Background: Iron-deficiency anemia is a major public health problem among young children worldwide, particularly in sub-Saharan Africa, where it impairs growth, immunity, and cognitive development. Iron deficiency, primarily from insufficient intake of iron-rich foods, is a leading cause of childhood anemia. Burundi is no exception, and data on factors associated with the consumption of iron-rich foods among preschool-aged children remain scarce. Objective: This study aimed to determine the prevalence of iron-rich food consumption and the factors associated with it among children aged 24 to 59 months in the Butezi health district of Burundi, to provide findings that could inform policymakers in the fight against malnutrition caused by micronutrient deficiencies. Methods: A cross-sectional study was conducted among 602 mother-child pairs in the Butezi health district. Consumption of iron-rich foods was defined as consumption of at least 2 of the following foods: legumes, meat, eggs, and green vegetables. The data were collected using a structured, pre-tested questionnaire administered in person in Kirundi by trained interviewers, and were then entered and analyzed using Stata 15 software. A descriptive statistical analysis, a univariate analysis, and a multivariate analysis with logistic regression were used to describe and identify the factors associated with the consumption of iron-rich foods. Adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) have been calculated and included. Results: The prevalence of iron-rich food intake was 41.20% (95% CI: 37.3% - 45.1%). Most of the children in the study ate more legumes (51.33%) and green vegetables (71.59%) than meat (11.13%) and eggs (1.99%). In the multivariate model, consumption of iron-rich foods was significantly associated with male gender (aOR = 1.71, 95% CI: 1.23 - 2.40), with the mother having completed secondary or higher education (aOR = 2.00, 95% CI: 1.12 - 3.58), owning both small and large livestock (aOR = 3.50, 95% CI: 1.26 - 10.01), the mother’s nutrition education (adjusted OR = 1.65, 95% CI: 1.03 - 2.62), the father’s involvement in the child’s feeding (aOR = 1.62, 95% CI: 1.09 - 2.40), and meal frequency (aOR = 0.54, 95% CI: 0.34 - 0.84 for one meal per day versus at least two per day). Conclusions: As the identified predictive factors were sociodemographic and dietary habits, interventions aimed at improving infant nutrition in the study area should consider multidimensional strategies, including maternal education,
References
[1]
Basrowi, R.W. and Dilantika, C. (2021) Optimizing Iron Adequacy and Absorption to Prevent Iron Deficiency Anemia: The Role of Combination of Fortified Iron and Vitamin C. World Nutrition Journal, 5, 33-39. https://doi.org/10.25220/wnj.v05.s1.0005
[2]
Medise, B.E. (2021) The Role of Iron for Supporting Children’s Growth and Development. World Nutrition Journal, 5, 16-24. https://doi.org/10.25220/wnj.v05.s1.0003
[3]
Moscheo, C., Licciardello, M., Samperi, P., La Spina, M., Di Cataldo, A. and Russo, G. (2022) New Insights into Iron Deficiency Anemia in Children: A Practical Review. Metabolites, 12, Article 289. https://doi.org/10.3390/metabo12040289
[4]
Firdose, K. and Firdose, N. (2022) Dietary Iron. In: Zakaria, M. and Hassan, T., Eds., Iron Metabolism—A Double-Edged Sword, IntechOpen, 1-19. https://doi.org/10.5772/intechopen.101265
[5]
Savarino, G., Corsello, A. and Corsello, G. (2021) Macronutrient Balance and Micronutrient Amounts through Growth and Development. Italian Journal of Pediatrics, 47, Article No. 109. https://doi.org/10.1186/s13052-021-01061-0
[6]
Orsango, A.Z., Habtu, W., Lejisa, T., Loha, E., Lindtj？rn, B. and Engebretsen, I.M.S. (2021) Iron Deficiency Anemia among Children Aged 2-5 Years in Southern Ethiopia: A Community-Based Cross-Sectional Study. PeerJ, 9, e11649. https://doi.org/10.7717/peerj.11649
[7]
Gedfie, S., Getawa, S. and Melku, M. (2022) Prevalence and Associated Factors of Iron Deficiency and Iron Deficiency Anemia among Under-5 Children: A Systematic Review and Meta-Analysis. Global Pediatric Health, 9, 1-13.
[8]
Obeagu, E.I., Obeagu, G.U. and Habimana, J.B. (2023) Iron Deficiency Anaemia in Children. International Research in Medical and Health Sciences, 6, 26-32.
