Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Subjects
2.3. Socio-Demographic and Nutritional Status Variables
2.4. Blood Biochemical Assessment
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- World Health Organization (WHO). Intermittent Iron Supplementation in Preschool and School-Age Children; WHO: Geneva, Switzerland, 2011. [Google Scholar]
- World Health Organization (WHO). The Global Prevalence of Anemia in 2011; WHO: Geneva, Switzerland, 2015. [Google Scholar]
- World Health Organization (WHO). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Vitamin and Mineral Nutrition Information System; WHO: Geneva, Switzerland, 2011. [Google Scholar]
- Hamid, J.J.M.; Mitra, A.K.; Rohani, A.; Norimah, A.K. Association of iron deficiency with or without anaemia and cognitive functions among primary school children in Malaysia. Malays. J. Nutr. 2010, 16, 261–270. [Google Scholar]
- Mubarak, A.; Fadel, W.; Said, S.; Hammar, M.A. Profile of Behavior and IQ in Anemic Children. CNS Spectr. 2010. [Google Scholar] [CrossRef] [PubMed]
- Gupta, S.; Taraphdar, P.; Roy, T.G.; Haldar, D.; Dey, S.K. The silent burden of anemia in school age children: A community based study in West Bengal. Indian J. Med. Sci. 2012. [Google Scholar] [CrossRef] [PubMed]
- Viprakasit, V.; Lee-Lee, C.; Chong, Q.T.; Lin, K.H.; Khuhapinant, A. Iron chelation therapy in the management of thalassemia: The Asian perspectives. Int. J. Hematol. 2009, 90, 435–445. [Google Scholar] [CrossRef] [PubMed]
- Knowles, J.; Thurnham, D.I.; Phengdy, B.; Houamboun, K.; Philavong, K. Impact of inflammation on the biomarkers of iron status in a cross-sectional survey of Lao women and children. Br. J. Nutr. 2013. [Google Scholar] [CrossRef] [PubMed]
- Gwetu, T.P.; Chhagan, M.K.; Taylor, M.; Kauchali, S.; Craib, M. Anaemia Control and the Interpretation of Biochemical Tests for Iron Status in Children. BMC Res. Notes 2017, 10, 163. [Google Scholar] [CrossRef] [PubMed]
- Thurnham, D.I.; McCabe, L.D.; Haldar, S.; Wieringa, F.T.; NorthropClewes, C.A. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: A meta-analysis 1–3. Am. J. Clin. Nutr. 2010, 92, 546–555. [Google Scholar] [CrossRef] [PubMed]
- Institute for Public Health. National Health and Morbidity Survey (NHMS) Non-Communicable Diseases, Risk Factors & Other Health Problems; Ministry of Health: Putrajaya, Malaysia, 2015.
- Poh, B.K.; Ng, B.K.; Siti Haslinda, M.D.; Nik Shanita, S.; Wong, J.E. Nutritional status and dietary intakes of children aged 6 months to 12 years: Findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). Br. J. Nutr. 2013, 110, 21–35. [Google Scholar] [CrossRef] [PubMed]
- Ngui, R.; Lim, Y.A.L.; Kin, L.C.; Chuen, C.S.; Jaffar, S. Association between anaemia, iron deficiency anaemia, neglected parasitic infections and socioeconomic factors in rural children of West Malaysia. PLoS Negl. Trop. Dis. 2012. [Google Scholar] [CrossRef] [PubMed]
