Geographical variation and temporal trend in anemia among children aged 6-59 months in low- and middle-income countries during 2000-2018: forecasting the 2030 SDG target

Change in the prevalence of anemia in children aged 6-59 months using the new World Health Organization 2024 criteria

The World Health Organization (WHO) has published new hemoglobin cutoff points for defining anemia and its measurement. This change could impact the prevalence of anemia, particularly in countries with populations living in high-altitude areas. This study estimates the national prevalences of anemia in children aged 6-59 months using Centers for Disease Control and Prevention (CDC) 1989 and WHO 2024 criteria. Data from 406,106 children in 48 countries (45 Demographic and Health Surveys [DHS Program] and 3 Andean [Ecuador, Bolivia, and Peru]) were analyzed. The pooled prevalence of anemia was 61.4% according to the WHO 2024 criteria. Three countries showed changes in anemia prevalence, with shifts of 10 or more percentage points (Uganda, Rwanda, and Jordan). Across all the studied countries, the prevalence of anemia was higher at greater altitudes, rural areas, and children from households of low wealth quintiles, regardless of the criteria used. Moreover, changes in anemia prevalence were identified when stratified by altitude of residence, showing differences in the levels of public health significance across various political-administrative regions in Andean countries. Overall, these findings provide valuable insights into the epidemiology of anemia and highlight the need for continued surveillance and targeted interventions to effectively address this global health challenge.

Childhood undernutrition mediates the relationship between open defecation with anemia among Ethiopian children: a nationally representative cross-sectional study

BACKGROUND

Poor sanitation and/or open defecation are a significant public health problem in Ethiopia, where access to improved sanitation facilities is still limited. There is a growing body of literature about the effect of open defecation on children's linear growth failure. However, very few studies about the effects of open defecation on child anemia exist. In this study, we examine whether childhood undernutrition (i.e. stunting, wasting, and underweight) mediates the relationship between open defecation and childhood anemia in children aged 6-59 months in Ethiopia.

METHODS

We used pooled Ethiopia Demographic and Health Survey data (2005-2016) comprising 21,918 (weighted data) children aged 6-59 months. Anemia was defined as an altitude-adjusted hemoglobin (Hb) level of less than 11 g/deciliter (g/dl) for children under 5 years. Childhood undernutrition was assessed using height-for-age Z-scores (HAZ), weight-for-age Z-scores (WAZ), and weight-for-height Z-scores (WHZ) for stunting, wasting, and underweight respectively. Mediation effects were calculated using the bootstrap and the indirect effect was considered significant when the 95% bootstrap confidence intervals (95% CI) did not contain zero. Moreover, separate multilevel regression analyses were used to explore the statistical association between open defecation and child anemia, after adjusting for potential confounders.

RESULTS

Our analysis revealed that nearly half (49.6%) of children aged 6 to 59 months were anemic, 46.8% were stunted, 9.9% were wasted, and 29.5% were underweight. Additionally, 45.1% of children belonged to households that practiced open defecation (OD). Open defecation was associated with anemia (AOR: 1.28; 95% CI: 1.18-1.39) and it positively predicted anemia with direct effect of β = 0.233, p < 0.001. Childhood undernutrition showed a partial mediating role in the relationship between OD and anemia. Analyzing the indirect effects, results revealed that child undernutrition significantly mediated the relationship between open defecation and anemia (stunting (βindirect = 0.014, p < 0.001), wasting (βindirect = 0.009, p = 0.002), and underweight (βindirect = 0.012, p < 0.001)). When the mediating role of child undernutrition was accounted for, open defecation had a positive impact on anemia with a total effect of βtotal = 0.285, p < 0.001.

CONCLUSION

Open defecation showed a significant direct effect on anemia. Child undernutrition remarkably mediated the relationship between OD and anemia that further magnified the effect. This finding has an important programmatic implication calling for strengthened, accelerated and large-scale implementation of strategies to end open defecation and achieve universal access to sanitation in Ethiopia.

