Soluble transferrin receptor level, inflammation markers, malaria, alpha‐thalassemia and selenium status are the major predictors of hemoglobin in children 6–23 months in Malawi

In sub‐Saharan Africa, nearly three‐fourths of children 6–23 months are anemic. Yet, the underlying causes had not been sufficiently explored. This study, based on data (n = 348) extracted from the Malawi Micronutrient Survey–2015/2016 dataset, evaluated the contribution of multiple factors to the hemoglobin status of children 6–23 months. The association between hemoglobin and 19 predictors was assessed using multiple linear regression analysis, and the relative contribution of the covariates was determined based on delta‐R (2) value. The study found that 43.9% of children were anemic and 76.9% had elevated soluble transferrin receptor (sTfR) levels. Unit changes in serum ferritin (µg/L) and sTfR (mg/L) were associated with 0.01 g/dl rise (p = .041) and 0.05 g/dl decline (p < .001) in hemoglobin, respectively. Each 1 ng/ml increase in plasma selenium was met with 0.007 g/dl (p = .02) rise in hemoglobin. Hemoglobin showed negative relationships with α‐1‐acid glycoprotein (AGP) (β = −.339, p = .007) and C‐reactive protein (CRP) (β = −.014, p = .004) and positive association with child's age in months (β = .038, p = .003) and altitude in meters (β = .001, p = .015). Children affected by α‐thalassemia (β = −.75, p < .001), malaria (β = −.43, p = .029), and fever (β = −.39, p = .008) had significantly lower hemoglobin levels. On the contrary, nine variables including serum zinc and retinol binding protein were not significant predictors of hemoglobin. sTfR had the highest delta‐R (2) contribution (9.1%) to hemoglobin variations, followed by inflammation (5.2%), α‐thalassemia (2.5%), age (2.1%), fever (1.9%), and malaria (1.5%). The analysis suggested iron status, inflammation, and malaria were the major predictors of hemoglobin among Malawian infants and young children.