Meta-Analysis the Effect of Exclusive Breastfeeding on Anemia in Children Under Five


  • Fikri Dian Dinu Azizah Master's Program in Public Health, Universitas Sebelas Maret
  • Eti Poncorini Pamungkasari Faculty of Medicine, Universitas Sebelas Maret
  • Bhisma Murti Master's Program in Public Health, Universitas Sebelas Maret



Background: The prevalence of iron deficiency anemia is still high, especially in children under five. One effort to prevent iron deficiency anemia is exclusive breastfeeding for newborns. This study aims to analyze exclusive breastfeeding on the incidence of anemia in children under five.

Subjects and Method: This study is a systematic review and meta-analysis, with PICO as follows: Population= toddlers aged <5 years; Intervention= exclusive breastfeeding; Comparison= non-exclusive breastfeeding; Outcome= iron deficiency anemia. The articles used in this study were obtained from several databases including PubMed, Springer Link, Science Direct, and Google Scholar, which were published from 2012 to 2022. The keywords to search for articles are as follows: "Children" AND ("exclusive Breastfeeding" OR "formula" OR "mixed feeding") AND (anemia OR "Iron deficiency"). The articles included in this study were full-text articles with a cross-sectional study design. Articles are collected using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 application.

Results: A meta-analysis of 9 cross-sectional studies from Ethiopia, Taiwan, Bangladesh and China concluded that exclusive breastfeeding is effective in reducing the risk of anemia in children under five. Toddlers who are exclusively breastfed have a risk of developing anemia 0.55 times compared to those who are not exclusively breastfed, and the reduced risk is statistically significant (aOR= 0.55; 95% CI= 0.32 to 0.92; p= 0.020).

Conclusion: Exclusive breastfeeding is effective in reducing the risk of anemia in children under five.

Keywords: exclusive breastfeeding, anemia, toddlers.

Correspondence: Fikri Dian Dinu Azizah. Master’s Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A Surakarta 57126, Central Java, Indonesia. Email: Mobile: 08122­5002311.


Allali S, Brousse V, Sacri AS, Chalumeau M, de Montalembert M (2017). Anemia in children: prevalence, causes, diagnostic workup, and long-term consequences. Expert Rev Hematol. 10(11): 1023-1028. doi: 10.1080/17474086.2017.1354696.

Aliyo A, Jibril A (2022). Assessment of anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia: Hospital-based cross-sectional study. PLoS One. 17(7):e0270853. doi: 10.1371/journal.pone.0270853.

Asoba GN, Sumbele IUN, Anchang-Kimbi JK, Metuge S, Teh RN (2019). Influence of infant feeding practices on the occurrence of malnutrition, malaria and anaemia in children ≤5 years in the Mount Cameroon area: A cross sectional study. PLoS One. 14(7):e0219386. doi: 10.1371/journal.pone.0219386.

Bzikowska-Jura A, Sobieraj P, Michalska-Kacymirow M, Wesołowska A (2021). investigation of iron and zinc concentrations in human milk in correlation to maternal factors: an observational pilot study in Poland. Nutrients. 13 (2): 303. doi: 10.3390/nu13020303.

Cai C, Granger M, Eck P, Friel J (2017). effect of daily iron supplementation in healthy exclusively breastfed infants: a systematic review with meta-analysis. Breastfeed Med. 12(10): 597-603. doi: 10.1089/bfm.2017.0003.

Chen CM, Mu SC, Shih CK, Chen YL, Tsai LY, Kuo YT, Cheong IM, et al. (2020). Iron Status of Infants in the First Year of Life in Northern Taiwan. Nutrients. 12(1):139. doi: 10.3390/nu12010139.

Faiqah S, Ristrini R, Irmayani I (2018). Hubungan usia, jenis kelamin dan berat badan lahir dengan kejadian anemia pada balita di Indonesia (The relationship between age, sex and birth weight with the incidence of anemia in children under five in Indonesia). Penelitian Sistem Kesehatan. 21(4): 281-289.

Gebrehaweria Gebremeskel M, Lemma Tirore L (2020). Factors associated with anemia among children 6-23 months of age in ethiopia: a multilevel analysis of data from the 2016 ethiopia demographic and health survey. Pediatric Health Med Ther. 11:347-357. doi: 10.2147/PHMT.S258114.

Helmyati S, Hamam H, Wiryatun L (2007). Kejadian anemia pada bayi usia 6 bu-lan yang berhubungan dengan sosial ekonomi keluarga dan usia pemberian makanan pendamping ASI (Incidence of anemia in infants aged 6 months associated with family socio-economic and age of complementary feeding). Berita Kedokteran Masyarakat. 23(1): 35-40.

Ibrahim F, Rahayu B (2021). Analisis faktor yang berhubungan dengan pemberian asi eksklusif (Analysis of factors related to exclusive breastfeeding). Jurnal Ilmiah Kesehatan Sandi Husada. 10(1): 18-24.

Krishnaswamy S, Bhattarai D, Bharti B, Bhatia P, Das R, Bansal D (2017). Iron deficiency and iron deficiency anemia in 3-5 months-old, breastfed healthy infants. Indian J Pediatr. 84(7):505-508. doi:10.1007/s1209801723304.

