{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:42:53Z","timestamp":1791996173870,"version":"4.4.0"},"reference-count":100,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:00:00Z","timestamp":1750723200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["GHTM-UID\/04413\/2020"],"award-info":[{"award-number":["GHTM-UID\/04413\/2020"]}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["UI\/BD\/151065\/2021"],"award-info":[{"award-number":["UI\/BD\/151065\/2021"]}]},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","award":["LA\/P\/0117\/2020"],"award-info":[{"award-number":["LA\/P\/0117\/2020"]}]},{"name":"LA-REAL","award":["GHTM-UID\/04413\/2020"],"award-info":[{"award-number":["GHTM-UID\/04413\/2020"]}]},{"name":"LA-REAL","award":["UI\/BD\/151065\/2021"],"award-info":[{"award-number":["UI\/BD\/151065\/2021"]}]},{"name":"LA-REAL","award":["LA\/P\/0117\/2020"],"award-info":[{"award-number":["LA\/P\/0117\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Childhood anemia remains a serious public health issue, negatively affecting cognitive and psychomotor development, with repercussions on school performance and adult productivity. This study aimed to characterize the profile of children aged 6 months to 5 years diagnosed with or at risk of anemia who attended a pediatric hospital in Lisbon, Portugal. Methods: A hospital-based, cross-sectional descriptive study was conducted from September 2023 to September 2024. Descriptive statistics, including frequency distributions and cross-tabulations, summarized participant characteristics and key variables. Results: We observed that 33.3% (74\/222) of the children were either anemic or at risk of anemia. Among these, 93.2% (69\/74) were confirmed anemic or at risk based on hemoglobin levels. Five children (6.8%) had normal hemoglobin but abnormal red-cell indices, with microcytic (60.0%; 3\/5) or normocytic (40.0%; 2\/5) patterns. Anemia rates were higher in males (55.1%), children aged 24\u201359 months, those residing in the Metropolitan Lisbon Area (82.6%), children whose caregivers had only basic or secondary education (58.0%), and those whose mothers were born in foreign countries (48.4%). Microcytic red-cell indices were observed in 63.1% of cases. Serum iron results indicated that 32.0% were pre-anemic and 40.0% anemic. Ferritin levels showed iron-deficiency anemia in 22.2% of tested cases. In addition, 33.3% carried the sickle cell trait, and 35.0% had elevated C-reactive protein, suggesting anemia of inflammation. Conclusions: Anemia is a moderate public health issue, mainly affecting children with less-educated caregivers and migrant mothers. Targeted public health actions, including systematic screening, caregiver education, and multiculturally sensitive interventions, are crucial to address anemia.<\/jats:p>","DOI":"10.3390\/children12070832","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T10:43:15Z","timestamp":1750761795000},"page":"832","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Characteristics of Anemia in Children Aged 6 Months to 5 Years Attending External Consultations at a Pediatric Hospital in Lisbon, Portugal"],"prefix":"10.3390","volume":"12","author":[{"given":"R\u00e9ka","family":"Maulide Cane","sequence":"first","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, INS, Minist\u00e9rio da Sa\u00fade, MISAU, Estrada Nacional EN1, Bairro da Vila\u2014Parcela no 3943, Distrito de Marracuene, Marracuene 264, Prov\u00edncia de Maputo, Mozambique"},{"name":"Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2498-9373","authenticated-orcid":false,"given":"S\u00e9rgio","family":"Chicumbe","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Sa\u00fade, INS, Minist\u00e9rio da Sa\u00fade, MISAU, Estrada Nacional EN1, Bairro da Vila\u2014Parcela no 3943, Distrito de Marracuene, Marracuene 264, Prov\u00edncia de Maputo, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssouf","family":"Keita","sequence":"additional","affiliation":[{"name":"World Bank, Global Financings Facility, Bamako, Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anaxore","family":"Casimiro","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal"},{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"},{"name":"NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Nova de Lisboa, Campo M\u00e1rtires da P\u00e1tria 130, 1169-056 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00e1rbara Martins","family":"Saraiva","sequence":"additional","affiliation":[{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Vasconcelos","sequence":"additional","affiliation":[{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9452-327X","authenticated-orcid":false,"given":"Beatriz Luzio","family":"Vaz","sequence":"additional","affiliation":[{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1338-423X","authenticated-orcid":false,"given":"Afonso","family":"Sousa","sequence":"additional","affiliation":[{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3415-6487","authenticated-orcid":false,"given":"Mafalda","family":"Cabral","sequence":"additional","affiliation":[{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Branco","family":"Caetano","sequence":"additional","affiliation":[{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8419-6033","authenticated-orcid":false,"given":"Lu\u00eds","family":"Varandas","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, Portugal"},{"name":"Hospital Dona Estef\u00e2nia, Unidade Local de Sa\u00fade S\u00e3o Jos\u00e9, 1169-045 Lisbon, Portugal"},{"name":"NOVA Medical School, Faculdade de Ci\u00eancias M\u00e9dicas, Universidade Nova de Lisboa, Campo M\u00e1rtires da P\u00e1tria 130, 1169-056 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4348-1986","authenticated-orcid":false,"given":"Isabel","family":"Craveiro","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisbon, 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Pediatr. Health"},{"key":"ref_3","unstructured":"World Health Organization (2025, January 30). Anaemia. World Health Organization. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/anaemia."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"402","DOI":"10.5603\/AHP.2021.0075","article-title":"Anemia in children: A pediatrician\u2019s view","volume":"52","author":"Matysiak","year":"2021","journal-title":"Acta Haematol. Pol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1159\/000505071","article-title":"Portuguese Consensus on Diagnosis, Treatment, and Management of Anemia in Pediatric Inflammatory Bowel Disease","volume":"27","author":"Lopes","year":"2020","journal-title":"GE Port. J. Gastroenterol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12199-020-00931-z","article-title":"Anemia as a risk factor for tuberculosis: A systematic review and meta-analysis","volume":"26","author":"Gelaw","year":"2021","journal-title":"Environ. Health Prev. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e13806","DOI":"10.1111\/mcn.13806","article-title":"Predictors of Anaemia Among Young Children Receiving Daily Micronutrient Powders (MNPs) for 24 Weeks in Bangladesh: A Secondary Analysis of the Zinc in Powders Trial","volume":"21","author":"Thompson","year":"2025","journal-title":"Matern. Child Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e253","DOI":"10.1016\/S2352-3026(24)00030-9","article-title":"Haemoglobin thresholds to define anaemia from age 6 months to 65 years: Estimates from international data sources","volume":"11","author":"Braat","year":"2024","journal-title":"Lancet Haematol."},{"key":"ref_9","unstructured":"King, F.S., Burgess, A., Quinn, V.J., and Osei, A.J. (2015). Nutrition for Developing Countries, Oxford University Press. [3rd ed.]."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Qiu, Y., Long, Z., and Long, Z. (2025). Epidemiology of dietary iron deficiency in China from 1990 to 2021: Findings from the global burden of disease study 2021. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-21665-z"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1111\/nyas.14092","article-title":"Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries","volume":"1450","author":"Chaparro","year":"2019","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.1016\/j.tjnut.2023.07.018","article-title":"Biology of Anemia: A Public Health Perspective","volume":"153","author":"Brittenham","year":"2023","journal-title":"J. Nutr."},{"key":"ref_13","unstructured":"USAID Advancing Nutrition (2025, April 02). Understanding Anemia and Its Coexisting Factors: A Brief. USAID, Available online: https:\/\/www.usaid.gov\/."