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Karekezi P, Nzabakiriraho JD, Gayawan E. Modeling the shared risks of malaria and anemia in Rwanda. PLoS One 2024; 19:e0298259. [PMID: 38648210 PMCID: PMC11034660 DOI: 10.1371/journal.pone.0298259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/22/2024] [Indexed: 04/25/2024] Open
Abstract
In sub-Saharan Africa, malaria and anemia contribute substantially to the high burden of morbidity and mortality among under-five children. In Rwanda, both diseases have remained public health challenge over the years in spite of the numerous intervention programs and policies put in place. This study aimed at understanding the geographical variations between the joint and specific risks of both diseases in the country while quantifying the effects of some socio-demographic and climatic factors. Using data extracted from Rwanda Demographic and Health Survey, a shared component model was conceived and inference was based on integrated nested Laplace approximation. The study findings revealed similar spatial patterns for the risk of malaria and the shared risks of both diseases, thus confirming the strong link between malaria and anaemia. The spatial patterns revealed that the risks for contracting both diseases are higher among children living in the districts of Rutsiro, Nyabihu, Rusizi, Ruhango, and Gisagara. The risks for both diseases are significantly associated with type of place of residence, sex of household head, ownership of bed net, wealth index and mother's educational attainment. Temperature and precipitation also have substantial association with both diseases. When developing malaria intervention programs and policies, it is important to take into account climatic and environmental variability in Rwanda. Also, potential intervention initiatives focusing on the lowest wealth index, children of uneducated mothers, and high risky regions need to be reinforced.
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Affiliation(s)
| | | | - Ezra Gayawan
- African Institute for Mathematical Sciences (AIMS), Kigali, Rwanda
- Department of Statistics, Federal University of Technology, Akure, Nigeria
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Asmare AA, Agmas YA. Determinants of coexistence of undernutrition and anemia among under-five children in Rwanda; evidence from 2019/20 demographic health survey: Application of bivariate binary logistic regression model. PLoS One 2024; 19:e0290111. [PMID: 38578819 PMCID: PMC10997128 DOI: 10.1371/journal.pone.0290111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/01/2023] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Undernutrition and anemia are significant public health issues among under-5 children, with potential long-term consequences for growth, development, and overall health. Thus, this study aims to conduct a bivariate binary logistic regression model by accounting for the possible dependency of childhood undernutrition and anemia. METHODS The data came from the DHS program's measurement. A total of 3,206 under-five children were involved in this study. A single composite index measure was calculated for stunting, wasting, and underweight using principal component analysis. A bivariate binary logistic regression model is used to assess the association between undernutrition and anemia given the effect of other predictors. RESULTS Among 3,206 under-five children considered in this study, 1482 (46.2%) and 658 (20.5%) children were agonized by anemia and undernutrition, respectively. In bivariate binary logistic regression model; Urban children [AOR = 0.751, 96% CI: 0.573-0.984; AOR = 0.663, 95% CI: 0.456-0.995] and anemic mothers [AOR = 1.160, 95% CI: 1.104-1.218; AOR = 1.663, 95% CI: 1.242-2.225] were significantly associated with both childhood anemia and undernutrition, respectively. Improved water sources [AOR = 0.681, 95% CI: 0.446-0.996], average-sized children [AOR = 0.567, 95% CI: 0.462-0.696], and diarrhea [AOR = 1.134, 95% CI: 1.120-2.792] were significantly associated with childhood anemia. Large-sized children [AOR = 0.882, 95% CI: 0.791-0.853] and those with fever [AOR = 1.152, 95% CI: 1.312-2.981] were significantly associated with under-five children's undernutrition. CONCLUSION The prevalence of both undernutrition and anemia among under-five-year-old children was high in Rwanda. The following determinants are statistically associated with both childhood undernutrition and anemia: place of residence; source of drinking water; maternal anemia; being a twin; birth size of children; diarrhea; fever; and child age. Anemia and nutritional deficiencies must be treated concurrently under one program, with evidence-based policies aimed at vulnerable populations.
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Affiliation(s)
| | - Yitateku Adugna Agmas
- Department of Rural Development and Agricultural Extension, Mekdela Amba University, Tuluawlyia, Ethiopia
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Individual, household and area predictors of anaemia among children aged 6–59 months in Nigeria. PUBLIC HEALTH IN PRACTICE 2022; 3:100229. [PMID: 36101749 PMCID: PMC9461611 DOI: 10.1016/j.puhip.2022.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/11/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives This study aims to determine the prevalence of anaemia among children aged 6–59 months in all states of Nigeria, including the Federal Capital Territory (FCT), and to quantify the predicted probabilities by individual, household and area factors. Study design This study is a secondary analysis of data sets from two national representative cross-sectional surveys in Nigeria: the Nigeria Demographic and Health Survey (2018 NDHS) and the National Human Development Index (2018 NHDR). The state human development index (HDI) and the state multidimensional poverty index (MPI) from the 2018 NHDR were incorporated into the 2018 NDHS. Methods The study included a weighted sample of 10,222 children aged 6–59 months. Both univariate and bivariate analyses were computed to determine the prevalence and factors associated with anaemia status, respectively. Multiple binary logistic regression analyses with adjusted predicted probabilities (APPs) were performed to quantify the predictors’ probabilities. Results The prevalence of anaemia among children aged 6–59 months in Nigeria was 68.1% (6962/10,222). Zamfara state had the highest prevalence (84.0% [266/317]), while Kaduna state recorded the lowest (50.0% [283/572]). The APPs of being anaemic decreased from 82.9% (95% confidence interval [CI]: 80.0–85.8) for children aged 6–18 months to 60.6% (95% CI: 56.8–64.4) for children aged 43–59 months, when other predictors were held constant. The APP for a child of an anaemic mother is 10.2% points higher than the APP for a child whose mother is not anaemic. In addition, the APPs for children decreased as the age group of their mothers increased. A child from a state that is mildly deprived in the MPI has a lower APP (67.2% [95% CI: 62.2–72.2]) compared with a child from highly deprived MPI state (79.0% [95% CI: 73.4–84.5]). Conclusions Health strategies, including supplementation programmes, should be carried out at both ante-natal and post-natal clinics to reduce the prevalence of anaemia, especially in vulnerable population groups.