Magnitude, Associated Factors and Morphological Types of Anemia Among Hospitalized 6-59 Months Age Children at Jimma Medical Center, Southwest Ethiopia - A Hospital-Based Cross-Sectional Study

Background

Anemia is among the major public health problems that cause significant morbidity and mortality among children around the world. Anemia in children of age 6 months to 5 years is a major health problem in most developing world countries with estimated prevalence of about 43%.

Objective

To determine the magnitude, associated factors and morphological types of anemia among hospitalized 6-59 months age children from June 15 to October 15, 2022 at Jimma Medical Center, southwest Ethiopia.

Methodology

Hospital-based cross- sectional study design was conducted from June 15 to October 15, 2022 at Jimma Medical Center, involving 383 hospitalized children aged 6-59 months by employing convenient sampling technique. Data of sociodemographic characteristics and other associated factors of the study individuals waere collected using a pre-structured questionnaire. Clinical data were collected by physical examination and from history of client by medical interns and nurses. Then 3 mL venous blood was collected and analyzed for complete blood count. Data were coded, cleared and entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. Bivariable and multivariable binary logistic regression was used to identify associated factors.

Results

The overall prevalence of anemia among hospitalized 6-59 months age children was 57.2%; out of them 30.82% were moderate. In the present study children with malaria infection, AOR = 1.15 (95% CI: 0.017, 0.781), Cchildren with severe malnutrition, AOR = 2.046 (95% CI: 0.306, 1.366), and children with low family income, AOR = 2.6 (95% CI 0.475, 0.894) were independent variables associated with anemia.

Conclusion and Recommendation

Anemia among study participants is found to be a severe public health problem. Based on this finding, more intervention is needed with health education on nutrition and child feeding.

Household environment associated with anaemia among children aged 6-59 months in Ethiopia: a multilevel analysis of Ethiopia demographic and health survey (2005-2016)

BACKGROUND

Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia.

METHODS

In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6-59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05.

RESULTS

The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7-49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1-49.1) in 2005, 42.8% (95%CI: 41.8-43.8) in 2011, and increased to 57.4% (95%CI: 56.3-58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05-1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12-1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13-1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child's age (6-35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05-1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01-1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02-1.19), children from poor households (AOR: 1.18: 95%CI: 1.06-1.31), and rural residence (AOR: 1.23, 95%CI: 1.06-1.42).

CONCLUSION

In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies.

A cross-sectional analysis of ambient fine particulate matter (PM2.5) exposure and haemoglobin levels in children aged under 5 years living in 36 countries

Low haemoglobin (Hb) concentrations and anaemia in children have adverse effects on development and functioning, some of which may have consequences in later life. Exposure to ambient air pollution is reported to be associated with anaemia, but there is little evidence specific to low- and middle-income countries (LMICs), where childhood anaemia prevalence is greatest. We aimed to determine if long-term ambient fine particulate matter (≤2.5 μm in aerodynamic diameter [PM_2.5]) exposure was associated with Hb levels and the prevalence of anaemia in children aged <5 years living in 36 LMICs. We used Demographic and Health Survey data, collected between 2010 and 2019, which included blood Hb measurements. Satellite-derived estimates of annual average PM_2.5 was the main exposure variable, which was linked to children's area of residence. Anaemia was defined according to standard World Health Organization guidelines (Hb < 11 g/dL). The association of PM_2.5 with Hb levels and anaemia prevalence was examined using multivariable linear and logistic regression models, respectively. We examined whether the effects of ambient PM_2.5 were modified by a child's sex and age, household wealth index, and urban/rural place of residence. Models were adjusted for relevant covariates, including other outdoor pollutants and household cooking fuel. The study included 154,443 children, of which 89,904 (58.2%) were anaemic. The country-level prevalence of anaemia ranged from 15.8% to 87.9%. Mean PM_2.5 exposure was 33.0 (±21.6) μg/m³. The adjusted model showed that a 10 μg/m³ increase in annual PM_2.5 concentration was associated with greater odds of anaemia (OR = 1.098 95% CI: 1.087, 1.109). The same increase in PM_2.5 was associated with a decrease in average Hb levels of 0.075 g/dL (95% CI: 0.081, 0.068). There was evidence of effect modification by household wealth index and place of residence, with greater adverse effects in children from lower wealth quintiles and children in rural areas. Exposure to annual PM_2.5 was cross-sectionally associated with decreased blood Hb levels, and greater risk of anaemia, in children aged <5 years living in 36 LMICs.

Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India

India is home to the highest global number of women and children suffering from anemia, with one in every two women impacted. India's current strategy for targeting areas with a high anemia burden is based on district-level averages, yet this fails to capture the substantial small area variation in micro-geographical (small area) units such as villages. We conducted statistical and econometric analyses to quantify the extent of small area variation in the three grades of anemia (severe, moderate, and mild) among women and children across 36 states/union territories and 707 districts of India. We utilized data from the fifth round of the National Family Health Survey conducted in 2019-21. The final analytic sample for analyses was 183,883 children aged 6-59 months and 690,153 women aged 15-49 years. The primary outcome variable for the analysis was the three anemia grades among women and children. We adopted a three-level and four-level logistic regression model to compute variance partitioning of anemia among women and children. We also computed precision-weighted prevalence estimates of women and childhood anemia across 707 districts and within-district, between-cluster variation using standard deviation (SD). For severe anemia among women, small area (villages or urban blocks) account for highest share (46.1%; Var: 0.494; SE: 0.150) in total variation followed by states (39.4%; Var: 0.422; SE: 0.134) and districts (12.8%; Var: 0.156; SE: 0.012). Similarly, clusters account for the highest share in the variation in severe (61.3%; Var: 0.899; SE: 0.069) and moderate (46.4%: Var: 0.398; SE: 0.011) anemia among children. For mild and moderate anemia among women, however, states were the highest source of variation. Additionally, we found a high and positive correlation between mean prevalence and inter-cluster SD of moderate and severe anemia among women and children. In contrast, the correlation was weaker for mild anemia among women (r = 0.61) and children (0.66). In this analysis, we are positing the critical importance of small area variation within districts when designing strategies for targeting high burden areas for anemia interventions.

Prevalence of anemia and its associated factors among under-five age children in Shanan gibe hospital, Southwest Ethiopia

BACKGROUND

Anemia is a major health problem in the worldwide. Because of health and socioeconomic problems, the prevalence of anemia is higher in developing countries. However, there was a limited finding in our study area. Therefore, the aim of this study was to determine the prevalence of anemia and its associated factors among under-five age children in Shanan Gibe Hospital (SGH), Southwest Ethiopia.

METHODS

Institution based cross sectional study was conducted at SGH, Ethiopia using consecutive convenient sampling technique during 1 January to 30 April, 2021. Data was collected by interviewing and capillary blood was taken from the fingertip for hemoglobin determination by using HaemoCue digital photometer. Additionally, stool sample was processed using wet mount and formal-ether concentration technique. Then after, the data were entered to Epidata version 3.1 and analysed with Statistical Package for the Social Sciences (SPSS) version 20. Factors associated with anaemia were assessed by bivariable and multivariable logistic regression model by considering P < 0.05 as statistical significance.

RESULTS

A total of 368 under five children were recruited to the study and the current prevalence of anemia was 48.9%. Of this anemia, 25.0% mild, 15.8% moderate and 8.2% were severely anemic. More ever, being rural resident (AOR = 6.11; 95% CI = 1.49-8.99, P = 0.002), family low income (AOR = 6.27, 95% CI = 1.35-11.43, P = 0.004), family size greater than five (AOR = 3.12; 95% CI =1.47-7.11, P = 0.002) and intestinal parasite infections such as Enteameoba histolytica (AOR =3.37; 95%CI = 2.16-11.31, P = 0.005), Hookworm (AOR = 6.09; 95%CI = 2.37-11.56, P = 0.001), and Trichuris trichuria (AOR = 2.79; 95%CI = 1.45-9.13, P = 0.002) (P < 0.05) were factors significantly associated with anemia among under five children.

CONCLUSION

The current prevalence of anemia among under five age children is relatively high. On the other hand, the rural residence, large family size, low family income, infection with Enteameoba histolytica, hookworm and Trichuris trichuria were the identified factors associated with anemia among under five children. Therefore, there should be massive and routine deworming program in addition to imperative targeting anemia prevention, and nutritional supplementation to reduce the burden of anemia.