},{"key":"ref_14","first-page":"e75862","article-title":"Intestinal Parasitic Infections in Children: A 10-Year Retrospective Study","volume":"16","author":"Martins","year":"2024","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4081\/jphia.2020.1131","article-title":"Socioeconomic factors associated with anemia among children aged 6-59 months in Namibia","volume":"11","author":"Shimanda","year":"2020","journal-title":"J. Public Health Afr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s13052-018-0547-0","article-title":"Anemia severity among children aged 6\u201359 months in Gondar town, Ethiopia: A community-based cross-sectional study","volume":"44","author":"Melku","year":"2018","journal-title":"Ital. J. Pediatr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e182899","DOI":"10.1001\/jamanetworkopen.2018.2899","article-title":"Trends in Socioeconomic Inequalities and Prevalence of Anemia Among Children and Nonpregnant Women in Low- and Middle-Income Countries","volume":"1","author":"Yang","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1186\/s12939-024-02315-z","article-title":"Trends and inequalities in anaemia prevalence among children aged 6\u201359 months in Ghana, 2003\u20132022","volume":"23","author":"Osborne","year":"2024","journal-title":"Int. J. Equity Health"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhao, B., Sun, M., Wu, T., Li, J., Shi, H., and Wei, Y. (2024). The association between maternal anemia and neonatal anemia: A systematic review and meta-analysis. BMC Pregnancy Childbirth, 24.","DOI":"10.1186\/s12884-024-06832-1"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Chandran, V., and Kirby, R.S. (2021). An Analysis of Maternal, Social and Household Factors Associated with Childhood Anemia. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18063105"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sowe, A., Wood, E., and Gautam, S.K. (2025). Maternal Anemia as a Predictor of Childhood Anemia: Evidence from Gambian Health Data. Nutrients, 17.","DOI":"10.3390\/nu17050879"},{"key":"ref_22","unstructured":"World Health Organization (2025, April 02). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-NMH-NHD-MNM-11.1."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Williams, A.M., Ansai, N., Ahluwalia, N., and Nguyen, D.T. (2025, April 02). Anemia Prevalence: United States, August 2021\u2013August 2023 (NCHS Data Brief No. 519). National Center for Health Statistics, Available online: https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db519.htm.","DOI":"10.15620\/cdc\/168890"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"339","DOI":"10.2174\/1573396320666230727102042","article-title":"Iron Deficiency Anemia: An Updated Review","volume":"20","author":"Leung","year":"2024","journal-title":"Curr. Pediatr. Rev."},{"key":"ref_25","first-page":"1462","article-title":"Evaluation of anemia in children","volume":"81","author":"Janus","year":"2010","journal-title":"Am. Fam. Physician"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/156482650702800109","article-title":"Risk Factors for Moderate to Severe Anemia among Children in Benin and Mali: Insights from a Multilevel Analysis","volume":"28","author":"Receveur","year":"2007","journal-title":"Food Nutr. Bull."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Benedict, R.K., Pullum, T.W., Riese, S., Milner, E., and Navaneetham, K. (2024). Is child anemia associated with early childhood development? A cross-sectional analysis of nine Demographic and Health Surveys. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0298967"},{"key":"ref_28","unstructured":"Maner, B.S., Killeen, R.B., and Moosavi, L. (2025, April 05). Mean corpuscular volume, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK545275\/."},{"key":"ref_29","unstructured":"Turner, J., Parsi, M., and Badireddy, M. (2025, April 05). Anemia, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK499994\/."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Yeboah, F.A., Bioh, J., Amoani, B., Effah, A., Senu, E., Mensah, O.S.O., Agyei, A., Kwarteng, S., Agomuo, S.K.S., and Opoku, S. (2024). Iron deficiency anemia and its association with cognitive function among adolescents in the Ashanti Region\u2014Ghana. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-20640-4"},{"key":"ref_31","first-page":"1379","article-title":"Anemia in children","volume":"64","author":"Irwin","year":"2001","journal-title":"Am. Fam. Physician"},{"key":"ref_32","unstructured":"Chaudhry, H.S., and Kasarla, M.R. (2025, April 29). Microcytic hypochromic anemia, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK470252\/."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"54","DOI":"10.11604\/pamj.2018.31.54.15498","article-title":"Evaluation of children with macrocytosis: Clinical study","volume":"31","author":"Sarbay","year":"2018","journal-title":"Pan Afr. Med. J."},{"key":"ref_34","unstructured":"Yilmaz, G., and Shaikh, H. (2025, April 29). Normochromic normocytic anemia, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK565880\/."