Factors associated with anemia and micronutrient deficiencies in children from Guatemala and Haiti

Anemia affects >2 billion people worldwide and is negatively associated with child development and academic performance. The purpose of this dissertation was to identify variables associated with anemia in children from Guatemala and Haiti. Generalized linear mixed models were used to identify significant associations with anemia (dependent variable) and maternal, child and household variables utilizing a cross-sectional design. For the Guatemala study, serum biomarkers (soluble transferrin receptor, ferritin, zinc, folate, vitamin B12, C-reactive protein, and α1-acid glycoprotein) were explored. For the Haiti study, a mediation analysis was constructed to understand the relationship between rural or urban residence and anemia. In Guatemala, 56% of children ages 6-24 months had anemia. For this age group, anemia was inversely associated with higher numbers of adults living in the household [OR=0.69; 95% CI (0.53-0.90)], and zinc deficiency increased the odds of anemia [OR=3.40; 95% CI (1.54-7.47)]. Conversely, only 12.1% of children ages 36-60 months had anemia, which was inversely associated with age [OR=0.90; 95%CI (0.81-1.00)]. In Haiti, 52.3% of children from rural areas had anemia, and stunting increased the odds of anemia [OR=3.42; 95%CI (1.47-7.97)], while children in households with more adults had lower odds, [OR=0.74; 95%CI (0.62-0.89)]. Among urban children, anemia prevalence was 75.4% and helminth morbidities increased the odds of anemia [OR=1.74; 95%CI (1.13-2.68)]. Age was inversely associated in both rural and urban children, [OR=0.88; 95%CI (0.81-0.96)] and [OR=0.93; 95%CI (0.88-1.00)], respectively. Only helminth morbidities partially mediated the relationship between anemia and place of residence (b=0.10, SE=0.05, P=0.037). In conclusion, zinc deficiency was associated with anemia in young Guatemalan children, highlighting the need of continued multidisciplinary interventions with multiple micronutrients. In Haitian school-aged children, anemia continues to be a severe public health problem. Key differences between urban and rural children were identified that should be considered when developing cost-effective interventions to improve nutritional and health status of this population, especially deworming measures in children residing in urban areas. Further research examining how household composition, feeding practices, accessibility to micronutrient supplements, and decreasing intestinal morbidity is needed to develop effective interventions seeking to improve the nutritional status of children in Guatemala and Haiti.