Iron Deficiency Risk Factors in Undernourished Children Aged 6-23 Months in Aceh, Indonesia
Article Sidebar
Issue
Vol. 13 No. 3 (2018)
Accepted
15 November 2018
Published
15 November 2018
Keywords:
-
anaemia, breastfeeding, iron deficiency, underweight, young children
Abstract
The study aimed to analyse both the prevalence and risk factors for iron deficiency in undernourished children aged 6-23 months in Aceh. A cross-sectional study design was applied on 154 underweight children selected through a cluster sampling. Ferritin serum was analysed using the the enzyme-linked immunosorbent assay (ELISA), haemoglobin level using the cyanmethaemoglobin, socio-demographic and food frequency data were collected by interviews. Data on iron intake, dietary diversity and nutrient density were assesed by the repeated 24 hours recall method for three days. The results showed that 27.3% of children suffered from iron deficiency (ID), 50.7% was anaemic and 19.7% suffered from iron deficiency anaemia (IDA). Only 37.7% of children had received exclusive breast milk, 45.5% were given timely introduction of complementary feeding, 33.1% met the minimum meal frequency, 28.6% met dietary diversity, and 23.4% met the criteria for acceptable diet, 33.1% had iron intake from complementary feeding >40% RDA and 24.7% had enough iron density. Age, breastfeeding status and mother’s occupation were significantly associated with the occurrence of ID where children aged 12-23 months were at lower risk than those aged 6-11 months (OR=0.28; 95%CI:0.09-0.83), while children who were not breastfed had 11.33 times higher risk of suffering from ID (OR=11.33; 95%CI:1.38-93.39). Working mothers had 8.29 higher risk of having children with ID (OR=8.29; 95%CI:1.71-40.08). The prevalence of ID in undernourished children was very high, thus it is necessary to improve the quality of breastfeeding and complementary feeding practicess as well as other interventions integrated into reducing malnutrition and iron deficiency to accelerate prevention of malnutrition in children.
References
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Ferguson E, Chege P, Kimiywe J, Wiesmann D, Hotz C. 2015. Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children. Matern Child Nutr 11:6-20. doi: https://doi.org/10.1111/mcn.12243.
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Lameshow S, Hosmer DW, Klar J, Lwanga SK. 1990. Adequacy Sample Size in Health Studies. WHO: John Wiley & Sons Ltd.
Liu J. 2011. Micronutrients deficiency and associated socio-demographic factors in Chinese children. World J Pediatr 7(3):217-223. doi:10.1007/s12519-011-0317-1.
Lozoff B, Kaciroti N, Walter T. 2006. Iron deficiency in infancy: Applying a physiologic framework for prediction. Am J Clin Nutr 84(6):1412-1421.
Marques RFSV, Tadder JAAC, Lopez FA, Braga JAP. 2014. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Rev Assoc Med Bras 60(1):18-22. http://dx.doi.org/10.1590/1806-9282.60.01.006.
[MoH] Ministry of Health. 2013. Indonesia Basic Health Research 2013: RISKESDAS
2013. Jakarta: Ministry of Health of Republic of Indonesia.
Mwangi MN, Phiri KS, Abkari A, Gbané M, Bourdet-Sicard R, Braesco VA, Zimmermann. MB, Prentice AM. 2017. Iron for Africa-report of an expert workshop. Nutrients 9:576. doi:10.3390/nu9060576.
Ogunba BO. 2015. Effect of maternal employment on infant feeding practices in Southwestern Nigeria. Food and Nutrition Sciences 6(7):597-604. http://dx.doi.org/10.4236/fns.2015.67063.
Qasem and Friel (2015). An overview of iron in term breast-fed infants. Pediatrics 9:79-84. doi: 10.4137/CMPed.s26572.
Qudsia F, Saboor M, Khosa SM, Ayub Q, Moinuddin. 2015. Comparative analysis of serum iron, serum ferritin and red cellfolate levels among breast fed, fortified milk and cow’s milk fed infants. Pak J Med Sci 31(3):706-709. doi: http://dx.doi.org/10.12669/pjms.313.6937.
Ray S, Chandra J, Bhattacharjee J, Sharma S, Agarwala A. 2018. Determinants of nutritional anaemia in children less than five years age. Int J Contemp Pediatr 3(2):403-408.http://dx.doi.org/10.18203/2349-3291.ijcp20161023.