- Al-Mekhlafi, M.H.; Surin, J.; Atiya, A.S.; Ariffin, W.A.; Mahdy, A.K. Anaemia and iron deficiency anaemia among aboriginal schoolchildren in rural Peninsular Malaysia: An update on a continuing problem. Trans. R. Soc. Trop. Med. Hyg. 2008. [Google Scholar] [CrossRef] [PubMed]
- Rajoo, Y.; Ambu, S.; Lim, Y.A.; Rajoo, K.; Tey, S. Neglected Intestinal Parasites, Malnutrition and Associated Key Factors: A Population Based Cross-Sectional Study among Indigenous Communities in Sarawak, Malaysia. PLoS ONE 2017. [Google Scholar] [CrossRef] [PubMed]
- Goswmai, S.; Das, K.K. Socio-economic and demographic determinants of childhood anemia. J. Pediatr. 2015, 91, 471–477. [Google Scholar] [CrossRef] [PubMed]
- Thirukkanesh, S.; Zahara, A.M. Compliance to vitamin and mineral supplementation among pregnant women in urban and rural areas in Malaysia. Pakistan J. Nutr. 2010, 9, 744–750. [Google Scholar]
- Best, C.; Neufingerl, N.; Van Geel, L.; Van Den Briel, T.; Osendarp, S. The Nutritional Status of School-Aged Children: Why Should We Care? Food Nutr. Bull. 2010, 31, 400–417. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Balarajan, Y.; Ramakrishnan, U.; Özaltin, E.; Shankar, A.H.; Subramanian, S.V. Anaemia in Low-Income and Middle-Income Countries. Lancet 2011, 378, 2123–2135. [Google Scholar] [CrossRef]
- World Health Organization (WHO). Global Nutrition Targets 2025: Policy Brief Series (WHO/NMH/NHD/14.2); World Health Organization: Geneva, Switzerland, 2014. [Google Scholar]
- Schaafsma, A.; Deurenberg, P.; Clame, W.; Ellen, G.H.M.; Huevel, V.D. Design of the South East Asian Nutrition Survey (SEANUTS): A four-country multistage cluster design study. Br. J. Nutr. 2013, 110, 2–10. [Google Scholar] [CrossRef] [PubMed]
- Department of Statistic (DOS). Household income survey report, Department of Statistic, Malaysia. In Press Statement of Sistem Maklumat Kemiskinan Negara (E-Kasih); Implementation Coordination Unit, Prime Minister’s Department: Putrajaya, Malaysia, 2007. [Google Scholar]
- World Health Organization (WHO). Growth Reference 5–19 Years. BMI-for Age (5–19 years). Published 2007. Available online: http://www.who.int/growthref/who2007_bmi_for_age/en/ (accessed on 4 April 2018).
- Department of Statistic. Population Distribution and Basic Demographic Characteristics Report 2010. Available online: https://www.dosm.gov.my (accessed on 10 February 2018).
- De Benoist, B.; Mc Lean, E.; Egli, I.; Cogswell, M. Worldwide prevalence of Anaemia 1993–2005; WHO Global Database on Anaemia Geneva, World Health Organization: Geneva, Switzerland, 2008. [Google Scholar]
- Rojroongwasinkul, N.; Kijboonchoo, K.; Wimonpeerapattana, W.; Purttiponthanee, S.; Yamborisut, U. SEANUTS: The nutritional status and dietary intakes of 0.5–12-year-old Thai children. Br. J. Nutr. 2013. [Google Scholar] [CrossRef] [PubMed]
