Prevalence and Predictors of Anemia among Six-Week-Old Infants in Kwale County, Kenya

Abstract

Anemia is a significant public health problem among children worldwide. Etiology of anemia is multifactorial, but iron deficiency is the most common cause of anemia in low- and middle-income countries. ID and anemia in early infancy can impair growth and cognitive development. Many African infants have low birth iron stores and are at risk of developing anemia early in infancy. The main objective of this study was to determine prevalence and predictors of anemia among six-week-old infants in Msambweni County referral hospital and Kwale sub-County hospital in Kwale County, Kenya. This study adopted a cross-sectional study design and a sample size of 424 mother-infant pairs. Structured questionnaires were administered to the mothers to obtain information on socio-demographic variables, maternal characteristics and birth information. Anthropometric data was collected for each child. A heel prick was done to measure hemoglobin and Zinc protoporphyrin concentration using point-of-care devices. Data was stored on Redcap and analysis done using STATA version 16. Prevalence of key nutritional conditions was determined. This was determining anemia and iron deficiency and nutritional status of the infants. Chi-square, univariate and multivariate regression analyses were done to determine factors associated with anemia. Error bars to show the distribution of anemia cases in Kwale County were developed. The results show that prevalence of ID, anemia and IDA was 60.4% (95%CI: 55.9-65.2), 21.0% (95%CI: 17.5-25.2) and 15.8% (95%CI: 12.7-19.7) respectively. The prevalence of wasting, underweight and stunting was 2.1% (95%CI: 1.1-4.1), 0.2% (95%CI: 0.0-1.7) and 6.2% (95%CI: 4.3 9.0) respectively. Univariate analysis showed that the risk of anemia was significantly higher among male infants (odds ratio (OR) = 2.20 (95%CI: 1.33-3.63), p = 0.002), iron deficient infants (OR = 2.35 (95%CI: 1.39-3.99), p = 0.001) and infants from Msambweni Sub-County (OR = 2.80 (95%CI: 1.40-4.62), p<0.001). Multivariate analysis revealed that odds of anemia were significantly higher in infants born to mothers who did not use iron supplements during pregnancy (adjusted odds ratio (aOR) = 74.01 (95%CI: 2.45-2238.21), p = 0.013 and significantly lower in infants born to mothers with parity ≥ 4 (aOR = 0.05 ((95%CI: 0.00-0.77), p = 0.024). The study concludes that anemia burden among infants in Kwale County is of moderate public health significance. Iron deficiency is a major concern with maternal use of iron supplements during pregnancy being a crucial factor in determining infants’ anemia status. This study therefore recommends that the County government of Kwale in conjunction with the ministry of health to develop a task force to review current Kenyan paediatric protocols that only specify provision of iron supplements to anaemic infants older than 6 months of age to include anemia treatment and provision of iron supplements to infants less than six months of age.