Reinbott A, Jordan I, Herrmann J, Kuchenbecker J, Kevanna O, Krawinkel MB. 2016. Role of breastfeeding and complementary food on hemoglobin and ferritin levels in a cambodian cross-sectional sample of children aged 3 to 24 months. PLoS ONE 11(3):e0150750.doi:10.1371/journal. pone.0150750.
Ringoringo HP. 2009. Insidens defisiensi besi dan anaemia defisiensi besi pada bayi berusia 0-12 bulan di Banjarbaru Kalimantan Selatan: studi kohort prospektif. Sari Pediatri 11(1).
Ryan AS, Zhou W, Arensberg MB. 2006. The effect of employment status on breastfeeding in the United States. Womens Health Issues 16(5):243-251. doi:10.1016/j.whi.2006.08.001.
Sailaja K, Reddy KV, Reddy KA, Keerthi S. 2017. Iron deficiency anaemia in young children (6 to 23 months) in relation to complementary feeding practicess in rural Telangana. Int J Contemp Pediatr 4(4):1240-1244.
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Soh P, Ferguson EL, McKenzie JE, Homs MYV and Gibson. RS. 2004. Iron deficiency and risk factors for lower iron stores in 6-24-month-old New Zealanders. EPJCN 58(1):71-79.
Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. 2013. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr 9(2):27-45.
Shubha DB, Angadi N. 2016. Infant and young child feeding practices of working and nonworking mothers in urban slums of Davangere city. Int J Med Sci Public Health 5:420-424.
Sumarmi S, Puspitasari N, Handajani R, Wirjatmadi B. 2016. Underweight as a risk factor for iron depletion and iron deficient erythropoiesis among young women in Rural Areas of East Java, Indonesia. Mal J Nutr 22(2):219-232.
Sumedi E, Sandjaja. 2015. Asupan zat besi, vitamin A dan zink anak indonesia umur 6-23 bulan. Penel Gizi Makan 38(2):167-175.
Thorisdottir AV, Thorsdottir I, Palsson GI. 2011. Nutrition and iron status of 1-year olds following a revision in infant dietary recommendations. Anaemia Article ID 986303: 9. doi:10.1155/2011/986303.
Tsai SF, Chen SJ, Yen HJ, Hung GY, Tsao PC, Jeng MJ, Lee YS, Soong WJ, Tang RB. 2014. Iron deficiency anemia in predominantly breastfed young children. Pediatr Neonatol 55:466-469. http://dx.doi.org/10.1016/j.pedneo.2014.02.005.
Uyoga MA, Karanja S, Paganini D, Cercamondi CI, Zimmermann SA, Ngugi B, Holding P, Moretti D, Zimmermann MB. 2016. Duration of exclusive breastfeeding is a positive predictor of iron status in 6 to 10 month-old infants in rural Kenya. Matern Child Nutr 1-9. doi:10.1111/mcn.12386
[PAHO, WHO, UNICEF] Pan American Health Organization, World Health Organization, Nations Children’s Fund. 2013. ProPAN: Process for the Promotion of Child Feeding. 2. ed. Washington DC: PAHO.
Wibowo L, Santika O, Harmiko MP. 2012. Survei dasar gizi dan kesehatan di wilayah world vision indonesia dan wahana visi Indonesia di kabupaten Merauke. J Gizi Pangan 7(1):11-18.
Woldie H, Kebede Y, Tariku A. 2015. Factors associated with anemia among children aged 6-23 months attending growth monitoring at tsitsika health center, wag-himra zone, Northeast Ethiopia. Journal of Nutritionand Metabolism. http://dx.doi.org/10.1155/2015/928632.
[WHO] World Health Organization. 2004. Complementary Feeding Counselling: a training course Participant’s Manual. Geneva: World Health Organization.
[WHO] World Health Organization. 2010. Indicators for assessing infant and young child feeding practicess. Part 1, definitions. Geneva: World Health Organization.
[WHO] World Health Organization. 2011. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization.
[WHO] World Health Organization. 2015. Infant and young child feeding. Geneva: World Health Organization.
[WHO] World Health Organization. 2016a. Micronutrient defeciencies. Geneva: World Health Organization.
