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. 2024 Feb 28;19(2):e0298967.
doi: 10.1371/journal.pone.0298967. eCollection 2024.

Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys

Rukundo K Benedict  1 , Thomas W Pullum  1 , Sara Riese  1 , Erin Milner  2
Affiliations

Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys

Rukundo K Benedict et al. PLoS One. .

Abstract

Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of five years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy-numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36-59 months. Nine Demographic and Health Surveys (DHS) from phase VII of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age five years were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social-emotional development in Benin (AOR = 1.00 p < 0.05) and physical development in Maldives (AORs = 0.97 p < 0.05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: RKB, TWP, and SR received funding support for this work from United States Agency for International Development (USAID) and RKB received publication support from the Bill and Melinda Gates Foundation. EM is employed through the USAID funded Sustaining Technical and Analytical Resources (STAR) mechanisms and is employed by one of the implementers, The Public Health Institute. The opinions herein are those of the authors and do not necessarily reflect the views of the USAID or the U.S. Government, or the Public Health Institute. Further, this does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Conceptual framework of the relationship between anemia status and early childhood development.
Thicker arrow shows pathway that was not directly assessed as brain development data (dashed box) was not available in the datasets. Other arrows and boxes show the pathways and relationships examined in the analyses.
Fig 2
Fig 2. Percentage of children age 36–59 months with anemia by severity.
Fig 3
Fig 3. Percentage of children age 36–59 months developmentally on-track by country.
Fig 4
Fig 4. Percentage of children age 36–59 months on-track for the physical, social-emotional, learning, and literacy-numeracy ECDI domains by country.
See this image and copyright information in PMC

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