},{"key":"ref_35","unstructured":"Moore, C.A., Killeen, R.B., and Adil, A. (2025, April 29). Macrocytic anemia, StatPearls, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459295\/."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e713","DOI":"10.1016\/S2352-3026(23)00160-6","article-title":"Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990\u20132021: Findings from the Global Burden of Disease Study 2021","volume":"10","author":"Gardner","year":"2023","journal-title":"Lancet Haematol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e627","DOI":"10.1016\/S2214-109X(22)00084-5","article-title":"National, regional, and global estimates of anaemia by severity in women and children for 2000\u20132019: A pooled analysis of population-representative data","volume":"10","author":"Stevens","year":"2022","journal-title":"Lancet Glob. Health"},{"key":"ref_38","unstructured":"World Health Organization (2025, March 12). Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. WHO\/NMH\/NHD\/MNM\/11.1. Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/177094\/9789241564960_eng.pdf."},{"key":"ref_39","first-page":"1048283","article-title":"Screening for Anemia and Iron Deficiency in the Adult Portuguese Population","volume":"2020","author":"Nunes","year":"2020","journal-title":"Anemia"},{"key":"ref_40","unstructured":"World Health Organization (2022). Global Health Observatory Data Repository: By Category, Child Malnutrition, Anaemia in Children, World Health Organization."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/imj.13020","article-title":"Prevalence of anaemia and iron deficiency in Portugal: The EMPIRE study","volume":"46","author":"Fonseca","year":"2016","journal-title":"Intern. Med. J."},{"key":"ref_42","first-page":"26","article-title":"Contextualising the High Prevalence of Anaemia in the Portuguese Population: Perception, Characterisation and Predictors: An EMPIRE Sub-Study","volume":"23","author":"Marques","year":"2016","journal-title":"Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Cane, R.M., Chidassicua, J.B., Varandas, L., and Craveiro, I. (2022). Anemia in Pregnant Women and Children Aged 6 to 59 Months Living in Mozambique and Portugal: An Overview of Systematic Reviews. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19084685"},{"key":"ref_44","first-page":"243","article-title":"D\u00e9fice de ferro na crian\u00e7a","volume":"3","author":"Carreira","year":"2004","journal-title":"Acta Pedi\u00e1trica Port."},{"key":"ref_45","first-page":"261","article-title":"Anemia por defici\u00eancia de ferro no lactente: Resultados preliminares do desenvolvimento aos cinco anos","volume":"18","author":"Antunes","year":"2005","journal-title":"Acta M\u00e9dica Port."},{"key":"ref_46","first-page":"607","article-title":"Prevalence of iron deficiency in early infancy","volume":"11","author":"Virella","year":"1998","journal-title":"Acta M\u00e9dica Port."},{"key":"ref_47","unstructured":"Minist\u00e9rio dos Neg\u00f3cios Estrangeiros (2025, February 19). Sobre Portugal. Portal Diplom\u00e1tico, Available online: https:\/\/portaldiplomatico.mne.gov.pt\/sobre-portugal."},{"key":"ref_48","unstructured":"European Union (2025, February 06). Portugal. Available online: https:\/\/european-union.europa.eu\/principles-countries-history\/eu-countries\/portugal_en."},{"key":"ref_49","unstructured":"European Parliament (2025, February 06). Economic, Social and Territorial Situation of Portugal: Briefing Requested by the REGI Committee. Available online: https:\/\/www.europarl.europa.eu\/RegData\/etudes\/BRIE\/2019\/629190\/IPOL_BRI(2019)629190_EN.pdf."},{"key":"ref_50","unstructured":"Servi\u00e7o Nacional de Sa\u00fade (2025, February 20). Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Available online: https:\/\/www.sns.gov.pt\/entidades-de-saude\/unidade-local-de-saude-de-sao-jose\/."},{"key":"ref_51","unstructured":"Hospital Dona Estef\u00e2nia (2025). Contexto Regional e Nacional da Institui\u00e7\u00e3o, ULS S\u00e3o Jos\u00e9."},{"key":"ref_52","unstructured":"World Health Organization (2025, May 27). Guideline on Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240088542."},{"key":"ref_53","unstructured":"World Health Organization (2025, May 27). Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations. Available online: https:\/\/www.who.int\/tools\/elena\/interventions\/ferritin-concentrations."