[WHO] World Health Organization. 2016b. Guideline: Daily iron supplementation in infants and children. Geneva: World Health Organization.
[WHO] World Heath Organization. 2017a. Micronutrient deficiencies. Geneva: World Health Organization.
[WHO] World Health Organization. 2017b. Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization.
Ahmad A, Zulfah S, Wagustina S. 2014. Iron deficiency and anaemia among under-two-years old-children (6-23 months) in Aceh Besar District. Gizi Indon 37(1):63-70.
Andersson M, Hurrell RF. 2010. Prevention of iron deficiency in infancy, childhood and adolescence. Annales Nestlé (English ed.) 68(3):120-131. doi: 10.1159/000319967.
Attanasio L, Kozhimannil KB, McGovern P, Gjerdingen D, Johnson PJ. 2013. The impact of prenatal employment on breastfeeding intentions and breastfeeding status at one week postpartum. J Hum Lact 29(4):620-628. doi:10.1177/0890334413504149.
Burke RM, Rebolledo PA, Aceituno AM, Revollo R, Iñiguez V, Klein M, Drews-Botsch C,
Leon JS, and Suchdev PS. 2018. Effect of infant feeding practices on iron status in a cohort study of Bolivian infants. BMC Pediatrics 18(1):107. https://doi.org/10.1186/s12887-018-1066-2.
Chandyo RK, Henjum S, Ulak M, Thorne-Lyman AL, Ulvik RJ, Shrestha PS, Locks L, Fawzi L and Strand TA. 2016. The prevalence of anaemia and iron deficiency is more common in breastfed infants than their mothers in Bhaktapur, Nepal. Eur J Clin Nutr 70(4):456-462.
Chekol DA, Biks GA, Gelaw YA, Melsew YA. 2017. Exclusive breastfeeding and mothers’ employment status in Gondar town, Northwest Ethiopia: a comparative cross-sectional study. Int Breastfeed J 12(1):27. https://doi.org/10.1186/s13006-017-0118-9
Clark KM, Li M, Zhu B, Liang F, Shao J, Zhang Y, Ji C, Zhao Z, Kaciroti N, Lozoff B. 2016. Breastfeeding, mixed, or formula feeding at 9 months of age and the prevalence of irondeficiency and iron deficiency anemia in two cohorts of infants in China. J Pediatr 181:56-61. http://dx.doi.org10.1016/j.jpeds.2016.10.041.
Dewey KG. 2007. Increasing iron intake of child-ren through complementary foods. Food and Nutrition Bulletin 28(4):595-609.
Domellof M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, Goudoever JV. 2014. Iron requirements of infants and toddlers. JPGN 58(1):119-29.
Drewnowski A. 2005. Concept of a nutritious food: toward a nutrient density score. Am J Clin Nutr 82(4):721-732.
Eussen S, Alles M, Uijterschout L, Brus F, Van der Horst-Graat J. 2015. Iron intake and status of children aged 6-36 months in Europe: a systematic review. Ann Nutr Metab 66:80-92. doi: 10.1159/000371357.
Ekwochi U, Osuorah DIC, Odetunde OI, Egbonu I, Ezechukwu CC. 2018. Prevalence of iron deficiency anaemia in anaemic under-5 children in Enugu South East Nigeria. Niger J Paed 41(2):129-132. doi:http://dx.doi.org/10.4314/njp.v41i2.
[FAO] Food Agricultural Organization, 2014. Guidelines for assesing nutrition-related knowladge, attitude and practicess. Rome: FAO.
Fátima RD, Marques SV, Aguiar JA, Taddei C, Lopez FA, Braga JAP. 2013. Haemoglobin values in the first six months of life in exclusively breastfed children. OJBD 3(4):130-135. http://dx.doi.org/10.4236/ojbd.2013.34024.
Ferguson E, Chege P, Kimiywe J, Wiesmann D, Hotz C. 2015. Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children. Matern Child Nutr 11:6-20. doi: https://doi.org/10.1111/mcn.12243.
Gibson RS. 2005. Principles of Nutrition Assesment: 2nd edition. New York: Oxford University Press.
Joo EY, Kim KY, Kim DH, Lee JE, Kim SK. 2016. Iron deficiency anaemia in infants and toddlers. Blood Res 51(4):268-273. https://doi.org/10.5045/br.2016.51.4.268.
