Prevalence of anaemia and associated factors among infants under 6 months in rural China

Objective: To examine Hb level and anaemia status among infants under 6 months of age in rural China. Design: A cross-sectional survey collected data among infants under 6 months and their primary caregivers in Sichuan, China. Anaemia was defined using both the WHO and China Pediatrics Association thresholds. Multivariable linear regression was used to identify relevant factors among two age groups (<4 months; 4-5 months). Setting: Eighty townships were selected in Sichuan, China from November to December 2019. Participants: Nine hundred and forty-two infants under 6 months, while Hb level was tested for 577 infants. Results: The overall mean (+/- sd) Hb level was 106 center dot 03 (+/- 12 center dot 04) g/l. About 62 center dot 6 % (95 % CI 58 center dot 5, 66 center dot 6) of sample infants were anaemic using the WHO threshold, and 20 center dot 5 % (95 % CI 17 center dot 3, 24 center dot 1) were anaemic using the China Pediatrics Association thresholds. Anaemia rates rose with increasing age in months. Multivariable linear regressions revealed that lower Hb levels were significantly associated with lower birth weight (beta = 4 center dot 14, 95 % CI 0 center dot 19, 8 center dot 08; 4-5 months: beta = 6 center dot 60, 95 % CI 2 center dot 94, 10 center dot 27) and delivery by caesarean section (beta = -4 center dot 64, 95 % CI -7 center dot 79, -1 center dot 49; 4-5 months: beta = -4 center dot 58, 95 % CI -7 center dot 45, -1 center dot 71). Conclusion: A large share of infants under 6 months in rural western China are anaemic. Infants with low birth weight and caesarean delivered should be prioritised for anaemia testing. Future studies should move the point of focus forward to at least 4 months of age and examine the link between caesarean section and anaemia to promote health and development in infancy.