[9]
Sundararajan, S. and Rabe, H. (2021) Prevention of Iron Deficiency Anemia in Infants and Toddlers. Pediatric Research, 89, 63-73. https://doi.org/10.1038/s41390-020-0907-5
[10]
Namaganda, S., Otekat, V., Ayebale, D., Katende, S., Wagubi, R., Muwanguzi, E., Olong, C., John, E.A. and Okongo, B. (2025) Prevalence and Determinants of Iron Deficiency Anemia among Children under Five Years at Luwero General Hospital, Uganda. Journal of Blood Medicine, 16, 579-588. https://doi.org/10.2147/JBM.S550926
[11]
Martinez-Torres, V., Torres, N., Davis, J.A. and Corrales-Medina, F.F. (2023) Anemia and Associated Risk Factors in Pediatric Patients. Pediatric Health, Medicine and Therapeutics, 14, 267-280. https://doi.org/10.2147/phmt.s389105
[12]
Akalu, Y., Yeshaw, Y., Tesema, G.A., Demissie, G.D., Molla, M.D., Muche, A., et al. (2021) Iron-Rich Food Consumption and Associated Factors among Children Aged 6-23 Months in Sub-Saharan Africa: A Multilevel Analysis of Demographic and Health Surveys. PLOS ONE, 16, e0253221. https://doi.org/10.1371/journal.pone.0253221
[13]
Osei Bonsu, E., Addo, I.Y., Boadi, C., Boadu, E.F. and Okeke, S.R. (2024) Determinants of Iron-Rich Food Deficiency among Children under 5 Years in Sub-Saharan Africa: A Comprehensive Analysis of Demographic and Health Surveys. BMJ Open, 14, e079856. https://doi.org/10.1136/bmjopen-2023-079856
[14]
Semagn, B.E., Gebreegziabher, Z.A. and Abebaw, W.A. (2023) Iron-Rich Food Consumption and Associated Factors among Children Aged 6-23 Months in Sierra Leone: Multi-Level Logistic Regression Analysis. BMC Public Health, 23, Article No. 1793. https://doi.org/10.1186/s12889-023-16737-x
[15]
Okwuonu, I.C., Narayanan, N.N., Egesi, C.N. and Taylor, N.J. (2021) Opportunities and Challenges for Biofortification of Cassava to Address Iron and Zinc Deficiency in Nigeria. Global Food Security, 28, Article 100478. https://doi.org/10.1016/j.gfs.2020.100478
[16]
Hailu, B.A. (2023) Mapping, Trends, and Factors Associated with Anemia among Children Aged under 5 Y in East Africa. Nutrition, 116, Article 112202. https://doi.org/10.1016/j.nut.2023.112202
[17]
Kassaw, A.B., Mohammed, A., Muche, A. and Molla, A. (2026) Spatial Distribution and Factors Associated with Co-Occurrence of Anemia and Undernutrition among Children Aged 6-59 Months in East Africa. PLOS ONE, 21, e0342437. https://doi.org/10.1371/journal.pone.0342437
[18]
Gaiser, M.L., Winkler, A.S., Klug, S.J., Nkurunziza, S. and Stelzle, D. (2023) Determinants of Stunting among Children under Age Five in Burundi: Evidence from the 2016-2017 Burundi Demographic and Health Survey (BDHS 2016-17). Food Science & Nutrition, 11, 4100-4112. https://doi.org/10.1002/fsn3.3400
[19]
WFP (2023) Comprehensive Food Security and Vulnerability Analysis. https://fscluster.org/sites/default/files/documents/cfsva_2023_burundi-final_report_english_0.pdf
DSNIS. Ministry of Health. Burundian Sanitary Health Card 2016. https://minisante.gov.bi/?page_id=188
[22]
WHO (2023) Anemia. https://www.who.int/health-topics/anaemia#tab=tab_1
[23]
The Leeds Teaching Hospitals NHS Trust (2023) Iron in Your Child’s Diet: A Practical Guide to Increasing Iron in Your Child’s Diet. 3rd Edition. https://flipbooks.leedsth.nhs.uk/LN004400.pdf
[24]
Royal United Hospitals Bath NHS Foundation Trust (2015) Iron in Children’s Diets.
