Objective  To explore quantitative association of peripheral blood hemoglobin with fever and diarrhea among infants and young children in rural regions of Hunan province.

  Methods  The data of the study were from a surveillance program for children nutrition improvement conducted during October – December 2017 among 3 630 children of 6 – 23 months old randomly selected with multistage stratified sampling in 12 counties in poverty stricken rural regions across Hunan province. The children′s information on demographic characteristics, feeding practice, and incidence of fever and diarrhea during past two weeks were collected by questionnaire interviews with their caregivers; fingertip blood of the children were sampled for hemoglobin detection using Swedish HemoCue 301 portable hemoglobin analyzer. Unconditional multivariate logistic regression model was used to adjust potential confounding factors for analyzing the associate of peripheral blood hemoglobin with incidences of fever and diarrhea.

  Results  The detection rate of anemia in the children was 28.7% (1 042/3 630). Of the children, 8.8%, 19.9%, 33.9%, 25.2%, and 12.2% had the blood hemoglobin of < 100, 100 – 109, 110 – 119, 120 – 129, and ≥ 130 g/L, respectively. The reported two-week incidence rate of fever and diarrhea were 15.1% and 14.0% in the children. The results of multivariate logistic regression analysis demonstrated that anemia was an independent risk factor for fever and diarrhea, with the adjusted odds ratio (OR) of 1.57 (95% confidence interval 95% CI:1.29 – 1.91) and 1.40 (95% CI:1.14 – 1.71). An inverse correlation between peripheral blood hemoglobin levels and the two-week incidence rate of fever and diarrhea was observed; compared to the hemoglobin of 120 – 129 g/L, the hemoglobin of < 100 and 100 – 109 g/L were associated with increased risks of fever morbidity, with the adjusted OR of 1.89 (95% CI: 1.34 – 2.67) and 1.67 (95% CI: 1.27 – 2.21); the hemoglobin of < 100, 100 – 109, and 110 – 119 g/L were also associated with increased risk of diarrhea morbidity, with the adjusted OR of 1.84 (95% CI: 1.28 – 2.64), 1.67 (95% CI: 1.24 – 2.24), and 1.34 (95% CI: 1.02 – 1.76), respectively.

  Conclusion  The two-week incidence rate of fever and diarrhea morbidity was high and affected by peripheral blood hemoglobin among 6 – 23 months old children in rural regions of Hunan province; effective prevention and treatment of anemia could reduce incidence rates of fever and diarrhea in the children.