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Biological and Community Health Determinants of Childhood Anemia: A Cross-Sectional Study in Primary Schools in Mosul, Iraq

Vol. 2 No. 2 (2025): Oktober:
DOI : https://doi.org/10.21070/ijhsm.v2i2.270
Published : Sep 28, 2025

Yousif Qasim Dawood (1)

(1) College of nursing University of Ninevah, Iraq
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Abstract:

Childhood anemia is a major global health issue, impairing growth, cognitive development, and immune function. Its prevalence is particularly concerning in post-conflict regions where healthcare infrastructure, nutrition, and sanitation are compromised. In Mosul, Iraq, years of conflict and displacement have heightened children’s vulnerability to nutritional deficiencies and infections, yet localized epidemiological data remain scarce. Limited evidence exists on the combined biological and community health determinants of anemia in Iraqi primary school children, restricting effective intervention planning. This study aimed to determine the prevalence of anemia among school-aged children in Mosul and identify its key biological and socio-environmental determinants. Results: A cross-sectional study of 850 children aged 6–12 years revealed an overall anemia prevalence of 42.5%, with mild anemia as the most common form (65.1%). Logistic regression analysis identified low maternal education (OR = 2.34, p < 0.001), low household income (OR = 2.16, p < 0.001), infrequent red meat intake (<2 times/week, OR = 2.80, p < 0.001), stunting (OR = 3.50, p < 0.001), and a history of parasitic infection (OR = 2.10, p = 0.003) as significant predictors. This is among the first large-scale studies in Mosul to integrate both biological and community-level determinants of anemia, reflecting the multifactorial nature of the condition in post-conflict settings. The findings underscore the urgent need for multisectoral interventions, including nutritional supplementation, deworming, health education, and sanitation improvements, to combat childhood anemia and improve long-term child health outcomes in Mosul.


Highlights:



  1. Childhood anemia prevalence in Mosul primary schools was 42.5%, classifying it as a severe public health problem.

  2. Key determinants included low maternal education, low household income, infrequent red meat consumption, stunting, and parasitic infections.

  3. Findings highlight the urgent need for multisectoral interventions combining nutrition, deworming, education, and sanitation improvements.

References

[1] A. Baldi and S.-R. Pasricha, "Anaemia: worldwide prevalence and progress in reduction," in Nutritional anemia: Springer, 2022, pp. 3-17.

[2] A. M. Williams et al., "Data needed to respond appropriately to anemia when it is a public health problem," Annals of the New York Academy of Sciences, vol. 1450, no. 1, pp. 268-280, 2019.

[3] O. Y. Addo et al., "Evaluation of hemoglobin cutoff levels to define anemia among healthy individuals," JAMA network open, vol. 4, no. 8, pp. e2119123-e2119123, 2021.

[4] L. Pivina, Y. Semenova, M. D. Doşa, M. Dauletyarova, and G. Bjørklund, "Iron deficiency, cognitive functions, and neurobehavioral disorders in children," Journal of molecular neuroscience, vol. 68, no. 1, pp. 1-10, 2019.

[5] P. A. M. Ntenda, K.-Y. Chuang, F. N. Tiruneh, and Y.-C. Chuang, "Multilevel analysis of the effects of individual-and community-level factors on childhood Anemia, severe Anemia, and hemoglobin concentration in Malawi," Journal of tropical pediatrics, vol. 64, no. 4, pp. 267-278, 2018.

[6] N. G. Onyeneho, B. C. Ozumba, and S. Subramanian, "Determinants of childhood anemia in India," Scientific reports, vol. 9, no. 1, p. 16540, 2019.

[7] R. M. M. Cotta et al., "Determinação social e biológica da anemia ferropriva," Cadernos de Saúde Pública, vol. 27, pp. s309-s320, 2011.

[8] P. S. Suchdev et al., "Overview of the biomarkers reflecting inflammation and nutritional determinants of anemia (BRINDA) project," Advances in Nutrition, vol. 7, no. 2, pp. 349-356, 2016.

[9] C. O. M. Rasheed, "Post-Conflict Urban Heritage Reconstruction: The Case of Historic Mosul, Iraq," Eastern Mediterranean University (EMU)-Doğu Akdeniz Üniversitesi (DAÜ), 2021.

[10] S. Goswmai and K. K. Das, "Socio‐economic and demographic determinants of childhood anemia," Jornal de Pediatria (Versão em Português), vol. 91, no. 5, pp. 471-477, 2015.

[11] V. Chandran and R. S. Kirby, "An analysis of maternal, social and household factors associated with childhood anemia," International journal of environmental research and public health, vol. 18, no. 6, p. 3105, 2021.

[12] F. Mesfin, Y. Berhane, and A. Worku, "Anemia among primary school children in Eastern Ethiopia," PloS one, vol. 10, no. 4, p. e0123615, 2015.

[13] Z. Getaneh et al., "Prevalence of anemia and associated factors among school children in Gondar town public primary schools, northwest Ethiopia: A school-based cross-sectional study," PloS one, vol. 12, no. 12, p. e0190151, 2017.

[14] N. D. Takhelchangbam, D. Saxena, N. P. Singh, and A. Singh, "Epidemiology of double burden of malnutrition: causes and consequences," Preventive Medicine: Research & Reviews, vol. 1, no. 6, pp. 305-309, 2024.

[15] A. Z. Orsango, E. Loha, B. Lindtjørn, and I. M. S. Engebretsen, "Co-morbid anaemia and stunting among children 2–5 years old in southern Ethiopia: a community-based cross-sectional study," BMJ Paediatrics Open, vol. 5, no. 1, p. e001039, 2021.

[16] S. A. Al-Haidari et al., "Intestinal schistosomiasis among schoolchildren in Sana’a Governorate, Yemen: Prevalence, associated factors and its effect on nutritional status and anemia," PLoS Neglected Tropical Diseases, vol. 15, no. 9, p. e0009757, 2021.

[17] S. H. Mohammed, B. Larijani, and A. Esmaillzadeh, "Concurrent anemia and stunting in young children: prevalence, dietary and non-dietary associated factors," Nutrition journal, vol. 18, no. 1, p. 10, 2019.

[18] G. Moshe et al., "Anemia and iron deficiency in children: association with red meat and poultry consumption," Journal of pediatric gastroenterology and nutrition, vol. 57, no. 6, pp. 722-727, 2013.

[19] D. Skolmowska and D. Głąbska, "Analysis of heme and non-heme iron intake and iron dietary sources in adolescent menstruating females in a national polish sample," Nutrients, vol. 11, no. 5, p. 1049, 2019.

[20] J. Kim et al., "Relationship between socioeconomic status and anemia prevalence in adolescent girls based on the fourth and fifth Korea National Health and Nutrition Examination Surveys," European journal of clinical nutrition, vol. 68, no. 2, pp. 253-258, 2014.

[21] H. Helliyana, E. Y. Aritonang, and S. R. Sanusi, "The associations between maternal education, chronic energy deficit, and anemia in pregnant women: an evidence from Lhokseumawe, Indonesia," Journal of Maternal and Child Health, vol. 4, no. 5, pp. 302-306, 2019.

[22] A. Bolka and S. Gebremedhin, "Prevalence of intestinal parasitic infection and its association with anemia among pregnant women in Wondo Genet district, Southern Ethiopia: a cross-sectional study," BMC infectious diseases, vol. 19, no. 1, p. 483, 2019.