[25]
Haque, S., Salman, M., Hossain, M.S., Saha, S.M., Farquhar, S., Hoque, M.N., et al. (2024) Factors Associated with Child and Maternal Dietary Diversity in the Urban Areas of Bangladesh. Food Science & Nutrition, 12, 419-429. https://doi.org/10.1002/fsn3.3755
[26]
Siddiqui, F., Salam, R.A., Lassi, Z.S. and Das, J.K. (2020) The Intertwined Relationship between Malnutrition and Poverty. Frontiers in Public Health, 8, Article No. 453. https://doi.org/10.3389/fpubh.2020.00453
[27]
Kuche, D., Moss, C., Eshetu, S., Ayana, G., Salasibew, M., Dangour, A.D., et al. (2019) Factors Associated with Dietary Diversity and Length‐for‐Age Z-Score in Rural Ethiopian Children Aged 6-23 Months: A Novel Approach to the Analysis of Baseline Data from the Sustainable Undernutrition Reduction in Ethiopia Evaluation. Maternal & Child Nutrition, 16, e12852. https://doi.org/10.1111/mcn.12852
[28]
United Nations Children’s Fund (UNICEF) (2021) Fed to Fail? The Crisis of Children’s Diets in Early Life. In: 2021 Child Nutrition Report, UNICEF. https://data.unicef.org/resources/fed-to-fail-2021-child-nutrition-report/
[29]
Roba, A.A., Ba？da？, ？., Brewis, A. and Roba, K.T. (2024) Maternal and Household Factors Affecting the Dietary Diversity of Preschool Children in Eastern Ethiopia: A Cross-Sectional Study. BMJ Open, 14, e080616. https://doi.org/10.1136/bmjopen-2023-080616
[30]
Elolu, S., Agako, A. and Okello, D.M. (2023) Household Food Security, Child Dietary Diversity and Coping Strategies among Rural Households. the Case of Kole District in Northern Uganda. Dialogues in Health, 3, Article 100149. https://doi.org/10.1016/j.dialog.2023.100149
[31]
Seidu, A., Hagan Jnr, J.E., Budu, E., Aboagye, R.G., Okyere, J., Sakyi, B., et al. (2023) High-Risk Fertility Behaviour and Undernutrition among Children Under-Five in Sub-Saharan Africa: A Cross-Sectional Study. BMJ Open, 13, e066543. https://doi.org/10.1136/bmjopen-2022-066543
[32]
FAO (2021) The State of Food Security and Nutrition in the World 2021. Food and Agriculture Organization of the United Nations.
[33]
Nkoko, N., Cronje, N. and Swanepoel, J.W. (2024) Factors Associated with Food Security among Small-Holder Farming Households in Lesotho. Agriculture & Food Security, 13, Article No. 3. https://doi.org/10.1186/s40066-023-00454-0
[34]
Roba, A.A., Tola, A., Dugassa, D., Tefera, M., Gure, T., Worku, T., et al. (2022) Antenatal Care Utilization and Nutrition Counseling Are Strongly Associated with Infant and Young Child Feeding Knowledge among Rural/Semi-Urban Women in Harari Region, Eastern Ethiopia. Frontiers in Pediatrics, 10, Article ID: 1013051. https://doi.org/10.3389/fped.2022.1013051
[35]
Brajesh, N., Shekhar, C., Ranjan, M. and Vishwakarma, S. (2024) The Role of Maternal Care Services on Feeding Practices among under Five Children in India, Nepal and Bangladesh. Global Social Welfare, 11, 61-76. https://doi.org/10.1007/s40609-023-00318-2
[36]
Nabuuma, D., Ekesa, B., Faber, M. and Mbhenyane, X. (2021) Community Perspectives on Food Security and Dietary Diversity among Rural Smallholder Farmers: A Qualitative Study in Central Uganda. Journal of Agriculture and Food Research, 5, Article 100183. https://doi.org/10.1016/j.jafr.2021.100183
[37]
Oyet, S.M., Kaahwa, R.M., Muggaga, C., Ongeng, D. and Okello-Uma, I. (2025) Household Dietary Diversity and Associated Factors in Rural and Peri-Urban Areas of Mbale District, Eastern Uganda. BMC Public Health, 25, Article No. 303. https://doi.org/10.1186/s12889-025-21476-2
[38]
Li, H., Kim, Y., Park, C., Kang, M. and Kang, Y. (2022) Gender-Common and Gender-Specific Determinants of Child Dietary Diversity in Eight Asia Pacific Countries. Journal of Global Health, 12, Article 04058. https://doi.org/10.7189/jogh.12.04058
[39]
Rezaeizadeh, G., Mansournia, M.A., Keshtkar, A., Farahani, Z., Zarepour, F., Sharafkhah, M., et al. (2024) Maternal Education and Its Influence on Child Growth and Nutritional Status during the First Two Years of Life: A Systematic Review and Meta-Analysis. eClinicalMedicine, 71, Article 102574. https://doi.org/10.1016/j.eclinm.2024.102574
[40]
UN Nutrition (2021) Livestock-Derived Foods and Sustainable Healthy Diets.
[41]
Galvin, L., Verissimo, C.K., Ambikapathi, R., Gunaratna, N.S., Rudnicka, P., Sunseri, A., et al. (2023) Effects of Engaging Fathers and Bundling Nutrition and Parenting Interventions on Household Gender Equality and Women’s Empowerment in Rural Tanzania: Results from EFFECTS, a Five-Arm Cluster-Randomized Controlled Trial. Social Science & Medicine, 324, Article 115869. https://doi.org/10.1016/j.socscimed.2023.115869
[42]
World Health Organization (WHO) (2003) Feeding and Nutrition of Infants and Young Children: Guidelines for the WHO European Region.
[43]
Mou, Y., Jansen, P.W., Raat, H., Nguyen, A.N. and Voortman, T. (2021) Associations of Family Feeding and Mealtime Practices with Children’s Overall Diet Quality: Results from a Prospective Population-Based Cohort. Appetite, 160, Article 105083. https://doi.org/10.1016/j.appet.2020.105083
