Statistical analyses were conducted using SPSS software (version
20.0). The level of significance was set at P < 0.05 for all statistical analyses. Descriptive analyses were based on frequencies and percentages. The characteristics of children admitted to the hospital were tabulated. The WHO criterion (hemoglobin < 11 g/dL) was used to diagnose anemia. Chi-square test was used to assess any significant difference between two groups (< 11 g/dL and 11 g/dL). Logistic regression was used to determine the associations between anemic cases (yes/no) as dependent variable and age (months), nutritional status, infectious disease, breast feeding, solid food introduction (before 6 months), meat intake (before 6 months) and iron supplement as independent variables. Results From June 2017 to October 2017, we selected randomly 295 patients that were admitted to the pediatric floor at the Ragheb Harb Hospital (RHH), a private tertiary care general Hospital with a capacity of about 200 beds including 35 beds in the pediatric floor located in the district of Nabatieh, in the south Lebanon region. Characterization of hospitalized children This study included 295 children, whose characteristics are described in Table 1. The group included 54.2% boys and 45.8% girls. The predominant age group varied between 24 and 60 months (35.6%). The mean age of children was 31.8 months ± 29.2. The majority of children were well-nourished (80.3%) and 13.9% were hospitalized for five or more days. The most frequent reasons for hospitalization resided in gastrointestinal (32.9%) and respiratory (28.1%) diseases. It was noticed that the percentage of anemia was higher in males (53.1%) than in females. Only 12.5% and 20.7% of children admitted in the hospital suffered from moderate and mild anemia, respectively. The majorities of children were breast-fed for more than 4 months (50.2%) as well as given iron supplement (58%). Please insert Table 1 here. Prevalence of anemia and associated factors The results of the chi-square test for trend indicated that the proportion of anemic cases decreased with age, varying from 48.3% in children between < 12 months to 12.5% in children 60 months and older (Table 2). These results were statistically significant (p-value = 0.000). No statistically significant difference was found concerning gender (p-value = 0.411) noting that anemia affected 29.1% of boys and 33.6% of girls. Anemia was highly related to nutritional status (p-value = 0.012). Comparisons between the remaining groups were not significant. Anemia was more frequent among children who were subjected to hospitalization for longer periods of time (43.2%) this difference was statistically significant (p-value = 0.050). In terms of clinical diagnosis, the chi-square test indicated that there was no statistically significant association with the hemoglobin level. Multivariate analysis showed that children < 12 months of age had a 6-fold higher risk of having anemia (Prevalence ratio - PR = 6.543; p-value = 0.001). The risk of anemia increased in malnourished children than in well-nourished children (PR = 2.631; p-value = 0.015). Although the risk of anemia decreased by almost 60% in children who had received iron supplement (PR = 0.420; p-value = 0.002). (Table 3) Please insert Table 2 and Table 3 here. Characterization of children in relation to hemoglobin levels The distribution of hemoglobin levels is presented in Figure 1. Overall, there was a 33.2% prevalence of anemia (95% CI: 9.95-10.27) and the average hemoglobin content was 11.5 g/dL ± 1.2 g/dL. Moderate anemia was found in 12.5% (95% CI: 9.07-9.56) of children and the mildest form was found in 20.7% (95% CI: 10.53-10.67). Please insert Figure 1 here. We calculated the Mentzer Index (MI) to determine the type of anemia and the possible etiologies, we found as results that the majority (85.7 %) of our anemic patients have an index greater than 13 with a mean value of 20 contrasting to patients who have a Mentzer index of less than 13, their mean value of MI was 10. Please insert Figure 2 here.