Anemia ferropriva e parasitoses em crianças de seis a 71 meses: estudo longitudinal no município de Novo Cruzeiro MG

Abstract

There are multiple causes of anaemia and parasites, schistosomiasis, morbidity, environmental factors and socioeconomic conditions may be main factors. A longitudinal study was conducted in 6- to 71-month-old children living in Novo Cruzeiro-MG to identify and classify cases of anaemia and iron deficiency and to evaluate the association with schistosomiasis and intestinal parasites, morbidity and environmental, social, and nutritional factors. Data collection was performed in February / March 2008 and July 2009 and included 414 children. Interviews were carried with parents or guardians and the information collected includedsocioeconomic and demographic variables and child related variables as health status, history of anaemia and morbidity. The assessment of food intake was carried out by the Food Frequency Questionnaire. Anthropometric data (weight and height) was expressed as z scoresfor weight-age, height-age, weight-height and body mass index. Blood samples were collected to characterize the anaemia, iron deficiency, the presence of infectious and inflammatory processes. Parasitological examinations were performed to evaluate the presence of parasitesand nonpathogenic intestinal protozoan. Serum levels of retinol (2008) were measured by HPLC to evaluate Vitamin A. The analyzes of the determinants of anaemia and iron deficiency were carried out using logistic regression models for cross-sectional data (2008 and 2009) and generalized estimating equations for longitudinal data. The prevalence of anaemia evaluated by hemoglobin levels was 35.9% and 9.8% (2008 and 2009). The prevalence of iron deficiency was 18.3% in 2008 and 21.8% in the exams performed in 2009. The prevalence for parasites or nonpathogenic intestinal protozoan infectious was 41.7% (2008). The most prevalent infection was by Schistosoma mansoni (8.6%), Ascaris lumbricoides (8.3%) and Giardia duodenalis (18.6%). In 2009, the overall prevalence was 50.7% with predominance of A. lumbricoides (5.7%), G. duodenalis (15.4%) and E. coli (21.2%). The deficits of weightage and height-age were 7.6% and 17.1% (2008) and 6.1% and 13.5% (2009. The variables associated with anaemia in cross-sectional studies (2008) were age, (< 36 months vs. 36 - 60 months; OR = 0,26: IC95% 0,130,53); maternal anaemia during pregnancy (OR = 2,66; IC95% 1,464,86), child history of anaemia (OR=3,61; IC95% 1,916,80), height-age (OR = 1,87; IC95% 1,003,48) and protozoan infection OR =2,47; IC95% 1,205,11); (2009) anaemia in 2008 (OR = 10,39; IC95% 4,1026,31), parasitic infection (helminthes OR = 3,63; IC95% 1,2510,52 or protozoan OR = 3,02; IC95% 1,267,23), high RDW (OR = 2,94; IC95%1,246,95), participation of the children in the Programa Bolsa Família (OR = 0,37; 0,17-0,78) and attendance by the Programa de Saúde da Família (OR = 0,13; IC95% 0,030,58). The predictors of iron deficiency (2008) in cross-sectional studies were: age and low birth weight (OR = 2,54; IC95% 1,085,94); (2009) age (< 36 meses vs. 36 60 months: OR = 0,34; IC95% 0,150,80) , iron deficiency in 2008 (OR = 3,88; IC95% 1,967,65), high RDW (OR = 2,51; IC95% 1,195,33), infectious or inflammatory process (OR = 8,75; IC95% 3,0025,51). Infections by parasites or nonpathogenic intestinal protozoan (2009) wereassociated with fever in the last 15 days (OR = 1,80; IC95% 1,092,96), eosinophilia (OR = 1,70; IC95% 1,102,63), and number of people by home (OR = 1,73; IC95% 1,032,89). In longitudinal analyses the risk factors for anaemia were iron deficiency (OR = 3,21; IC95% 1,965,26), parasitism (OR = 1,86; IC95% 1,242,81), height-for-age (OR = 2,10; IC95% 1,363,24), low intake of retinol (OR = 1,74; IC95% 1,112,73), adjusted for time. The variables associated with iron deficiency in longitudinal analysis, adjusted by time, were infection or inflammation process (OR = 2,86; IC95% 1,435,73), parasite infectious (OR = 0,63; IC95% 0,410,94), low intake of iron (OR = 1,78; IC95% 1,033,06), z-escore (OR = 0,97; IC95% 0,950,99). Nutritional status, parasite infectious, undernutrition and infectious diseases were associated with anaemia and iron deficiency, that suggested iron deficiency anaemia in these children as a chronic process.