Critical Appraisal - General Checklist

STUDY DESIGN
Is the objective of the study sufficiently described? Yes Unclear No
Please describe!
The aim of this study was to determine the prevalence, severity, and predictors of
nutritional IDA in school age children in Southwest Ethiopia.

Is the design of the study sufficiently described? Yes Unclear No

Please describe!
Cross-sectional study

Was the design of the study appropriate to the objective? Yes Unclear No
Please describe!
Because it the aim of the study is to determine the exposure

Is the source of the subjects clearly described? Yes Unclear No

Please describe!
A community based cross-sectional study was conducted in Jimma Town, Southwest
Ethiopia from April to July 2013. A total of 616 school children
aged 6 to 12 years were included in the study using multistage sampling technique.

Is the method of selection of the subjects clearly described Yes Unclear No

(i.e. inclusion and exclusion criteria)?
Please describe!
First, a list of clusters was established by using Kebeles (the smallest administrative
unit in Ethiopia). From the total 13 Kebeles (clusters) of the town, 6 Kebeles were
selected randomly by lottery method. The sampling frame was prepared for the
household in the selected Kebeles and sample was proportionally allocated to the
selected Kebeles. By using systematic random sampling method households were
identified in each of the selected Kebele. In each of the selected Kebele, the first
household was selected randomly and the next household was determined by
sampling interval. Sampling interval (K) was calculated by dividing the total
household of each Kebele to the sample size. One child was interviewed from each of
the selected households. If more than one child dwells in a household, one was
chosen by the lottery method. School age children with history of severe illness, and
recent medication use including treatment for anemia for the last two weeks prior to
data collection were excluded from the study.

Was the sample of subjects appropriate with regard to the Yes Unclear No
population to which the findings will be referred?
Please describe!
Because it doesn’t explained in the journal

Was the sample size based on pre--‐study considerations Yes Unclear No

of statistical power?
Please describe!
Because it doesn’t explained in the journal

Is the design of the study acceptable? Yes No

Please describe!
Ethical clearance was obtained from Jimma University Ethical Review Committee.
Permission was sought from the Jimma Town municipality. Written informed
consent was obtained from the guardians of the children and additional oral assent
was obtained from 7–12 years old children after describing the benefits and risks of
the study. Children with intestinal parasitic infections and those with hematological
values below the reference ranges were referred to health professionals in Jimma
University Specialized Hospital for possible interventions.
 Critical Appraisal - General Checklist

CONDUCT OF STUDY
Was a satisfactory (high) response rate achieved? Yes Unclear No
Please describe!
Socio-demographic, economic and data on dietary patterns was collected using
pretested questionnaire. Moreover, anthropometric measurements and laboratory
data were collected. The data collection staff includes clinical nurses and laboratory
technologists, under supervision of general practitioners. One day training was
given to the data collectors and supervisors prior to data collection. To assure the
quality of the data generated, standard operating procedures were followed during
specimen collection and all laboratory procedures. The laboratory analysis were
performed according to the manufacturers’ instructions. Control reagents were
used for the hematology and clinical chemistry analyzers to check thereproducibility
of the results. Training was given for the data collectors to minimize technical
and observation bias.

ANALYSIS AND PRESENTATION

Is there a statement adequately describing or refencing Yes No
all the statistical procedures used?
Please describe!
Both bivariable and multivariable logistic regression analysis were done to identify
the independent predictors of IDA in children. All the variables were analyzed in
bivariable logistic regression analysis and then those with p - value,0.25 and those
believed to have biological relation with iron deficiency anemia were candidate for
multivariable logistic regression analysis. Accordingly, children with low family
monthly income, not consuming protein source foods, not consuming dairy
products, not consuming discretionary calories and having an intestinal parasite
infection were identified as predictors of IDA among the children.

Were the statistical methods used appropriate for the Yes Unclear No
data?
Please describe!
Because they can explain about prevalence of anemia was 43.7%, and that of IDA
was 37.4%. Notconsuming protein source foods [AOR52.30, 95%CI(1.04,5.14)], not-
consuming dairy products [AOR51.83, 95%CI(1.14,5.14)], not-consuming
discretionary calories [AOR52.77, 95%CI(1.42,5.40)], low family income
[AOR56.14, 95%CI(2.90,12.9)] and intestinal parasitic infections [AOR51.45,
95%CI(1.23, 5.27)] were predictors of IDA.

Were they used correctly? Yes Unclear No

Please describe!
Because they can answer the objectives of the study

Is the presentation of statistical material (tables, Yes No

graphical, numerical) satisfactory?
Please describe!
Because, they present all of the factors that might cause the IDA

Are sufficient analysis presented? Yes Unclear No

Please describe!
Data were entered into computer using EPI data version 3.1, cleaned and exported
to SPSS Version 20 for analysis. Descriptive statistics were employed to summarize
the data. Multivariable logistic regression analysis was done to identify the
independent predictors of nutritional iron deficiency anemia. All variables with a p
value less than 0.05 were considered as statistical significance. Anthropometric data
were entered and processed by WHO Anthro Plus version
1.0.4 software.
 Critical Appraisal - General Checklist
Are confidence intervals given for the main results? Yes No
Please describe!
This shows that, anemia is a severe public health problem among school age
children. The possible explanation for severe anemia among children in the present
study could be due to dietary deficiency for economic constraints and
high burden of intestinal parasitic infection.

OVERALL ASSESSMENT
Are the conclusions drawn from the statistical Yes Unclear No
analyses justified?
Please describe!
Iron deficiency anemia is a moderate public health problem in the
study site. Dietary deficiencies and intestinal parasitic infections were predictors of
IDA. Therefore, emphasis should be given to the strategies for the prevention of risk
factors for IDA.

Is the paper statistically acceptable? Yes No

Please describe!
Because they incude the statistical material, eg. tables