Anemia and its Association with Dietary Intake and Infant and Young Child Feeding practices: A Cross-Sectional Study Amongst 0-2-years-old Syrian Refugee Children in Lebanon

Abstract

High levels of pediatric anemia are reported in the Eastern Mediterranean Region. This is particularly true for infants and young children below two years of age, given their increased nutritional requirements and rapid growth rates. Displaced populations such as Syrian refugees are more prone to develop anemia and other nutritional deficiencies, given the high rates of infections in these populations, coupled with poor dietary intake, lack of proper hygiene practices as well as overall compromised nutritional status. No studies have investigated the possible determinants of anemia among Syrian refugee children in Lebanon. Hence, this study aims to assess the prevalence of anemia amongst Syrian refugee children aged 0-2 years old living in the Greater Beirut area and to investigate the association of anemia with feeding practices, dietary intakes and anthropometric characteristics. This is a cross-sectional study that was conducted in the Greater Beirut area among 0-2-year-old Syrian refugee children (n=255). Mothers were recruited from randomly selected primary health care centers in the most vulnerable areas of Greater Beirut according to the highest vulnerability level of localities. A multicomponent questionnaire was used for data collection, inquiring about socio-demographic characteristics and infant and young child feeding practices. Dietary intakes were assessed based on a single 24-hour recall. Anthropometric measurements of the children and infants were obtained using standardized protocols. Children Hemoglobin levels were measured using a small blood drop from the finger in children aged 6 months and above, and from the heel among infants aged below 6 months. The prevalence of anemia in our sample was estimated at 35.3%, with no cases of severe anemia being identified. Children between the age of 6 to 11 months had the highest rates of anemia (50.7%) and regression analyses showed that children aged 6 to 11 months were four times (OR: 4.53, 95% CI: 2.12- 9.72) more likely to be anemic compared to children below 6 months of age. In addition, children aged between 12 to 23 months were twice (OR: 2.39, 95% CI: 1.17- 4.90) as likely to be anemic compared to infants aged below 6 months. Inadequate iron intake was associated with approximately three-fold higher odds (OR=3.55; 95% CI: 1.96-6.43) of anemia compared to those that had adequate iron intake. No significant associations were identified between anemia status and the intake of other hematinic micronutrients such as folate, vitamin A, vitamin C, vitamin B12, or Zinc. As for anthropometric indicators, the prevalence of stunting in the study sample was the highest amongst 12 to 23 months old children (13.4%), compared to younger children (2.3% in those aged less than 6 months and 2.9% in those aged between 6 and 11 months), with a significant difference between groups based on anemia status. Stunted children had a significantly higher odds of being anemic compared to those with normal height for age (OR=3.08; 95% CI: 0.94, 10.07). The prevalence of underweight and wasting was low (3.9% and 6.7% respectively) and these indicators were not associated with anemia. The rates of exclusive breastfeeding were low (21.6%) and the proportion of children meeting the minimum dietary diversity did not exceed 30%. No significant associations were observed between exclusive breastfeeding, complementary feeding indicators, and anemia. However, children who were breastfed within one hour of birth were found to be at a significantly higher risk of being anemic (OR: 1.87 95% CI: 1.06 – 3.31). This study provided new data regarding the prevalence of anemia in Syrian refugee children aged less than 2 years, a highly vulnerable population group. The study has also investigated the association of anemia with dietary intake, and nutritional status, shedding light on anemia determinants that can be potentially tackled by future interventions. Taken together, the study findings highlight the need for cost-effective, feasible, and culture-specific interventions aimed at enhancing the nutritional status of Syrian refugee infants and young children, optimizing their dietary intakes, and improving infant and young child feeding practices in this displaced population.