Iron and nutritional status of children 12-59 months in Migwani division, Mwingi district, Kenya
Poor nutritional status, anaemia, iron deficiency and iron deficiency anaemia among children in many parts of Kenya continues to be public health issues especially in arid and semi-arid lands which are generally food insecure. Available nutritional status monitoring methods in Kenya do not capture adequate data for decision making. The general objective of this study was to determine iron and nutritional status and associated factors among children 12-59 months old in Migwani Division, Mwingi, a district within arid and semi-arid lands of Kenya. A cross-sectional study was conducted among 293 children (147 boys and 146 girls) aged 12-59 months in January/ February 2010 in Migwani division, Mwingi district. Nutritional status of the children was assessed using anthropometric indices and the WHO 2005 child growth reference standards. Haemoglobin concentration was determined using a haematological analyzer and anaemia defined as haemoglobin concentration <110glL. Hb concentration and anaemia was adjusted for altitude and ethnicity. Serum ferritin concentration was determined using enzyme linked fluorescent immune assay- ALF A and iron deficiency was defined as serum ferritin concentration <12 ug/l. Iron deficiency anaemia was defined as concurrent anaemia and iron deficiency. Serum ferritin and iron deficiency was corrected for infection using C-reactive protein which was determined using nyco card reader. SPSS version 16 and EPI info-ENA were used for data analysis. Multiple logistic regressions were done to determine independent factors. Stepwise backward elimination method was used to develop the best final models. Research was approved by Kenyatta National Hospital Ethical Review committee. Over half (54.1 %) of the subjects (48.0 - 60.1 C.I.) were stunted while 35.8% (30.7 - 41.4 CL) were underweight. These rates were higher than the national average as reported in the 2008/09 Kenya Demographic and Health Survey. The prevalence of Global Acute Malnutrition was 10.3% (6.3 - 16.3 c.I.). Prevalence of anaemia before and after adjusting for altitude and ethnicity was 34.5% and 16.7% respectively. The prevalence of iron deficiency before and after correcting for infection was 23.0% and 29.5% respectively. Factors found to be independently associated with anaemia were: birth order (OR=0.77; p=.001), age (OR=1.04; p=.0323), dietary diversity (OR=1.71; p=.001), stunting (OR=4.28; p=.0007) and iron deficiency (OR=4.23; p=.0006). Age (OR=I.06; p=.000)was independently associated with iron deficiency while factors independently associated with iron deficiency anaemia were age (OR=1.05; p=.024) and birth order (OR=0.79; p=0.006). Breastfeeding status (OR=0.35; P=.012), stunting (OR=49.47; p=.000)and wasting (OR=152.17; p=.000)were independently associated with Underweight. Underweight (OR=14.67; p=.000) was independently associated with stunting while factors independently associated with wasting were age (OR=1.04; p=.036) and underweight (OR=25.51; p=.000). We conclude that anaemia status among children in Migwani is of mild public health significance (5.0-19.9%) while global acute malnutrition is a serious public health issue (10-14%) according to World Health Organization classification. Low birth order, young age, low dietary diversity, stunting and iron deficiency are risk factors to anaemia. Young age is risk to iron deficiency. Young age is a risk factor while low birth order is a protective factor to iron deficiency anaemia. Underweight is associated with stunting while young age and underweight are risk factors to wasting. Breastfeeding children were protected from underweight while stunting and wasting are risk factors to underweight. The households and community members should improve care and support of children while the government and NGOs should put/improve mechanisms in place to prevent and correct the problem of stunting, anaemia and iron deficiency such as promotion of exclusive breastfeeding and dietary diversification. There is need to strengthen nutrition status monitoring in the area in order to implement timely and evidence based interventions.