Disparity of anemia prevalence and associated factors among rural to urban migrant and the local children under two years old: a population based cross-sectional study in Pinghu, China

Background: Number of internal rural to urban migrant children in China increased rapidly. The disparity of anemia prevalence among them and children of local permanent residents has been reported, both in big and middle-size cities. There has been no population-based study to explore the associated factors on feeding behaviors in small size cities of China. This study aimed to identify whether there was a difference in the prevalence of anemia between children of rural to urban migrant families and local children under 2 years old in a small coastal city in China, and to identify the associated factors of any observed difference. Methods: A community-based, cross-sectional survey was conducted in Pinghu, a newly-developing city in Zhejiang Province, China, among the caregivers of 988 children (667 who were identified as children of migrants and 321 locals) aged 6-23 months. Disparity of anemia prevalence were reported. Association between anemia prevalence and socio-economic status and feeding behaviors were explored among two groups respectively. Results: Anemia prevalence among the migrant and local children was 36.6% and 18.7% respectively (aPR 1.86, 95% CI 1. 40 to 2.47). Results from adjusted Poisson models revealed: having elder sibling/s were found as an associated factor of anemia with the aPR 1.47 (95% CI 1.16 to 1.87) among migrant children and 2.58 (95% CI 1.37 to 4.58) among local ones; anemia status was associated with continued breastfeeding at 6 months (aPR = 1.57, 95% CI 1.15 to 2.14) and lack of iron-rich and/or iron-fortified foods (aPR = 0.68, 95% CI 0.50 to 0.89) among the migrant children but not among local ones. Conclusion: Anemia was more prevalent among migrant children, especially those aged 6-11 months. Dislike their local counterparts, migrant children were more vulnerable at early life and seemed sensitive to feeding behaviors, such as, over reliance on breastfeeding for nutrition after aged 6 months, lack of iron-rich and/or iron-fortified foods. Future strategies to narrow the gap of anemia prevalence between the migrant and local children should target more susceptible groups and through improvement of feeding practices among younger children in those kinds of newly-developing areas of China.