Leite MS, Cardoso AM, Coimbra CE Jr, Welch JR, Gugelmin SA, Lira PC, Horta BL, et al. (2013). Prevalence of anemia and associated factors among indigenous children in Brazil: results from the First National Survey of Indigenous People's Health and Nutrition. Nutr J. 2013 May 28;12:69. doi: 10.1186/147528911269

Li H, Xiao J, Liao M, Huang G, Zheng J, Wang H, Huang Q, et al. (2020). Anemia prevalence, severity and associated factors among children aged 6-71 months in rural Hunan Province, China: a community-based cross-sectional study. BMC Public Health. 20(1):989. doi: 10.1186/s1288902009129y.

Malako BG, Teshome MS, Belachew T (2018). Anemia and associated factors among children aged 6-23 months in Damot Sore District, Wolaita Zone, South Ethiopia. BMC Hematol. 18:14. doi: 10.1186/s1287801801081.

Malkanthi, Silva, Udith K. Jayasinghe-Mudalige (2010). Risk factor associated with high prevalence of anemia among children under 5 years of age in paddy farming househholds in Sri Lanka. Food and Nutrition Bulletin. The United Nations University. 31(4).

Marol R, Marol R (2021). Prevalence of anemia in exclusively breastfed full term babies between 3-6 months of age. Int J Contemp Pediatr. 8(2): 300-305.

Mollah M, Mosaddik A, Hossain A, Naznin S, Roy AA, Ali S, Hassan P, et al. (2021). Key predictors of anemia in under five children in rural setting of Bangladesh: a cross sectional study. Am. J. Med. Biol. Res. 9(1):10-15. doi: 10.12691/ajmbr913

Osman KA, Zinsstag J, Tschopp R, Schelling E, Hattendorf J, Umer A, Ali S, et al. (2020). Nutritional status and intestinal parasites among young children from pastoralist communities of the Ethiopian Somali region. Matern Child Nutr. 16(3):e12955. doi: 10.1111/mcn.12955.

Ruangkit C, Prachakittikul N, Hemprachitchai N, Dumrongwongsiri O, Soonsawad S (2021). Association of infant feeding practices with iron status and hematologic parameters in 6-month-old infants. Children (Basel). 8(12):1159. doi: 10.3390/children8121159.

Sawitri D (2017). Berat badan lahir rendah berpengaruh terhadap kejadian anemia defisiensi besi di Wilayah Puskesmas Jatilawang Kabupaten Banyumas (Low birth weight affects the incidence of iron deficiency anemia in the Jatilawang Health Center, Banyumas Regency), Universitas Muhammadiyah, Purwakarta.

Spinelli MGN, Marchioni DML, Souza JMP, Souza SB de, Szarfarc SC (2005). Fatores de risco para anemia em criancas de 6 a 12 meses no Brasil. Rev Panam Salud Publica. 17(2):84-91.

Sekartini R, Soedjatmiko, Wawolumaya C, Yuniar I, Dewi R, Nyance, Imam, et al. (2005). Prevalensi anemia defisiensi besi pada bayi usia prevalensi anemia defisiensi besi pada bayi usia 4 – 12 bulan 4 – 12 bulan 4 – 12 bulan di Kecamatan Matraman dan di Kecamatan Matraman dan Sekitarnya (Prevalence of iron deficiency anemia in infants Prevalence of iron deficiency anemia in infants aged 4 – 12 months 4 – 12 months 4 – 12 months in Matraman District and in Matraman District and its surroundings), Jakarta Timur Sekitarnya, Jakarta Timur. Sari Pediatri. 7(1): 1-8.

Supriyati YR (2018). Faktor risiko kejadian anemia pada bayi usia 6 bulan di Puskesmas Tegalrejo Kota Yogyakarta (Risk factors for anemia in infants aged 6 months at the Tegalrejo Health Center, Yogyakarta City). Prodi Sarjana Terapan Kebidanan Jurusan Kebidanan Politeknik Kesehatan Kementerian Kesehatan Yogyakarta.

Takele WW, Baraki AG, Wolde HF, Desyibelew HD, Derseh BT, Dadi AF, Mekonnen, Akalu TY (2021). Anemia and contributing factors in severely malnourished infants and children aged between 0 and 59 months admitted to the treatment centers of the Amhara Region, Ethiopia: A Multicenter Chart. Review Study. 202(663-6043).

World Health Organization (2011). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Retrieved from: bitstream/handle/10665/85839/WHO_NMH_NHD_MNM_ 11.1_eng.pdf

World Health Organization (2019). Anaemia in women and children. topics/anaemia_in_women_and_children

World Health Organization. (2022). HIV/ AIDS. Retrieved from:




How to Cite

Azizah, F. D. D., Pamungkasari, E. P., & Murti, B. (2023). Meta-Analysis the Effect of Exclusive Breastfeeding on Anemia in Children Under Five . Journal of Maternal and Child Health, 8(2), 237–246.