- Sandjaja, S.; Budiman, B.; Harahap, H.; Ernawati, F.; Soekatri, M. Food consumption and nutritional and biochemical status of 0.5–12-year-old Indonesian children: The SEANUTS study. Br. J. Nutr. 2013. [Google Scholar] [CrossRef] [PubMed]
- Le Nguyen, B.K.; Le Thi, H.; Nguyen Do, V.A.; Tran Thuy, N.; Nguyen Huu, C. Double burden of undernutrition and overnutrition in Vietnam in 2011: Results of the SEANUTS study in 0.5–11-year-old children. Br. J. Nutr. 2013. [Google Scholar] [CrossRef] [PubMed]
- Foo, L.H.; E-Siong, T.; Dhanaraj, P.; Leng, H. Iron status and dietary iron intake of adolescents from a rural community in Sabah, Malaysia. Asia Pac. J. Clin. Nutr. 2004, 13, 48–55. [Google Scholar] [PubMed]
- Nurul-Fadhilah, A.; Pey, S.T.; Leng, H.F. Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia. Nutrients 2016, 8, 551. [Google Scholar] [Green Version]
- Tan, J.A.M.A.; Lee, P.C.; Wee, Y.C.; Tan, K.L.; Mahali, N.F.; George, E.; Chua, K.H. High prevalence of alpha-and beta-thalassemia in the Kadazandusuns in East Malaysia: Challenges in providing effective health care for an indigenous group. BioMed Res. Int. 2010. [Google Scholar] [CrossRef] [PubMed]
- George, E.; Jamal, A.R.; Khalid, F.; Osman, K.A. High performance liquid chromatography (HPLC) as a screening tool for classical beta-thalassaemia trait in Malaysia. Malays. J. Med. Sci. MJMS 2001, 8, 40. [Google Scholar] [PubMed]
- Mohd Pauzy, L.H.; Esa, E.; Mahani Mokhri, N.; Yusoff, Y.M.; Jamaludin, N.A.; Zakaria, Z. Thalassemia Distribution Based on Screening Programs in the Population of the East Malaysian State of Sabah. J. Blood Disord. Transfus. 2018. [Google Scholar] [CrossRef]
- Ngim, C.F.; Lai, N.M.; Ibrahim, H.; Ratnasingam, V. Attitudes towards prenatal diagnosis and abortion in a multi-ethnic country: A survey among parents of children with thalassaemia major in Malaysia. J. Community Genet. 2013, 4, 215–221. [Google Scholar] [CrossRef] [PubMed]
- Jameela, S.; Sabirah, S.O.; Babam, J.; Phan, C.L.; Visalachy, P.; Chang, K.M.; Salwana, M.A.; Zuraidah, A.; Subramanian, Y.; Rahimah, A. Thalassaemia Screening among Students in a Secondary School in Ampang, Malaysia. Med. J. Malays. 2011, 66, 522–524. [Google Scholar]
- Ferrari, M.; Cuenca-Garcia, M.; Valtuena, J.; Moreno, L.A.; Censi, L.; Gonzalez-Gross, M.; Androutsos, O.; Gilbert, C.C.; Huybrechts, I.; Dallongeville, J.; et al. Inflammation profile in overweight/obese adolescents in Europe: An analysis in relation to iron status. Eur. J. Clin. Nutr. 2015, 69, 247. [Google Scholar] [CrossRef] [PubMed]
- Ranasinghe, C.; Gamage, P.; Katulanda, P.; Andraweera, N.; Thilakarathne, S.; Tharanga, P. Relationship between Body Mass Index (BMI) and Body Fat Percentage, Estimated by Bioelectrical Impedance, in a Group of Sri Lankan Adults: A Cross Sectional Study. BMC Public Health 2013, 13, 797. [Google Scholar] [CrossRef] [PubMed]
