Maternal reports of sleep in 6–18 month-old infants from Nepal and Zanzibar: Association with iron deficiency anemia and stunting

Kordas, Katarzyna; Siegel, Emily H.; Olney, Deanna K.; Katz, Joanne; Tielsch, James M.; Chwaya, Hababu M.; Kariger, Patricia K.; LeClerq, Steven C.; Khatry, Subarna K.; Stoltzfus, Rebecca J.

doi:10.1016/j.earlhumdev.2007.10.007

« Previous Next »Early Human Development
Volume 84, Issue 6 , Pages 389-398, June 2008

Maternal reports of sleep in 6–18 month-old infants from Nepal and Zanzibar: Association with iron deficiency anemia and stunting

Katarzyna Kordas
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, United States
- Corresponding author. Environmental Health Department, OHP, Harvard School of Public Health, 401 Landmark Center, Boston, MA 02215, United States.
Emily H. Siegel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
Deanna K. Olney
- Program in International and Community Nutrition, University of California, Davis, United States
Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
James M. Tielsch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
Hababu M. Chwaya
- UNICEF, Zanzibar, Tanzania
Patricia K. Kariger
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
Steven C. LeClerq
- Nepal Nutrition Project-Sarlahi, Nepal Netra Jyoti Sangh, Kathmandu, Nepal
Subarna K. Khatry
- Nepal Nutrition Project-Sarlahi, Nepal Netra Jyoti Sangh, Kathmandu, Nepal
Rebecca J. Stoltzfus
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States

Received 21 January 2007; received in revised form 9 October 2007; accepted 15 October 2007.

Abstract

Background

Infants with iron deficiency anemia (IDA) and stunting explore and interact less with their environment. They may also be fatigued more often, suggesting their sleep may be affected. It is unclear whether fatigue in these infants is due to poor nighttime sleep or if it is compensated for with frequent naps or longer sleep.

Aims

In 2 studies from Pemba Island, Zanzibar and 1 from Nepal we investigated the relationship between IDA, stunting, and maternal reports of sleep in 6–18 mo old infants.

Methods

Parents reported on the number and duration of naps, hours of nighttime sleep, and frequency of night waking. Anemia was defined as Hb<10 g/dL, iron deficiency as zinc protoporphyrin (ZPP≥90 μmol/mol heme), stunting as HAZ<−2 SD, and IDA as Hb<10 g/dL and ZPP≥90 μmol/mol heme.

Results

The prevalence of IDA and stunting was 34–84% and 22–37%, respectively. Most infants napped during the day and took approximately 1.5 naps (mean nap duration 1.4–1.7 h). Mean nighttime sleep duration was 8.3–9.7 h and infants awoke 2.1–2.5 times per night. Both IDA and stunting were associated with differences in reported sleep characterized by shorter night sleep duration and higher frequency of night waking; stunting was also related to shorter nap duration.

Conclusions

We found reduced sleep duration and increased night waking among infants with IDA and stunting. Because sleep plays an essential role in infant development, our findings indicate a clear need for further research into these relationships.

Keywords: Infant, Sleep, Developing country, Iron deficiency anemia, Stunting