(P24-024-24) Risk Factors for Lower Hemoglobin in Young Children From Rural Ethiopia: A Longitudinal Study

Objectives: This study examined the effect of diet, morbidity, parasitic infection, inflammation, selected nutrient intakes and biomarkers, child and maternal nutritional status, season, and household socioeconomic status on hemoglobin levels among children under five years in rural Ethiopia.

Methods: Children (n=873) aged 6-36 months from Jimma and East Wollega, Oromia, Ethiopia, were followed longitudinally in a randomized controlled trial from April 2015 to June 2016. Data were collected on household demographics, child anthropometry, child, and maternal hemoglobin (Hb), selected biomarkers, dietary intake, illness (past two weeks), and inflammation (CRP and AGP). The prevalence of anemia (Hb < 11 g/dL) was calculated, and nutrient adequacy ratios (NARs) for available nutrients were calculated from 24-hour dietary recalls. The association of risk factors with hemoglobin was estimated using longitudinal linear mixed models.

Results: Mean hemoglobin during the food insecure preharvest season was 11.4±1.5 g/dL, increasing to 11.8±1.4 g/dL during the more food secure postharvest season. Rates of illness (29-30% in a two-week period) and inflammation (35-37%) were constant over seasons. Children consumed energy-deficient diets in both seasons (pre-harvest NAR 0.55, Q1-Q3 0.35-0.79; post-harvest NAR 0.60, Q1-Q3 0.42-0.81). Consumption of vitamins A, B3, and C, zinc, and calcium was also low in both seasons. Child iron consumption was adequate, but phytate consumption was high.

In the multivariable model, child age (b=0.04, p< 0.0001), child height-for-age-z-score (b=0.19, p< 0.0001), maternal Hb (b=0.11, p=0.0045), cough (last two weeks) (b=-0.24, p=0.0545), protein consumption (b=0.02, p=0.0552), and postharvest season (b=0.68, p=0.002) remained significant predictors of hemoglobin concentration.

Conclusions: While nutrient intakes remained poor, there was a strong seasonal change in hemoglobin among young Ethiopian children. Interventions are needed to address multiple causes of anemia.

Funding Sources: The RCT was funded by the Agricultural Technology Adoption Initiative (ATAI) and the Nutritious Maize for Ethiopia (NuME) Project. However, we did not receive any funding for this specific study.