A M E R I C A N U N I V E R S I T Y O F A R M E N I A - CHSR

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eing outcomes is the comprehensive way of intervention programs for children and their families [25]. It has long term benefits for physical and mental health, educational achievement and emotional functioning [2]. The clinical definition of the health status in this survey was based on the patient’s history, coming from the detailed interviewing of the caretakers about complaints and recent illnesses. Other characteristics determining health status are diagnosis of a disease or disorder through physical examination, laboratory testing or other instrumental investigations. General conclusion on the health status is based on all these findings and made by a medical team. Among independent variables, socio-economic status (SES) is widely used, and its most sensitive indicator was the family income. Aiming to estimate the SES only monetary value was used, excluding other sources of income such as farming, gifts and humanitarian assistance. The cut-off level of SES was family income, where the estimated basic package was less than 6,000 Armenian Dram per capita [27]. According to this definition the SES was classified as low and high. The impact of other independent variables on outcome like mothers’ age, educational level and employment status, and child’s gender and nutritional status were also taken into account. The levels of some independent variables were reduced for the analytic reasons. Mother’s educational level was defined as high (more than 10 years old) and low (less or equal to 10 years of education) after reducing 4 levels. Breastfeeding, assessing the nutritional status of children was reduced from five levels into two: never breastfed or breastfed up to 2 months (one level) and breastfed more than 2 months (another level). In children, anthropometrics are increasingly significant and the best indicators of nutritional status [20, 28]. Acute malnutrition or past (chronic) malnutrition is generally characterized by low weight-for-age (WA), which is an indicator of being underweight [2]. Mid-upper arm 17
circumference, which is used for estimating acute malnutrition in emergency cases were considered inappropriate. Another parameter - weight-for-height (WH) is an indicator that relates body mass to stature (wasting). Height-for-age (HA) is a measure of linear growth and considered as an indicator of past nutritional adequacy. Any deficit of this indicator is the sign of stunting [25]. As a cut-off level ±2 Z-scores of WA, WH, and HA were considered abnormal. Another method of nutritional assessment is determining the hemoglobin (Hb) concentration or hematocrit (Hct), where for children aged 2-5 and 5-8 years old anemia is defined as an hemoglobin concentration < 11.2 g/dl (hematocrit < 34%) and 11.5 g/dl (hematocrit 34.5%) respectively [29, 30]. However, the effectiveness of screening on anemia will be lowered if the cut-off level is not adjusted for high and mid altitudes, mentioned in many studies [29] (Table 4). Therefore, during analysis of this study the cut-off level was defined as 11.4g/dl (11.2 + 0.2) for children aged 2-5, 11.7 g/dl (11.5 + 0.2) for children aged 5-8, and 12.1 g/dl (11.9 + 0.2) for children after 8 (Table 3). [31, 32, 33]. These cut-off levels were defined due to adaptive responses of hematological parameters to high and mid altitude environment and the elevated hemoglobin concentration in high and low altitude is explained by systolic pulmonary arterial pressure (Ppa) difference [32]. Data collection and management Collected data was paper-based information with different types of variable measurement. The data were coded and data screen was formatted, using SPSS-11 software package. In order to eliminate the errors cleaning and double entry with checking were performed, regrouping and recoding were used for analyzing the data [22]. The data, used for assessment of nutritional status were transferred and analyzed in EpiInfo2000. Main statistical methods, used to analyze the data were variance ratio, two-sample t-test with equal variances, Pearson chi-square, and 18
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Page 5 and 6: Abstract Rationale and main goal: T
Page 7 and 8: stress, loss of sense of control, a
Page 9 and 10: important parts of decision-making
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Page 29 and 30: Tables Table 1. Socio-demographic c
Page 31 and 32: Table 4. Adjustment of maximum hemo
Page 33 and 34: Table 9. Results of simple logistic
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Page 41 and 42: Appendix 3 CONSENT FORM Children’
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A M E R I C A N U N I V E R S I T Y O F A R M E N I A - CHSR

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