- Greenberg, A.S.; Obin, M.S. Obesity and the role of adipose tissue in inflammation and metabolism. Am. J. Clin. Nutr. 2006, 83, 461S–465S. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Monteiro, R.; Azevedo, I. Chronic inflammation in obesity and the metabolic syndrome. Mediat. Inflamm. 2010. [Google Scholar] [CrossRef] [PubMed]
- Chen, S. Association between Dietary Intake and Nutritional Status among Adolescent Girls in Kilosa District, Tanzania. Master’s Thesis, University of Massachusetts Amherst, Amherst, MA, USA, February 2012. [Google Scholar]
- Ganz, T.; Nemeth, E. Hepcidin and iron homeostasis. Biochim. Biophys. Acta (BBA) Mol. Cell. Res. 2012, 1823, 1434–1443. [Google Scholar] [CrossRef] [PubMed]
% | Lower CI | Upper CI | Mean | SE | |
---|---|---|---|---|---|
Age | 9.9 | 0.1 | |||
Sex | |||||
Boys | 50.1 | 43.8 | 56.3 | ||
Girls | 49.9 | 43.7 | 56.2 | ||
Ethnicity | |||||
Malay | 62.2 | 56.5 | 67.6 | ||
Chinese | 20.3 | 16.4 | 24.9 | ||
Indian | 6.6 | 4.4 | 9.6 | ||
Others | 10.9 | 8.2 | 14.2 | ||
Area of residence | |||||
Urban | 80.8 | 76.7 | 84.3 | ||
Rural | 19.2 | 15.7 | 23.3 | ||
Monthly household income ‡ | |||||
Low (<MYR 2300) | 52.6 | 46.3 | 58.8 | ||
Medium (MYR 2300–5599) | 33.0 | 27.5 | 39.0 | ||
High (≥MYR 5600) | 14.4 | 10.7 | 19.2 | ||
Anthropometric measurements | |||||
Weight (kg) | 34.3 | 0.7 | |||
Height (cm) | 135.6 | 0.7 | |||
Body mass index (BMI) (kg/m2) | 18.2 | 0.3 | |||
BMI-for-age (Z-score) | 0.3 | 0.1 | |||
Height-for-age (Z-score) | −0.4 | 0.1 | |||
BMI status | |||||
Thinness | 9.2 | 5.9 | 14.0 | ||
Normal weight | 57.9 | 51.6 | 64.0 | ||
Overweight | 14.1 | 10.2 | 19.3 | ||
Obese | 18.8 | 14.7 | 23.7 | ||
Height | |||||
Stunted | 4.8 | 2.9 | 7.7 |
Hb (g/L) | Ferritin (μg/L) | Ferritincorrected (μg/L) | ||||
---|---|---|---|---|---|---|
Mean | SE | Mean | SE | Mean | SE | |
Overall | 132.4 | 0.5 | 51.0 | 2.2 | 46.6 | 1.6 |
BMI status | ||||||
Thin/normal weight | 132.0 | 0.6 | 43.8 | 1.8 | 42.7 | 1.7 |
Overweight/obese | 133.2 | 0.8 | 65.6 a | 4.6 | 54.5 a | 3.2 |
Height | ||||||
Stunted | 125.1 b | 1.4 | 45.6 | 5.0 | 45.3 | 5.0 |
Normal height | 132.8 | 0.5 | 51.3 | 2.2 | 46.6 | 1.7 |
Anaemia | Iron Deficiency | Iron Deficiencycorrected | ||||
---|---|---|---|---|---|---|
% | CI | % | CI | % | CI | |
Overall | 4.0 | 2.4–6.7 | 5.1 | 2.7–9.4 | 5.2 | 2.8–9.4 |
Sex | ||||||
Boys | 4.5 | 2.4–8.4 | 3.1 | 1.5–6.6 | 3.1 | 1.5–6.6 |
Girls | 3.6 | 1.5–8.1 | 7.0 | 3.0–15.5 | 7.2 | 3.1–15.6 |
Ethnicity | ||||||
Malay | 4.2 a,b | 2.1–8.4 | 5.6 | 2.3–12.8 | 5.6 | 2.3–12.8 |
Chinese | 0.6 a | 0.1–2.4 | 2.2 | 0.5–9.9 | 2.2 | 0.5–9.9 |
Indian | 3.3 a,b | 0.5–20.4 | 13.8 | 6.0–28.8 | 13.8 | 6.0–28.8 |
Others | 9.9 b | 4.6–19.8 | 2.2 | 0.6–7.9 | 2.8 | 0.9–8.4 |
Area of residence | ||||||
Urban | 3.8 | 2.0–7.0 | 6.0 | 3.1–11.3 | 6.0 | 3.1–11.3 |
Rural | 5.2 | 2.5–10.7 | 1.4 | 0.6–3.2 | 1.4 | 0.6–3.2 |
Monthly household income ‡ | ||||||
Low (<MYR 2300) | 5.8 | 3.2–10.5 | 6.4 | 2.8–14.0 | 6.4 | 2.8–14.0 |
Medium/High (MYR 2300 and above) | 2.0 | 0.8–5.3 | 3.6 | 1.4–8.9 | 3.8 | 1.5–8.9 |
BMI status | ||||||
