gms | German Medical Science

Research Question: In order to assess the prevalence of stunting and anemia, the choice of the most appropriate reference standards is key. Within the Andean population, being characterized by low average height, the use of WHO height percentiles in children older than 5 years may generate an overestimation of stunting. Moreover the use of the WHO recommended hemoglobin altitude correction factors may create an overestimation of anemia. The project presented served the threefold purpose of, firstly, exploring the health and nutritional status; secondly, providing basic medical care; and thirdly, investigating the impact of different reference standards for hemoglobin levels and anthropomorphic percentiles on the prevalence of anemia and stunting.

Method: A total of 417 children between 0–15 years were interviewed and medically examined in 19 rural Andean communities from October to November 2020. Medical examinations included the assessment of anthropomorphic measures (size, weight) and levels of hemoglobin and hematocrit using an onsite blood photometer. Children and parents were offered nutritional counselling and preventive anthelminthic therapy according to the obtained screening results. Prevalence of stunting using WHO recommended versus national reference standards were calculated. Anemia prevalence was calculated with and without WHO recommended hemoglobin altitude correction.

Results: A majority (248, 58.9%) of children identified themselves as indigenous and 141 (33.5%) as mestizo. Using WHO height percentile standards, the medium BMI was 17.4 kg/m² (± 2.4). 17.7% (n=74) of the children were by definition suffering from stunting. Using national percentiles this was reduced to 3.1% (n=13). Medium hemoglobin levels were 14.3 mg/dL (± 1.6 mg/dl) with seven children (1.7%) being anemic. After correcting hemoglobin values for altitude following WHO recommendations, the medium hemoglobin level was 12.1 mg/dL (± 1.6 mg/dl), with 25.1% (n=105) of children diagnosed as being anemic.

Discussion: The use of adapted standard references has a great impact on the estimated prevalence of stunting and anemia in children in the Andean region of Ecuador. Anemia prevalence after altitude correction of hemoglobin was much higher, in line with previous literature. Nearly all diagnoses of “stunting” were only reached when using international, not regionally validated growth percentiles. These findings highlight the need for further research to optimize correction factors and tentatively supports the use of the recently developed national adaptations of growth percentiles for Ecuadorian children aged 5–19 years in order to increase the effectiveness of health prevention programs.