The Association between Recent Infections and Anemia in Children: A Secondary Analysis of the Nepal Demographic and Health Survey

Background: Studies have reported transient decreases in hemoglobin levels during febrile illnesses, such as pneumonia. Nevertheless, the duration of the impact of common childhood infections on anemia assessment has not been fully elucidated. This study investigates the potential associations between recent episodes of fever, diarrhea, or acute respiratory infection (ARI) and anemia in children. Materials and Methods: A secondary analysis of the Nepal Demographic and Health Survey datasets was conducted. Parental reports of fever, diarrhea, or ARI within the 2 weeks preceding the survey were analyzed for children aged 6–59 months. Anemia was defined as a hemoglobin level of <11.0 g/dL. The prevalence of anemia and mean hemoglobin levels were compared among children with and without recent infections, stratified by age. The association between recent infections and anemia was assessed by multiple logistic regression. Results: Among the 6,483 children, the prevalence of anemia was 47%. Fever, diarrhea, and ARI occurred in 22%, 11%, and 11% of them, respectively. Children aged 6–11 months with recent fever had a higher prevalence of anemia. However, regarding anemia prevalence or mean hemoglobin levels, this trend was not observed in the other age groups. Multiple logistic regression analyses showed no significant associations between fever (odds ratio [OR], 1.10; 95% confidence interval [CI], 0.97–1.26, P-value = 0.13), diarrhea (OR, 0.94; 95% CI, 0.79–1.12, P-value = 0.50), or ARI (OR, 1.06; 95% CI, 0.86–1.30, P-value = 0.59) and anemia. Conclusion: Based on the findings of this study, fever, diarrhea, or ARI were not significantly associated with anemia during the two weeks prior to the survey, with the exception of fever in infants aged 6–11 months. These findings imply that the hemoglobin levels measured two weeks post-infection likely reflect the underlying anemia status rather than the transient infection-related effects.