Thin/normal weight | 5.0 | 2.8–8.7 | 6.0 | 2.8–12.4 | 6.0 | 2.8–12.4 |
Overweight/Obese | 2.1 | 0.6–6.6 | 3.2 | 1.4–7.4 | 3.4 | 1.5–7.6 |
Height | ||||||
Stunted | 7.2 | 1.9–23.1 | 0 | 0 | 0 | 0 |
Non-stunted | 3.9 | 2.2–6.6 | 5.3 | 2.8–9.8 | 5.4 | 2.9–9.9 |
Children without Inflammation | Children with Inflammation | |||
---|---|---|---|---|
% | CI | % | CI | |
Overall | 84.2 | 79.2–88.2 | 15.8 | 11.8–20.8 |
Sex | ||||
Boys | 84.5 | 78.2–89.3 | 15.5 | 10.7–21.8 |
Girls | 83.9 | 75.5–89.9 | 16.1 | 10.1–24.5 |
Ethnicity | ||||
Malay | 85.2 | 77.8–90.5 | 14.8 | 9.5–22.2 |
Chinese | 85.2 | 76.7–91.0 | 14.8 | 9.0–23.3 |
Indian | 80.6 | 58.3–92.5 | 19.4 | 7.5–41.7 |
Others | 78.8 | 64.9–88.2 | 21.2 | 11.8–35.1 |
Area of residence | ||||
Urban | 85.0 | 79.0–89.5 | 15.0 | 10.5–21.0 |
Rural | 81.2 | 71.8–87.9 | 18.8 | 12.1–28.2 |
Monthly household income ‡ | ||||
Low (<MYR 2300) | 82.8 | 75.1–88.5 | 17.2 | 11.5–24.9 |
Medium/High (MYR 2300 and above) | 85.8 | 78.8–90.8 | 14.2 | 9.2–21.2 |
BMI status | ||||
Thin/normal weight | 92.6 a | 88.2–95.4 | 7.4 a | 4.6–11.8 |
Overweight/Obese | 67.2 b | 56.4–76.5 | 32.8 b | 23.5–43.6 |
Height | ||||
Stunted | 96.0 | 84.9–99.0 | 4.0 | 1.0–15.1 |
Non-stunted | 83.6 | 78.4–87.8 | 16.4 | 12.2–21.6 |
Children without Inflammation | Children with Inflammation | |||||
---|---|---|---|---|---|---|
Mean | SE | CI | Mean | SE | CI | |
Hb (g/L) | 132.1 | 0.6 | 131.1–133.2 | 133.9 | 1.1 | 131.8–136.0 |
Ferritin (ug/L) | 46.8 | 1.9 | 43.1–50.5 | 73.4 * | 7.2 | 59.3–87.5 |
Ferritin corrected (ug/L) | 46.8 | 1.9 | 43.1–50.5 | 45.4 | 2.6 | 40.2–50.6 |
Prevalence (%) | ||||||
Anaemia | 4.5 | 1.2 | 2.6–7.6 | 1.7 | 1.2 | 0.4–6.7 |
ID | 6.0 | 1.9 | 3.2–11.0 | - | - | - |
ID corrected | 6.0 | 1.9 | 3.2–11.0 | 0.4 * | 0.4 | 0.1–3.1 |
IDA | 0.6 | 0.4 | 0.1–2.3 | - | - | - |
IDA corrected | 0.6 | 0.4 | 0.1–2.3 | - | - | - |
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nik Shanita, S.; Siti Hanisa, A.; Noor Afifah, A.R.; Lee, S.T.; Chong, K.H.; George, P.; Norazida, A.B.; Budin, S.B.; Khouw, I.; Norimah, A.K.; et al. Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia. Int. J. Environ. Res. Public Health 2018, 15, 2332. https://doi.org/10.3390/ijerph15112332
Nik Shanita S, Siti Hanisa A, Noor Afifah AR, Lee ST, Chong KH, George P, Norazida AB, Budin SB, Khouw I, Norimah AK, et al. Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia. International Journal of Environmental Research and Public Health. 2018; 15(11):2332. https://doi.org/10.3390/ijerph15112332
Chicago/Turabian StyleNik Shanita, Safii, Awal Siti Hanisa, Ab Rahim Noor Afifah, Shoo Thien Lee, Kar Hau Chong, Penny George, Abu Bakar Norazida, Siti Balkis Budin, Ilse Khouw, A Karim Norimah, and et al. 2018. "Prevalence of Anaemia and Iron Deficiency among Primary Schoolchildren in Malaysia" International Journal of Environmental Research and Public Health 15, no. 11: 2332. https://doi.org/10.3390/ijerph15112332