Prolonged Undernutrition and the Risk of Anemia in Indonesian Children

Background: Various studies have reported the coexistence of undernutrition and anemia. This study aims to determine the correlation between prolonged undernutrition and the occurrence of anemia in Indonesian children. Methods: This retrospective cohort study examined 2296 under-five children in the 2007 Indonesian Family Life Survey (IFLS) and its follow-up in 2014 to observe the association between children's prolonged undernutrition (stunted and wasted) and anemia status. Results: Children who had prolonged wasting had increased risk of remaining anemic (relative risk (RR): 2.02, 95 % CI 1.00-4.08) but after adjustment for the confounding variables, the association was less clear (adjusted RR (aRR): 3.02, 95 % CI 0.82-11.12. p = 0.097). Meanwhile, children who had prolonged stunting from 2007 to 2014 had 2.80 times greater risk of remaining anemic compared to children who were normal (RR: 1.47, 95 % CI 1.05-2.06), but the relationship between prolonged stunting and anemia becomes no longer significant after adjustment for potential confounding variables (aRR: 1.78, 95 % CI 0.78-4.10). Nevertheless, prolonged stunting was a predictor of anemia risk in children with lower meat consumption (aRR: 2.44, 95 % CI 1.42-4.19). Conclusion: Chronic undernutrition, i.e., stunting, in children is closely associated with anemia. Public health interventions and approaches with combined effects can be effective in preventing undernutrition and anemia in both children and adolescents.