},{"key":"ref_54","unstructured":"World Health Organization (2025, May 27). WHO Guideline on Use of Ferritin Concentrations to Assess Iron Status in Individuals and Populations (WHO\/NMH\/NHD\/EPG\/20.1). Available online: https:\/\/iris.who.int\/bitstream\/handle\/10665\/331505\/9789240000124-eng.pdf?sequence=1."},{"key":"ref_55","unstructured":"Centers for Disease Control and Prevention (1998). Recommendations to prevent and control iron deficiency in the United States. Morb. Mortal. Wkly. Rep., 47, 1\u201329. Available online: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/00051880.htm."},{"key":"ref_56","unstructured":"UpToDate (2025, May 27). Approach to the Child with Anemia. Available online: https:\/\/www.uptodate.com\/contents\/approach-to-the-child-with-anemia?search=Approach%20to%20the%20child%20with%20anemia&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1."},{"key":"ref_57","unstructured":"North Bristol NHS Trust (2025, May 27). Children\u2019s Reference Ranges for Routine Haematology Tests [PDF]. Available online: https:\/\/www.nbt.nhs.uk\/sites\/default\/files\/Childrens%20FBC%20Reference%20Ranges.pdf."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"48","DOI":"10.2215\/CJN.05301107","article-title":"Anemia and Risk of Hospitalization in Pediatric Chronic Kidney Disease","volume":"4","author":"Staples","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_59","unstructured":"World Health Organization (2025, May 27). Iron Deficiency Anaemia: Assessment, Prevention and Control: A Guide for Programme Managers. WHO\/NHD\/01.3. World Health Organization. Available online: https:\/\/www.who.int\/publications\/m\/item\/iron-children-6to23--archived-iron-deficiency-anaemia-assessment-prevention-and-control."},{"key":"ref_60","unstructured":"University of Iowa Health Care (2025, May 27). Pediatric Reference Ranges. University of Iowa Health Care. Available online: https:\/\/www.healthcare.uiowa.edu\/path_handbook\/appendix\/heme\/pediatric_normals.html."},{"key":"ref_61","unstructured":"World Health Organization (2025, May 27). Prevalence of Anemia Among Children Under 5 Years (%). Global Health Observatory (GHO) Data. Available online: https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/7042."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1605807","DOI":"10.3389\/ijph.2023.1605807","article-title":"Minimum Dietary Diversity Among Children Aged 6\u201359 Months in East Africa Countries: A Multilevel Analysis","volume":"68","author":"Raru","year":"2023","journal-title":"Int. J. Public Health"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Paulo, H.A., Andrew, J., Luoga, P., Omary, H., Chombo, S., Mbishi, J.V., and Addo, I.Y. (2024). Minimum dietary diversity behaviour among children aged 6 to 24 months and their determinants: Insights from 31 Sub-Saharan African (SSA) countries. BMC Nutr., 10.","DOI":"10.1186\/s40795-024-00967-2"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Lencha, F.M., Zaza, Z.J., Digesa, L.E., and Ayana, T.M. (2022). Minimum dietary diversity and associated factors among children under the age of five attending public health facilities in Wolaita Soddo town, Southern Ethiopia, 2021: A cross-sectional study. BMC Public Heal, 22.","DOI":"10.1186\/s12889-022-14861-8"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1136\/archdischild-2021-323218","article-title":"Diet and development among children aged 36\u201359 months in low-income countries","volume":"107","author":"Bliznashka","year":"2021","journal-title":"Arch. Dis. Child."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3040845","DOI":"10.1155\/2020\/3040845","article-title":"Dietary Diversity and Associated Factors among Children Aged 6-59 Months in Ethiopia: Analysis of Ethiopian Demographic and Health Survey 2016 (EDHS 2016)","volume":"2020","author":"Woldegebriel","year":"2020","journal-title":"Int. J. Pediatr."},{"key":"ref_67","unstructured":"Dire\u00e7\u00e3o-Geral da Sa\u00fade (2025, May 27). Roda dos Alimentos. Programa Nacional para a Promo\u00e7\u00e3o da Alimenta\u00e7\u00e3o Saud\u00e1vel. Available online: https:\/\/alimentacaosaudavel.dgs.pt\/roda-dos-alimentos."},{"key":"ref_68","unstructured":"World Health Organization (2025, March 15). Child Growth Standards. World Health Organization. Available online: https:\/\/www.who.int\/tools\/child-growth-standards\/standards."},{"key":"ref_69","unstructured":"IBM Corp (2021). IBM SPSS Statistics for Windows, Version 28.0, IBM Corp."},{"key":"ref_70","unstructured":"World Health Organization (2025, March 20). Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations. Guideline Central. Available online: https:\/\/www.guidelinecentral.com\/guideline\/3534081\/#section-3534102."},{"key":"ref_71","unstructured":"World Health Organization (2025, March 20). Nutrition Landscape Information System (Nlis). Anaemia. Nutrition and Nutrition-Related Health and Development Data. Geneva, Switzerland: WHO. Available online: https:\/\/www.who.int\/data\/nutrition\/nlis\/info\/anaemia."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"da Silva, L.L.S., Fawzi, W.W., Cardoso, M.A., ENFAC Working Group, and Connor, J.R. (2018). Factors associated with anemia in young children in Brazil. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204504"},{"key":"ref_73","first-page":"200","article-title":"Factors Associated with Haemoglobin Concentration among Timor-Leste Children Aged 6\u201359 Months","volume":"26","author":"Agho","year":"2008","journal-title":"J. Health Popul. Nutr."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1017\/S1368980019005287","article-title":"Prevalence of anaemia in Brazilian children in different epidemiological scenarios: An updated meta-analysis","volume":"24","author":"Ferreira","year":"2020","journal-title":"Public Health Nutr"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"100","DOI":"10.5581\/1516-8484.20110028","article-title":"Prevalence of anemia in under five-year-old children in a children's hospital in Recife, Brazil","volume":"33","author":"Gonzalez","year":"2010","journal-title":"Rev. Bras. Hematol. Hemoter."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1590\/S0102-311X2011000500018","article-title":"Anemia em crian\u00e7as de 6 a 59 meses e fatores associados no Munic\u00edpio de Jord\u00e3o, Estado do Acre, Brasil","volume":"27","author":"Oliveira","year":"2011","journal-title":"Cad. Sa\u00fade P\u00fablica"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Fan\u00e7ony, C., Lavinha, J., Brito, M., and Barros, H. (2020). Anemia in preschool children from Angola: A review of the evidence. Porto Biomed. J., 5.","DOI":"10.1097\/j.pbj.0000000000000060"},{"key":"ref_78","first-page":"646","article-title":"Prevalence of Anaemia and Associated Factors among Children below Five Years of Age in Cape Verde, West Africa","volume":"32","author":"Semedo","year":"2014","journal-title":"J. Health Popul. Nutr."},{"key":"ref_79","first-page":"164213","article-title":"Malnutrition and anemia in children aged 6 to 59 months in the Autonomous Region of Pr\u00edncipe and its relation to maternal health","volume":"5","author":"Silva","year":"2023","journal-title":"Popul. Med."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Ncogo, P., Romay-Barja, M., Benito, A., Aparicio, P., Nseng, G., Berzosa, P., Santana-Morales, M.A., Riloha, M., Valladares, B., and Herrador, Z. (2017). Prevalence of anemia and associated factors in children living in urban and rural settings from Bata District, Equatorial Guinea, 2013. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0176613"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1038\/s41430-024-01516-7","article-title":"Prevalence of anemia among children aged 6\u201359 months in the Ntele camp for internally displaced persons (Cabo Delgado, Mozambique): A preliminary study","volume":"79","author":"Aly","year":"2024","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2278876","DOI":"10.1080\/17441692.2023.2278876","article-title":"Prevalence and factors related to anaemia in children aged 6\u201359 months attending a quaternary health facility in Maputo, Mozambique","volume":"18","author":"Cane","year":"2023","journal-title":"Glob. Public Health"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"e051395","DOI":"10.1136\/bmjopen-2021-051395","article-title":"Inequities in childhood anaemia at provincial borders in Mozambique: Cross-sectional study results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey","volume":"11","author":"Muhajarine","year":"2021","journal-title":"BMJ Open"},{"key":"ref_84","first-page":"e53770","article-title":"Migrant Pathology Screening in the Pediatric Population: A Five-Year Retrospective Study From a Level II Hospital","volume":"16","author":"Ribeiro","year":"2024","journal-title":"Cureus"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1097\/MPG.0000000000001015","article-title":"Iron and Vitamin D Deficiency in Healthy Young Children in Western Europe Despite Current Nutritional Recommendations","volume":"62","author":"Akkermans","year":"2016","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1663S","DOI":"10.3945\/ajcn.117.156018","article-title":"Iron