Frontiers in nutrition · 2026
Childhood anemia and household salt iodization in Peru: population disparities among children aged 6-59 months.
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Briceño-Chavez Jhofree Einstein, Portal-Valqui Lily Mabel, Yoplac-Oyarce Adriana Mishell, Bustamante-Rodríguez Juan Carlos, Ballena-Caicedo Jhosmer, Zuzunaga-Montoya Fiorella E, Vera-Ponce Víctor Juan
Аннотация
BACKGROUND: Childhood anemia remains a priority public health problem in Peru. Although universal salt iodization is an established strategy to prevent iodine deficiency disorders, evidence on household-level salt iodization and disparities in anemia remains limited.
OBJECTIVE: To estimate anemia prevalence and evaluate disparities according to the adequacy of iodine content in household salt among girls and boys aged 6 to 59 months in Peru, as well as to explore variation according to area of residence and household wealth level.
METHODS: Analytical cross-sectional study using data from the Peruvian Demographic and Family Health Survey (ENDES) 2014-2023. We included 110,561 children aged 6 to 59 months with valid hemoglobin measurement and a household salt iodine rapid test. Anemia was defined as altitude-adjusted hemoglobin <11.0 g/dL. The main exposure was inadequate household salt iodization (<15 ppm), compared with adequate iodization (≥15 ppm). Weighted prevalences, absolute gaps, and crude and adjusted prevalence ratios (PRs) were estimated using Poisson regression for complex survey design, adjusting for age and sex.
RESULTS: The average weighted prevalence of anemia was 31.1% (95% CI: 30.7-31.6). Anemia was more frequent in households with inadequately iodized salt than in those with adequately iodized salt (35.73% vs. 30.49%). The absolute gap was 5.24 percentage points (95% CI: 3.7-6.7), and the crude PR was 1.17 (95% CI: 1.13-1.21). After adjustment for age and sex, the association remained (aPR = 1.16; 95% CI: 1.12-1.20). Absolute differences varied by area of residence and wealth quintile; no statistical evidence of additive-scale interaction was observed with extreme poverty or rural residence. Including 2024 as a sensitivity analysis did not materially change the estimate.
CONCLUSION: Anemia was more frequent among children living in households with inadequately iodized salt. The findings support an interpretation centered on population disparities and nutritional vulnerability rather than on a direct causal relationship attributable to iodine in household salt.
OBJECTIVE: To estimate anemia prevalence and evaluate disparities according to the adequacy of iodine content in household salt among girls and boys aged 6 to 59 months in Peru, as well as to explore variation according to area of residence and household wealth level.
METHODS: Analytical cross-sectional study using data from the Peruvian Demographic and Family Health Survey (ENDES) 2014-2023. We included 110,561 children aged 6 to 59 months with valid hemoglobin measurement and a household salt iodine rapid test. Anemia was defined as altitude-adjusted hemoglobin <11.0 g/dL. The main exposure was inadequate household salt iodization (<15 ppm), compared with adequate iodization (≥15 ppm). Weighted prevalences, absolute gaps, and crude and adjusted prevalence ratios (PRs) were estimated using Poisson regression for complex survey design, adjusting for age and sex.
RESULTS: The average weighted prevalence of anemia was 31.1% (95% CI: 30.7-31.6). Anemia was more frequent in households with inadequately iodized salt than in those with adequately iodized salt (35.73% vs. 30.49%). The absolute gap was 5.24 percentage points (95% CI: 3.7-6.7), and the crude PR was 1.17 (95% CI: 1.13-1.21). After adjustment for age and sex, the association remained (aPR = 1.16; 95% CI: 1.12-1.20). Absolute differences varied by area of residence and wealth quintile; no statistical evidence of additive-scale interaction was observed with extreme poverty or rural residence. Including 2024 as a sensitivity analysis did not materially change the estimate.
CONCLUSION: Anemia was more frequent among children living in households with inadequately iodized salt. The findings support an interpretation centered on population disparities and nutritional vulnerability rather than on a direct causal relationship attributable to iodine in household salt.