# Prevalence and Predictors of Anemia and Iron Deficiency in Children Aged 6 to 12 Years in Tunisia: A Nationwide Cross-Sectional Study

## TL;DR

This study finds that iron deficiency is common in Tunisian children aged 6 to 12 and identifies dietary and socioeconomic factors as key contributors.

## Contribution

The study provides new insights into the prevalence and predictors of anemia and iron deficiency in a nationally representative sample of Tunisian children.

## Key findings

- Iron deficiency affects 25% of children, with 42% of anemic children also having iron deficiency anemia.
- Girls in rural areas are more likely to have iron deficiency than boys.
- Children in public schools are 1.74 times more likely to have iron deficiency than those in private schools.

## Abstract

Background: Anemia and iron deficiency (ID) affect children and are regarded as a major public health problem in developing countries. This study aimed to evaluate the prevalences of anemia and ID in Tunisian children aged 6 to 12 years and to identify their associated risk factors. Methods: A nationwide cross-sectional survey was conducted across the seven major regions of Tunisia. A total of 2610 schoolchildren were selected using a two-stage random sampling method. Venous blood was collected to measure hemoglobin and ferritin for iron status determination. C-reactive protein (CRP) and Alpha-1-acid glycoprotein (AGP) were also measured to establish the inflammatory status of children. Multivariable logistic regression models were performed to identify factors associated with anemia and ID. Results: Anemia affected 5.7% of children, similarly between girls and boys. A quarter of children had ID and iron deficiency anemia (IDA) was diagnosed in 42% of the anaemic schoolchildren. In rural areas, girls were more affected by ID than boys whereas no significant difference was observed for anemia between both genders. Multivariate analysis revealed that insufficient consumption of iron-rich foods significantly increased the risk of ID (OR = 1.40; 95% CI [1.05–1.85]; p = 0.021). Children in public schools were 1.74 times more likely to be at risk of ID (95% CI [1.34–2.21]; p = 0.004) than those in private schools. Conclusions: To alleviate the burden of ID, national interventions should focus on iron supplementation, food diversification, nutritional education and regular longitudinal studies.