Predictors of anemia in mothers and children in Uttar Pradesh, India

Abstract

Abstract Objective: Anemia affects more than half of Indian women and children, but the contribution of its causes remains unquantified. We examined interrelationships between hemoglobin and nutritional, environmental, infectious, and genetic determinants of anemia in non-pregnant mothers and children in Uttar Pradesh (UP). Design: We conducted a cross-sectional survey of households in 25 districts of UP between October and December 2016. We collected socio-demographic data, anthropometry, and venous blood in 1238 non-pregnant mothers and their children. We analyzed venous blood samples for malaria, hemoglobin, ferritin, retinol, folate, zinc, vitamin B12, C-reactive protein (CRP), α1-acid glycoprotein (AGP), and β-thalassemia. We used path analysis to examine pathways through which predictors of anemia were associated with hemoglobin concentration. Setting: Rural and urban households in 25 districts of UP. Participants: Mothers 18-49 years and children 6-59 months in UP. Results: A total of 36.4% of mothers and 56.0% of children were anemic, and 26.7% of women and 44.6% of children had iron deficiency anemia. Ferritin was the strongest predictor of hemoglobin [β (95% CI) = 1.03 (0.80, 1.27) g/dL in women and 0.90 (0.68, 1.12) g/dL in children]. In children only, red blood cell folate and AGP were negatively associated with hemoglobin and retinol was positively associated with hemoglobin. Conclusions: Over 70% of mothers and children with anemia had iron deficiency, needing urgent attention. However, several simultaneous predictors of hemoglobin exist, including nutrient deficiencies and inflammation. The potential of iron interventions to address anemia may be constrained unless coexisting determinants are jointly addressed.