Childhood anemia and household salt iodization in Peru: population disparities among children aged 6–59 months

Briceño-Chavez J.E.; Portal-Valqui L.M.; Yoplac-Oyarce A.M.; Bustamante-Rodríguez J.C.; Ballena-Caicedo J.; Zuzunaga-Montoya F.E.; Vera-Ponce V.J. · Frontiers in Nutrition (2026) · DOI: 10.3389/fnut.2026.1865961

Resumen

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. Copyright

Instituciones: Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas