Abstract
Background
Anemia is common among children in Aboriginal communities in Canada. The objectives of this study were to determine the prevalence of anemia and to identify its associated risk factors among young children in Aboriginal communities in northern Ontario and Nunavut.
Methods
115 children from one Inuit and two Cree First Nations communities participated. We collected information on demographic and dietary factors and measured hemoglobin (Hb), ferritin (SF), serum transferrin receptor (sTfR) and Helicobacter pylori IgG antibodies. Odds ratios and 95% confidence intervals were determined to examine risk factors associated with anemia and iron deficiency (ID) and further analyzed using stepwise regression procedures.
Results
Prevalence of anemia (Hb<110 g/L) was 36.0%. Iron deficiency (sTfR>8.5 mg/L) was present in 27.6% of the study population. Approximately 53.3% had depleted iron stores (SF<12 Jg/L). Consumption of cow/evaporated milk was the only independent risk factor associated with anemia. Infection with H. pylori and prolonged consumption of breastmilk were also associated, although not independently, with anemia. Formula intake was negatively associated with ID.
Interpretation
The prevalence of anemia in Aboriginal children was eight times higher than among similar populations in urban Canada and was especially high among Inuit children. ID was the major cause of anemia, but not the only one, since 10% of anemic children were not iron deficient. Given that the consumption of cow/evaporated milk was found to be a significant independent risk factor associated with anemia, public health strategies should include promotion of breastfeeding, combined with iron-rich complementary foods, while addressing socio-economic conditions that may be preventing these practices from being adopted. H. pylori may be a major contributing factor to anemia, thus improvements in water quality and sanitation also need to be considered.
MeSH terms: Iron-deficiency anemia, Native Americans, Inupiats, risk factors
Résumé
Contexte
L’anémie est une affection courante touchant les enfants au sein des communautés autochtones du Canada. Cette étude visait à déterminer la prévalence de l’anémie et à cerner les facteurs de risque associés parmi les jeunes enfants des communautés autochtones du Nord de l’Ontario et du Nunavut.
Méthode
Cent quinze enfants d’une communauté inuite et de deux communautés des Premières nations cries ont participé. Des facteurs démographiques et diététiques ont été pris en compte, et les taux d’hémoglobine (Hb), de ferritine (FS), du récepteur soluble de la transferrine (Rs-TF) et des anticorps de type IgG dirigés contre Helicobacter pylori ont été mesurés. Des rapports de cotes (RC) et des intervalles de confiance à 95% ont été déterminés pour examiner les facteurs de risque associés à l’anémie et à la carence en fer, puis analysés plus en détail avec des méthodes de régression multiple pas-à-pas.
Résultats
La prévalence de l’anémie (Hb<110 g/L) était de 36,0%. La carence en fer (Rs-TF>8,5 mg/L) était présente dans 27,6% de la population étudiée. Le stock de fer était épuisé dans approximativement 53,3% des cas (FS<12 Jg/L). La consommation de lait de vache ou de lait concentré était le seul facteur de risque indépendant associé à l’anémie. Les infections à H. pylori et la consommation prolongée de lait maternel étaient également associées, bien que non indépendamment, à l’anémie. La prise de préparations lactées pour nourrisson était inversement associée à la carence en fer.
Interprétation
La prévalence de l’anémie était huit fois plus élevée chez les enfants autochtones que chez les populations similaires du Canada urbain, et elle était particulièrement élevée parmi les enfants inuits. La carence en fer était la principale cause d’anémie, mais pas la seule, puisque 10% des enfants anémiés n’avaient pas de carence en fer. étant donné que la consommation de lait de vache ou de lait concentré s’est avérée être un facteur de risque indépendant significatif associé à l’anémie, les stratégies de santé publique devraient inclure la promotion de l’allaitement maternel, combinée à une alimentation complémentaire riche en fer, tout en tenant compte des conditions socio-économiques qui peuvent empêcher l’adoption de ces pratiques. H. pylori apparaît comme un facteur important contribuant à l’anémie, ainsi des améliorations de la qualité de l’eau et de l’hygiène doivent également être prises en compte.
Footnotes
A correction to this article is available at 10.1007/BF03405192
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