iron, zinc and vitamin A1 | |
No | 282 (48.1) |
Yes | 304 (51.9) |
Children that meet recommendation for iron, zinc, vitamin A, protein and, energy1 | |
No | 342 (58.4) |
Yes | 244 (41.6) |
Sex1 | |
Male | 299 (52.6) |
Female | 269 (47.4) |
Age (months)1 | 20 ± 8.5* |
Area of residence1 | |
Metropolitan Lima | 201 (35.4) |
Urban área | 154 (27.1) |
Rural área | 213 (37.5) |
Access to safe drinking water2 | |
Do not Access | 106 (18.1) |
Access | 480 (81.9) |
Children with a reported infectious or parasitic disease2 | |
None | 267 (68.8) |
At least 1 reported infection | 121 (31.2) |
* Mean ± standard deviation |
† Some values may not add up to 586 due to missing data. |
1Reported from FNSS |
2Reported from ISHS |
The population had a prevalence of childhood anemia of 53.2%. The distribution of children affected by anemia showed great discrepancy among the areas of residence, with the highest number in rural areas (Rural area: 64.3%, Urban area: 54.5%, Metropolitan Lima: 40.3%). Children who met their iron recommendations for age was 61.6%. Of the children with anemia, 45.1% meet their iron recommendation (p < 0.001). The children who met their recommendations for iron, zinc, and vitamin A was 51.9%. Of the children with anemia, 45.1% met their recommendations for iron, zinc, and vitamin A (p < 0.001). The children who met their recommendations for iron, zinc, vitamin A, protein and energy was 41.6%. Of those with anemia, 45.1% meet their recommendations for iron, zinc, vitamin A, protein, and energy (p = 0.001). The association between nutrition uptake and anima is displayed in Table 2.
Table 2
Factors associated with anemia in bivariate analysis
Variables | Children with anemia | p |
No (n = 274) | Yes (n = 312) |
n(%) | n(%) |
Area of residence | | | < 0.001 |
Metropolitan Lima | 120 (59.7) | 81 (40.3) | |
Urban | 70 (45.5) | 84 (54.5) | |
Rural | 76 (35.7) | 137 (64.3) | |
Children that meet recommendation for iron | | | < 0.001 |
No | 74 (33.9) | 144 (60.1) | |
Yes | 192 (54.9) | 158 (45.1) | |
Children that meet recommendation for iron, zinc, and vitamin A | | | < 0.001 |
No | 107 (37.9) | 175 (62.1) | |
Yes | 167 (54.9) | 137 (45.1) | |
Children that meet recommendation for iron, zinc, vitamin A, protein and energy | | | 0.001 |
No | 140 (40.9) | 202 (59.1) | |
Yes | 134 (54.9) | 110 (45.1) | |
Children with an infectious or parasitic disease reported | | | 0.057 |
None | 121 (73.8) | 143 (64.4) | |
At least 1 | 43 (26.2) | 78 (35.6) | |
Access to safe drinking water | | | 0.002 |
No | 39 (14.1) | 73 (23.4) | |
Yes | 235 (85.9) | 239 (76.6) | |
| Children with safe drinking water | |
| No (n = 75) | Yes (n = 293) | |
Children with an infectious or parasitic disease reported | | | 0.002 |
None | 47 (62.7) | 245 (84.6) | |
At least 1 | 28 (37.3) | 48 (15.4) | |
The second-round of analysis included data linked from FNSS and the ISHS and had 388 participants. The prevalence of children who were reported to have an infectious or parasitic disease (IPD) in the last year was 31.2%. Of those with anemia, 35% had an IPD, while those without anemia, 26% reported having an IPD, a difference of 35% (p = 0.057). Regarding household sanitation, 18.1% of the children did not have access to safe drinking water. Of those with anemia, 23% did not have access to safe drinking water, while of those without anemia, 14% did not have access to safe drinking water (p = 0.020). Among the group of children who do not have access to safe drinking water, 37% had an IPD reported, of those that have safe drinking water, 15% had an IPD reported (p = 0.002). The data on IPD, access to safe drinking water, and their relationship with children with anemia are included in Table 2. An additional analysis was conducted to assess methods of water treatment: 85.8% (332) of the participants who have access to safe drinking water report boiling their water to treat it, 3.88% (15) report treating the water with chlorine, and 0.78% (3) report treating another way.
The logistic multivariant regression analysis displayed that having a IPD increases the odds of having anemia (OR = 1.6, p = 0.043), independent of satisfying micronutrient uptake requirements (iron, zinc, and vitamin A). Additionally, having access to clean drinking water decreases the odds of anemia (OR = 0.58, p = 0.044), independent of satisfying micronutrient requirements. The results of the logistic regressions are in Table 3.
Table 3
Logistic Regression Analysis to predict effect on anemia
N = 398 | OR | P-value | 95% Confidence Interval |
IPD | 1.6 | 0.043* | 1.02–2.53 |
Iron Requirements | 0.54 | 0.019* | 0.32–0.90 |
Zinc Requirements | 0.94 | 0.827 | 0.54–1.62 |
Vitamin A Requirements | 0.92 | 0.78 | 0.52–1.62 |
Intercept | 1.86 | 0.014 | 1.14–3.05 |
Safe Drinking Water | 0.58 | 0.044 | 0.34–0.99 |
Iron Requirements | 0.59 | 0.038 | 0.36–0.97 |
Zinc Requirements | 0.86 | 0.591 | 0.51–1.48 |
Vitamin A Requirements | 0.98 | 0.940 | 0.56–1.70 |
Intercept | 3.04 | 0.000 | 1.63–5.65 |