status of young children in Europe","volume":"106","author":"Eussen","year":"2017","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1590\/S0034-89102011000300003","article-title":"Prevalence of anemia and associated factors in children aged 6-59 months in Pernambuco, Northeastern Brazil","volume":"45","author":"Leal","year":"2011","journal-title":"Rev. Saude Publica"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e1643","DOI":"10.1002\/hsr2.1643","article-title":"Anemia prevalence and its predictors among children under-five years in Ghana. A multilevel analysis of the cross-sectional 2019 Ghana Malaria Indicator Survey","volume":"6","author":"Aheto","year":"2023","journal-title":"Health Sci. Rep."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13643-020-01289-7","article-title":"Under-five anemia and its associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia: Systematic review and meta-analysis","volume":"9","author":"Belachew","year":"2020","journal-title":"Syst. Rev."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1382940","DOI":"10.1155\/2022\/1382940","article-title":"Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis","volume":"2022","author":"Tadesse","year":"2022","journal-title":"Anemia"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.12688\/f1000research.24707.3","article-title":"Prevalence and factors associated with anemia among children under five years of age in Rombo district, Kilimanjaro region, Northern Tanzania","volume":"9","author":"Mboya","year":"2023","journal-title":"F1000Research"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"267","DOI":"10.2147\/PHMT.S389105","article-title":"Anemia and Associated Risk Factors in Pediatric Patients","volume":"14","author":"Torres","year":"2023","journal-title":"Pediatr. Health Med. Ther."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Sunardi, D., Bardosono, S., Basrowi, R.W., Wasito, E., and Vandenplas, Y. (2021). Dietary Determinants of Anemia in Children Aged 6\u201336 Months: A Cross-Sectional Study in Indonesia. Nutrients, 13.","DOI":"10.3390\/nu13072397"},{"key":"ref_94","first-page":"416","article-title":"Hemoglobinopatias em Portugal e a interven\u00e7\u00e3o do m\u00e9dico de fam\u00edlia","volume":"32","author":"Costa","year":"2016","journal-title":"Rev. Port. Med. Geral E Familiar"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"45","DOI":"10.32385\/rpmgf.v25i1.10590","article-title":"A sa\u00fade dos imigrantes em Portugal","volume":"25","author":"Estrela","year":"2009","journal-title":"Rev. Port. Cl\u00ednica Geral"},{"key":"ref_96","first-page":"648","article-title":"The prevalence and predictors of iron deficiency anemia in toddlers: A population-based study","volume":"6","author":"Raju","year":"2023","journal-title":"J. Adv. Med. Pharm."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"e10494","DOI":"10.1016\/j.heliyon.2022.e10494","article-title":"Magnitude and morphological types of anemia differ by age among under five children: A facility-based study","volume":"8","author":"Omer","year":"2022","journal-title":"Heliyon"},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Fatima, T., Faridi, M.M.A., and Srivastava, G. (2022). Iron status of exclusively breastfed low-birth-weight infants born to anemic mothers and effect of maternal iron supplementation for 3 versus 6 months: A randomized double-blind placebo control trial. Front. Pediatr., 10.","DOI":"10.3389\/fped.2022.880431"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1093\/jn\/136.2.452","article-title":"Risk of Infant Anemia Is Associated with Exclusive Breast-Feeding and Maternal Anemia in a Mexican Cohort","volume":"136","author":"Guerrero","year":"2006","journal-title":"J. Nutr."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/1440-1630.12732","article-title":"Mealtime behaviours of young children with sensory food aversions: An observational study","volume":"68","author":"Caldwell","year":"2021","journal-title":"Aust. Occup. Ther. J."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/832\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:57:48Z","timestamp":1760032668000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/832"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,24]]},"references-count":100,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["children12070832"],"URL":"https:\/\/doi.org\/10.3390\/children12070832","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,24]]}}}