Recurrence of iron-deficiency anemia in Peruvian Andean children aged 12 to 35 months living in poverty: the role of ferrous sulfate supplementation and associated factors

Introduction : There are few studies on the factors that cause iron-deficiency anemia (IDA) recurrence in Andean children living in income poverty. Objective : This study aimed to identify risk factors related to health determinants for anemia recurrence in Peruvian Andean children aged 12 to 35 months. Methodology : The mothers of 189 children (63 cases of recurrence of anemia) in the Sánchez Carrión Province in the northern highlands of Peru were evaluated with a 40-question survey of health determinants (Cronbach’s alpha = 0.70). Results : The cases (recurrence) and controls (no recurrence) were comparable according to sex, age, residence altitude, and poverty level. Of 18 factors analyzed by bivariate analysis and binary logistic regression, six risk factors for recurrence were identified: malnutrition OR = 4.89, 95% CI 1.727–13.828; negligent care OR = 3.33, 95% CI 1.229–9.004; poor hygiene habits OR = 5.50, 95% CI 2.165–13.972; overcrowding OR = 3.16, 95% CI 1.125–8.869; inaccessibility of ferrous sulfate OR = 7.18, 95% CI 2.253–22.903; and child rejection of ferrous sulfate OR = 14.65, 95% CI 5.056–42.419. Conclusions : This study identified complex physiological and socioeconomic determinants associated with IDA relapse. Effective IDA reduction strategies require context-specific comprehensive approaches that integrate culturally relevant education, improve living conditions, provide access to palatable iron-rich foods, and increase iron supplementation availability and adherence.