Anemia and associated factors among breastfeeding infants 0-6 months old at Kangemi slums, Kenya

Abstract

ABSTRACT Controversies surrounding exclusive breast feeding for the first six months of life and the risk of developing anemia exist. Studies worldwide have indicated uncertainties on the way forward given the World Health Organization’s firm stand on exclusive breastfeeding as the most appropriate practice for infants less than six months old. Research on anemia among infants below six months in Kenya is scanty. The objective of this study, conducted in March and April, 2014, was to determine the prevalence of anemia and associated factors among breastfeeding infants 0-6 months in Kangemi slums, Nairobi, Kenya. A cross-sectional study was conducted on 139 breastfeeding infants aged 0-6 months and their respective mothers. An interviewer administered questionnaire was used to capture data on demographic and socio-economic characteristics, breastfeeding practices, iron and folic acid intake patterns and dietary patterns. Nutritional status of mothers and infants was assessed through anthropometric measurements. Anemia status was assessed using the rapid hemoglobin test kit (HemoCue®). Infants’ blood was drawn from the heel while mothers’ blood was from a finger prick. Data were analyzed using the Statistical Package for Social Sciences (version 20) and Microsoft Excel (2007). Socio-demographic and economic data were analyzed using descriptive statistics. Nutritional status of infants was classified according to the World Health Organization Child Growth Standards of 2006 and the mother’s Body Mass Index was classified according to WHO 2000 BMI cut-offs. Factors associated with anemia were analyzed using logistic regression. The level of significance was determined at p-value <0.05. Average household size was 3.8±1.12 members. Anemia prevalence (35.3%) was of moderate public health significance with 36.8% among exclusively breastfeeding compared to 28% of non-exclusively breastfeeding infants (χ2=0.702, df=1, p=0.402). There was no significant xvii difference in mean hemoglobin levels between infants exclusively breastfed and those non-exclusively breastfed (t0.025, 137=-1.040, p=0.300). Prevalence of anemia among breastfeeding mothers was 30%. Majority of infants (82%) were on exclusive breastfeeding, a proportion that gradually decreased with age. A reduced estimated relative risk of anemia (OR=0.713, 0.95CI: 0.34-1.50) was observed among infants aged less than 4 months as compared to those aged 4-6 months. Over two thirds (68.4%) of the mothers had received IFAs supplementation below the recommended threshold of 90 days in their last pregnancy. No significant difference was noted in mean hemoglobin levels of the mothers based on the duration of IFAs intake (F=0.818, p=0.486). There was no significant association between IFAs intake and maternal anemia. Global Acute Malnutrition rate was 5.8% with 5.2% and 6.2% among male and female infants respectively. Underweight and stunting levels were 2.2 and 19.4% respectively. Maternal BMI had a significant positive relationship with the infants’ nutritional status as well as their hemoglobin levels (r=0.176, p=0.039 and r=0.182, p=0.032 respectively). A small proportion (3.6%) of the mothers were underweight with a considerable proportion (39%) being overweight/obese. The mean Women Dietary Diversity Score (WDDS) was 6±1.26 food groups, with 71.2% of the lactating women consuming a diet high in diversity. A significant correlation was found between maternal BMI and WDDS (p=0.576). In conclusion, there is a likelihood of exclusively breastfed infants below 6 months being anemic in Kenya, to a level of moderate public health significance, and to a level that is not statistically different from the non-exclusively breast fed infants. Key factors of significant positive association with infant anemia include maternal nutritional status (both Body Mass Index and hemoglobin levels) and amount of household income spent on food. Hence special attention is warranted for maternal nutrition and low income households for exclusive breast feeding to xviii adequately address anemia in infants. In addition, supplementation of lactating mothers with iron/folic acid should be considered. A study to assess the iron content of breast milk among at risk mothers in resource poor settings is recommended to effectively address this problem. Key words: anemia, exclusive breastfeeding, infants below 6 months, lactating mothers

ABSTRACT Controversies surrounding exclusive breast feeding for the first six months of life and the risk of developing anemia exist. Studies worldwide have indicated uncertainties on the way forward given the World Health Organization’s firm stand on exclusive breastfeeding as the most appropriate practice for infants less than six months old. Research on anemia among infants below six months in Kenya is scanty. The objective of this study, conducted in March and April, 2014, was to determine the prevalence of anemia and associated factors among breastfeeding infants 0-6 months in Kangemi slums, Nairobi, Kenya. A cross-sectional study was conducted on 139 breastfeeding infants aged 0-6 months and their respective mothers. An interviewer administered questionnaire was used to capture data on demographic and socio-economic characteristics, breastfeeding practices, iron and folic acid intake patterns and dietary patterns. Nutritional status of mothers and infants was assessed through anthropometric measurements. Anemia status was assessed using the rapid hemoglobin test kit (HemoCue®). Infants’ blood was drawn from the heel while mothers’ blood was from a finger prick. Data were analyzed using the Statistical Package for Social Sciences (version 20) and Microsoft Excel (2007). Socio-demographic and economic data were analyzed using descriptive statistics. Nutritional status of infants was classified according to the World Health Organization Child Growth Standards of 2006 and the mother’s Body Mass Index was classified according to WHO 2000 BMI cut-offs. Factors associated with anemia were analyzed using logistic regression. The level of significance was determined at p-value <0.05. Average household size was 3.8±1.12 members. Anemia prevalence (35.3%) was of moderate public health significance with 36.8% among exclusively breastfeeding compared to 28% of non-exclusively breastfeeding infants (χ2=0.702, df=1, p=0.402). There was no significant xvii difference in mean hemoglobin levels between infants exclusively breastfed and those non-exclusively breastfed (t0.025, 137=-1.040, p=0.300). Prevalence of anemia among breastfeeding mothers was 30%. Majority of infants (82%) were on exclusive breastfeeding, a proportion that gradually decreased with age. A reduced estimated relative risk of anemia (OR=0.713, 0.95CI: 0.34-1.50) was observed among infants aged less than 4 months as compared to those aged 4-6 months. Over two thirds (68.4%) of the mothers had received IFAs supplementation below the recommended threshold of 90 days in their last pregnancy. No significant difference was noted in mean hemoglobin levels of the mothers based on the duration of IFAs intake (F=0.818, p=0.486). There was no significant association between IFAs intake and maternal anemia. Global Acute Malnutrition rate was 5.8% with 5.2% and 6.2% among male and female infants respectively. Underweight and stunting levels were 2.2 and 19.4% respectively. Maternal BMI had a significant positive relationship with the infants’ nutritional status as well as their hemoglobin levels (r=0.176, p=0.039 and r=0.182, p=0.032 respectively). A small proportion (3.6%) of the mothers were underweight with a considerable proportion (39%) being overweight/obese. The mean Women Dietary Diversity Score (WDDS) was 6±1.26 food groups, with 71.2% of the lactating women consuming a diet high in diversity. A significant correlation was found between maternal BMI and WDDS (p=0.576). In conclusion, there is a likelihood of exclusively breastfed infants below 6 months being anemic in Kenya, to a level of moderate public health significance, and to a level that is not statistically different from the non-exclusively breast fed infants. Key factors of significant positive association with infant anemia include maternal nutritional status (both Body Mass Index and hemoglobin levels) and amount of household income spent on food. Hence special attention is warranted for maternal nutrition and low income households for exclusive breast feeding to xviii adequately address anemia in infants. In addition, supplementation of lactating mothers with iron/folic acid should be considered. A study to assess the iron content of breast milk among at risk mothers in resource poor settings is recommended to effectively address this problem. Key words: anemia, exclusive breastfeeding, infants below 6 months, lactating mothers