Kabir A, Maitrot MRL. 2017. Factors influencing feeding practicess of extreme poor infants and young children in families of working mothers in Dhaka slums: A qualitative study. PLoS ONE 12(2): e0172119. doi:10.1371/journal. pone.0172119.
Kang YS, Kim JH, Ahn EH, Yoo EG, Kim MK. 2015. Iron and vitamin D status in breastfed infants and their mothers. Korean J Pediatr 58(8):283-287. http://dx.doi.org/10.3345/kjp.2015.58.8.283.
Kejo D, Petrucka1 PM, Martin H, Kimanya ME, Mosha TCE. 2018. Prevalence and predictors of anemia among children under 5 years of age in Arusha District, Tanzania. Pediatric Health Med Ther 9:9-15. doi:10.2147/PHMT.S148515.
Laillou A, Pham TV, Tran NT, Le HT, Wieringa F. 2012. Micronutrient deficits are still public health issues among women and young children in vietnam. PLoS ONE 7(4):e34906. doi:10.1371/journal.pone.0034906.
Lameshow S, Hosmer DW, Klar J, Lwanga SK. 1990. Adequacy Sample Size in Health Studies. WHO: John Wiley & Sons Ltd.
Liu J. 2011. Micronutrients deficiency and associated socio-demographic factors in Chinese children. World J Pediatr 7(3):217-223. doi:10.1007/s12519-011-0317-1.
Lozoff B, Kaciroti N, Walter T. 2006. Iron deficiency in infancy: Applying a physiologic framework for prediction. Am J Clin Nutr 84(6):1412-1421.
Marques RFSV, Tadder JAAC, Lopez FA, Braga JAP. 2014. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Rev Assoc Med Bras 60(1):18-22. http://dx.doi.org/10.1590/1806-9282.60.01.006.
[MoH] Ministry of Health. 2013. Indonesia Basic Health Research 2013: RISKESDAS
2013. Jakarta: Ministry of Health of Republic of Indonesia.
Mwangi MN, Phiri KS, Abkari A, Gbané M, Bourdet-Sicard R, Braesco VA, Zimmermann. MB, Prentice AM. 2017. Iron for Africa-report of an expert workshop. Nutrients 9:576. doi:10.3390/nu9060576.
Ogunba BO. 2015. Effect of maternal employment on infant feeding practices in Southwestern Nigeria. Food and Nutrition Sciences 6(7):597-604. http://dx.doi.org/10.4236/fns.2015.67063.
Qasem and Friel (2015). An overview of iron in term breast-fed infants. Pediatrics 9:79-84. doi: 10.4137/CMPed.s26572.
Qudsia F, Saboor M, Khosa SM, Ayub Q, Moinuddin. 2015. Comparative analysis of serum iron, serum ferritin and red cellfolate levels among breast fed, fortified milk and cow’s milk fed infants. Pak J Med Sci 31(3):706-709. doi: http://dx.doi.org/10.12669/pjms.313.6937.
Ray S, Chandra J, Bhattacharjee J, Sharma S, Agarwala A. 2018. Determinants of nutritional anaemia in children less than five years age. Int J Contemp Pediatr 3(2):403-408.http://dx.doi.org/10.18203/2349-3291.ijcp20161023.
Reinbott A, Jordan I, Herrmann J, Kuchenbecker J, Kevanna O, Krawinkel MB. 2016. Role of breastfeeding and complementary food on hemoglobin and ferritin levels in a cambodian cross-sectional sample of children aged 3 to 24 months. PLoS ONE 11(3):e0150750.doi:10.1371/journal. pone.0150750.
Ringoringo HP. 2009. Insidens defisiensi besi dan anaemia defisiensi besi pada bayi berusia 0-12 bulan di Banjarbaru Kalimantan Selatan: studi kohort prospektif. Sari Pediatri 11(1).
Ryan AS, Zhou W, Arensberg MB. 2006. The effect of employment status on breastfeeding in the United States. Womens Health Issues 16(5):243-251. doi:10.1016/j.whi.2006.08.001.
Sailaja K, Reddy KV, Reddy KA, Keerthi S. 2017. Iron deficiency anaemia in young children (6 to 23 months) in relation to complementary feeding practicess in rural Telangana. Int J Contemp Pediatr 4(4):1240-1244.
