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Rural and urban disparities in anemia among Peruvian children aged 6-59 months: a multivariate decomposition and
Ali Al-Kassab-Córdova1, Carolina Mendez-Guerra2, Andrés Quevedo-Ramirez3
1Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú aliac1998@gmail.com.
Insights
Anemia remains a significant public health concern in Peru, particularly in rural areas. Key factors like wealth, mother's education, and employment explain most of the urban-rural anemia gap in children.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Anemia is a global health issue affecting young children.
- Despite reductions, anemia persists in Peru, with higher rates in rural areas.
- The urban-rural disparity in childhood anemia determinants requires investigation.
Purpose of the Study:
- To evaluate determinants of the urban-rural anemia prevalence gap in Peruvian children (6-59 months).
- To analyze the spatial distribution of childhood anemia in Peru.
Main Methods:
- Secondary data analysis of the 2019 Peruvian Demographic Health Survey (18,846 children).
- Multivariate decomposition analysis to identify factors contributing to the urban-rural anemia gap.
- Spatial analysis including Global Moran’s I, Ordinary Kriging, and SaTScan.
Main Results:
- National anemia prevalence was 29.47%; rural areas (38.25%) significantly higher than urban (26.39%).
- 88.61% of the urban-rural anemia gap is explained by differences in respondent characteristics.
- Wealth index, mother's education, employment, number of children, and mother's age were key determinants.
- Significant spatial heterogeneity and six high-prevalence anemia clusters identified.
Conclusions:
- A substantial anemia prevalence gap exists between urban and rural children in Peru.
- Targeted interventions are crucial to address geographic disparities in childhood anemia.
Introduction:
Anemia is a global public health issue that affects mainly children aged less than 5 years. In Peru, despite the reduction in the prevalence of anemia between 2010 and 2018, anemia remains a major concern, especially in high-risk zones such as rural areas. Several sociodemographic factors have been associated with anemia in children; however, components contributing to the urban-rural gap have not been previously assessed. The purpose of this study was to evaluate the determinants of the difference in anemia prevalence between urban and rural areas, and its spatial distribution in Peruvian children aged 6-59 months.
Methods:
A secondary data analysis was conducted using the 2019 Peruvian Demographic Health Survey. The study population included 18 846 children aged 6-59 months. A multivariate decomposition analysis for non-linear response model was performed to identify the factors contributing to the gap in the prevalence of anemia across urban and rural areas. Global Moran´s I autocorrelation, Ordinary Kriging interpolation and Bernoulli-based purely spatial scan statistics were employed to assess the spatial pattern of anemia.
Results:
Nationwide, the prevalence of anemia in Peru was 29.47% (95%CI 28.63-30.33). In rural areas, it was 38.25%, and in urban areas 26.39%. The decomposition analysis revealed that 88.61% of the difference in the prevalence of anemia between urban and rural areas was attributed to the difference in the respondents' characteristics. Wealth index, mother´s education, mother´s employment status, number of living children and mother´s age were key determinants contributing to the rural-urban gap. Spatial heterogeneity of anemia prevalence in childhood was observed at both inter- and intradepartmental level. The SaTScan spatial analysis identified six significant cluster areas with high prevalence of anemia in childhood.
Conclusion:
A considerable gap of anemia prevalence between urban and rural areas was found. Targeted interventions are necessary to reduce geographic disparities.
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