Research Article: Childhood anemia and household salt iodization in Peru: population disparities among children aged 6–59?months
Abstract:
Childhood anemia remains a priority public health problem in Peru. Although universal salt iodization is an established strategy to prevent iodine deficiency disorders, evidence on household-level salt iodization and disparities in anemia remains limited.
To estimate anemia prevalence and evaluate disparities according to the adequacy of iodine content in household salt among girls and boys aged 6 to 59?months in Peru, as well as to explore variation according to area of residence and household wealth level.
Analytical cross-sectional study using data from the Peruvian Demographic and Family Health Survey (ENDES) 2014–2023. We included 110,561 children aged 6 to 59?months with valid hemoglobin measurement and a household salt iodine rapid test. Anemia was defined as altitude-adjusted hemoglobin <11.0?g/dL. The main exposure was inadequate household salt iodization (<15?ppm), compared with adequate iodization (?15?ppm). Weighted prevalences, absolute gaps, and crude and adjusted prevalence ratios (PRs) were estimated using Poisson regression for complex survey design, adjusting for age and sex.
The average weighted prevalence of anemia was 31.1% (95% CI: 30.7–31.6). Anemia was more frequent in households with inadequately iodized salt than in those with adequately iodized salt (35.73% vs. 30.49%). The absolute gap was 5.24 percentage points (95% CI: 3.7–6.7), and the crude PR was 1.17 (95% CI: 1.13–1.21). After adjustment for age and sex, the association remained (aPR?=?1.16; 95% CI: 1.12–1.20). Absolute differences varied by area of residence and wealth quintile; no statistical evidence of additive-scale interaction was observed with extreme poverty or rural residence. Including 2024 as a sensitivity analysis did not materially change the estimate.
Anemia was more frequent among children living in households with inadequately iodized salt. The findings support an interpretation centered on population disparities and nutritional vulnerability rather than on a direct causal relationship attributable to iodine in household salt.
Introduction:
Childhood anemia remains a priority public health problem in Peru. Although universal salt iodization is an established strategy to prevent iodine deficiency disorders, evidence on household-level salt iodization and disparities in anemia remains limited.
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