Santos RFD, Gonzalez ESC, de Albuquerque EC, de Arruda, IKG, Diniz AS, Figueroa JN, and Pereira APC. 2011. Prevalence of anaemia in under five-year-old children in a children’shospital in Recife, Brazil. Rev Bras Hematol Hemoter 33(2):100-104.
Soh P, Ferguson EL, McKenzie JE, Homs MYV and Gibson. RS. 2004. Iron deficiency and risk factors for lower iron stores in 6-24-month-old New Zealanders. EPJCN 58(1):71-79.
Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. 2013. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr 9(2):27-45.
Shubha DB, Angadi N. 2016. Infant and young child feeding practices of working and nonworking mothers in urban slums of Davangere city. Int J Med Sci Public Health 5:420-424.
Sumarmi S, Puspitasari N, Handajani R, Wirjatmadi B. 2016. Underweight as a risk factor for iron depletion and iron deficient erythropoiesis among young women in Rural Areas of East Java, Indonesia. Mal J Nutr 22(2):219-232.
Sumedi E, Sandjaja. 2015. Asupan zat besi, vitamin A dan zink anak indonesia umur 6-23 bulan. Penel Gizi Makan 38(2):167-175.
Thorisdottir AV, Thorsdottir I, Palsson GI. 2011. Nutrition and iron status of 1-year olds following a revision in infant dietary recommendations. Anaemia Article ID 986303: 9. doi:10.1155/2011/986303.
Tsai SF, Chen SJ, Yen HJ, Hung GY, Tsao PC, Jeng MJ, Lee YS, Soong WJ, Tang RB. 2014. Iron deficiency anemia in predominantly breastfed young children. Pediatr Neonatol 55:466-469. http://dx.doi.org/10.1016/j.pedneo.2014.02.005.
Uyoga MA, Karanja S, Paganini D, Cercamondi CI, Zimmermann SA, Ngugi B, Holding P, Moretti D, Zimmermann MB. 2016. Duration of exclusive breastfeeding is a positive predictor of iron status in 6 to 10 month-old infants in rural Kenya. Matern Child Nutr 1-9. doi:10.1111/mcn.12386
[PAHO, WHO, UNICEF] Pan American Health Organization, World Health Organization, Nations Children’s Fund. 2013. ProPAN: Process for the Promotion of Child Feeding. 2. ed. Washington DC: PAHO.
Wibowo L, Santika O, Harmiko MP. 2012. Survei dasar gizi dan kesehatan di wilayah world vision indonesia dan wahana visi Indonesia di kabupaten Merauke. J Gizi Pangan 7(1):11-18.
Woldie H, Kebede Y, Tariku A. 2015. Factors associated with anemia among children aged 6-23 months attending growth monitoring at tsitsika health center, wag-himra zone, Northeast Ethiopia. Journal of Nutritionand Metabolism. http://dx.doi.org/10.1155/2015/928632.
[WHO] World Health Organization. 2004. Complementary Feeding Counselling: a training course Participant’s Manual. Geneva: World Health Organization.
[WHO] World Health Organization. 2010. Indicators for assessing infant and young child feeding practicess. Part 1, definitions. Geneva: World Health Organization.
[WHO] World Health Organization. 2011. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva: World Health Organization.
[WHO] World Health Organization. 2015. Infant and young child feeding. Geneva: World Health Organization.
[WHO] World Health Organization. 2016a. Micronutrient defeciencies. Geneva: World Health Organization.
[WHO] World Health Organization. 2016b. Guideline: Daily iron supplementation in infants and children. Geneva: World Health Organization.
[WHO] World Heath Organization. 2017a. Micronutrient deficiencies. Geneva: World Health Organization.
[WHO] World Health Organization. 2017b. Nutritional anaemias: tools for effective prevention and control. Geneva: World Health Organization.
Authors
AhmadA., MadanijahS., DwirianiC. M., & KolopakingR. (2018). Iron Deficiency Risk Factors in Undernourished Children Aged 6-23 Months in Aceh, Indonesia. Jurnal Gizi Dan Pangan, 13(3), 145-156. https://doi.org/10.25182/jgp.2018.13.3.145-156
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