Anemia—a medical condition associated with an insufficient number of red blood cells or their capacity to transport oxygen to the blood—affects millions of children worldwide and can weaken a child’s immune system. In Peru, it is estimated that 404,938 out of 600,000 newborns will be diagnosed with pediatric anemia during their first year of life. Peru’s National Institute of Health suggest that research is needed to better understand what factors contribute to this occurrence. 

Public health experts with the University of Miami Miller School of Medicine, University of California San Francisco, and Catholic University of Santa Maria in Peru, led a Frontiers study to assess the pediatric anemia care experience of mothers from Arequipa, Peru. They interviewed 14 mothers in Arequipa to understand their perspective on pediatric anemia, as well as to understand how they perceive its prevention and treatment measures.

“Despite governmental efforts, pediatric anemia rates have not decreased in Peru over the last five years,” said study lead author Paola Louzado-Feliciano, M.S., research associate in the Miller School’s Department of Public Health Sciences. “As mothers are usually the primary child caregivers in Peru, it was imperative to conceptualize their understanding of pediatric anemia and learn about their preferred methods to combat this health problem.”

In low- and middle-income countries like Peru, anemia in children can be influenced by environmental factors, community, household factors, and individual’s health and nutritional level.

“Designing impactful public interventions to address pediatric anemia in low resource settings requires a deep understanding of the determinants and root causes of anemia,” said study senior author Dr. Alberto Caban-Martinez, D.O., Ph.D., M.P.H., associate professor in the Miller School’s Department of Public Health Sciences. “Ms. Louzado Feliciano’s scientific contribution sheds critical insight into material perceptions of pediatric anemia.”

Controlling pediatric anemia—as stated in the study—is a top priority for Peru’s Ministry of Health and Ministry of Development and Social Inclusion. These entities have collaborated with regional government health departments, community health workers, and health care practitioners to prevent and control the condition among this population. Still, data published by Peru’s National Institute of Computing and Statistics suggest that prevalence rates of the condition are stagnant.

Between May 2018 to June 2018, co-authors of the Frontiers study administered a short demographic questionnaire and conducted language-sensitive interviews with mothers of children who were clinically diagnosed with anemia in three different governmental health centers in Arequipa.

Besides iron deficiency, co-authors of the study investigated what other factors might be contributing to the ongoing pediatric anemia. Assessment survey focus on parental understandings, cultural traditional, and social representations might affect health care preventive or treatment intervention adherence.  

Through these questions, the Peruvian mothers expressed their understanding of pediatric anemia, their attitudes about provider recommendations for pediatric anemia control, and perceived barriers to effective control of the condition.

As an example, mothers specifically expressed that anemia is a consequence of malnourishment and tended to not define anemia as a medical condition. Their preferred method for anemia prevention and treatment was consequently following a well-balanced diet with a high consumption of iron-rich foods. The study suggests that the lack of understanding can be one of the reasons why the mothers demonstrated an adverse attitude towards utilizing other prevention measures that have shown to be effective. Generally, mothers had preconceived notions of these measures—believing that they caused more harm than good. 

Mothers also expressed doubt toward national pediatric anemia guidelines, as they believed recommendations received at health clinics jeopardized their children’s overall health. Therefore, barriers to effective anemia control expressed by the mothers included limited and confusing health information received during pediatric healthcare appointments, lack of systematic protocols in health clinics, and inconsistent referral processes.

“Our research illustrates how mothers of anemic children conceptualize and manage anemia which plays a vital role in the compliance of treatment measures (e.g., iron drops) recommended by health providers in Arequipa, Peru,” said Louzado-Feliciano. “Disseminating our study’s findings to Peru’s Ministry of Health, Peru’s Public Health Department, governmental health centers providers, and policymakers is of high importance.”

This study provides evidence on maternal perceived barriers to the use of current anemia prevention and treatment measurers available for their children. The information can guide health care providers in Peru on how to fill gaps for proper pediatric anemia treatment and prevention. 

Authors note that future research should focus on collecting data from different jurisdictions throughout Peru, including both public and private health centers—as suggested in the study. This will in turn help to better conceptualize clinical practice and policy guidelines utilized during pediatric anemia cases. 

Co-authors of the study also included University of California at San Francisco’s Brianna Vargas, M.S., Madhavi Dandu, M.D., Shannon Fuller, M.S., Holly M. Martin, M.D., and Nicole Santos, Ph.D., M.S., as well as Catholic University of Santa Maria’s Ángela Quiñones, M.D.

Written by Amanda Torres

Published on December 9, 2020