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Okyere J, Aboagye RG, Ahinkorah BO, Seidu AA, Ameyaw EK, Budu E, Zegeye B, Yaya S. High-risk fertility behaviour and childhood anaemia in sub-Saharan Africa. BMJ Open 2022; 12:e051921. [PMID: 35545380 PMCID: PMC9096488 DOI: 10.1136/bmjopen-2021-051921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study sought to examine the association between high-risk fertility behaviour and childhood anaemia in sub-Saharan Africa . DESIGN An analytical study was conducted using cross-sectional data from mothers with children under age 5 (n=64 512) from 28 sub-Saharan African countries. Multilevel logistic regression models were fitted to examine the association between high-risk fertility behaviour and childhood anaemia. The results were presented using adjusted odds ratios (aORs) with 95% confidence interval (CI). SETTING Twenty-eight sub-Saharan African countries. OUTCOME MEASURE Childhood anaemia. RESULTS The percentage of children with anaemia in the 28 countries was 66.7%. We found that age more than 34 at delivery and short birth interval had significant associations with childhood anaemia. Children of mothers whose most recent delivery occurred after 34 years were less likely to be anaemic compared with those whose most recent delivery occurred before age 34 (aOR=0.89; 95% CI 0.83 to 0.95). We found that children born to mothers with short birth intervals were more likely to be anaemic, compared with those with long birth intervals (aOR=1.08; 95% CI 1.01 to 1.16). CONCLUSIONS We, therefore, draw the attention of policy makers and programme implementers to invest in policies and programmes aimed at combating childhood anaemia in sub-Saharan Africa to focus on the population at risk, that is, women whose most recent delivery occurred at younger ages and those with short birth intervals. Encouraging contraceptive use and creating awareness about the importance of birth spacing among reproductive-age women would be more helpful.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Bright Opoku Ahinkorah
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Abstract
BACKGROUND Rwanda's commitment to reducing malnutrition is evident in their multisectoral nutrition policy and wide array of nutrition partners. However, the prevalence of micronutrient deficiencies and the suitability of current strategies to address existing deficiencies is unclear. OBJECTIVE To review the available evidence related to the prevalence of micronutrient deficiencies across the life cycle and strategies in place to address them. METHODS We reviewed scientific and grey literature on nutritional problems in Rwanda, emphasizing micronutrient deficiencies and anemia, and current strategies to address micronutrient malnutrition. RESULTS Overall, there is scant evidence related to the types and prevalence of micronutrient deficiencies among populations across the life cycle in Rwanda. Existing evidence is primarily limited to outdated or small regional surveys focusing on iron or vitamin A among women and young children. Surveys have assessed the prevalence of anemia and indicate that anemia is very high among young children and moderately high among other age-groups. However, there are limited data on the context-specific causes of anemia in Rwanda across population groups. Current nutrition strategies mainly target women and young children and are primarily designed to reduce vitamin A deficiency and/or anemia caused by micronutrient deficiencies. CONCLUSIONS Rwanda has many nutrition programs in place that address micronutrient deficiencies in young children and a few for women of reproductive age. However, gaps exist in knowledge of the extent of different types of micronutrient deficiencies among all populations across the life cycle and whether the delivery of nutrients through current programs is meeting actual needs.
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Affiliation(s)
| | - Deanna K Olney
- 8357International Food Policy Research Institute, Washington, DC, USA
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Woldegebriel AG, Gebrehiwot GG, Desta AA, Ajemu KF, Berhe AA, Woldearegay TW, Bezabih NM. Identification of Factors Influencing Anemia among Children Aged 6-59 Months in Ethiopia Using Ethiopia Demographic and Health Survey 2016 Data. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:161-175. [PMID: 33824615 PMCID: PMC8018423 DOI: 10.2147/phmt.s283681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
Background Anemia is the most common nutritional problem and a widespread micronutrient-deficiency disorder on a global scale. In Ethiopia, childhood anemia is highly prevalent and a major public health concern. This study aimed to identify factors associated with anemia among children aged 6–59 months in Ethiopia. Methods Data weres extracted from the 2016 Ethiopia Demographic and Health Survey (EDHS). We found records for 8,603 children aged 6–59 months in the data set. After 448 had been excluded due to incomplete records, 8,155 children were included in the final analysis. Pearson’s χ2 was used to assess associations between each factor and categorical outcome variables. Multivariate logistic regression analyses were done to determine factors associated with anemia, and significant associations were declared at p≤0.05 for the final model. Results More than half (51.5%) the children were male and the overall mean age was 31.85±15.66 months. Mean hemoglobin concentration was 10.37±17.55 g/dL. The overall prevalence of anemia was 56.6%: 3.7%, 30.4%, and 22.5% severe, moderate, and mild anemia, respectively. Increased child age, decreased maternal age, lowest rung on wealth index, mother living alone, mother engaged in outside work, increased birth order, decreased birth interval, one antenatal care visit, severe stunting, and severe underweight were significantly associated with anemia. Conclusion The prevalence of anemia in this study was the highest of all EDHS reports. It had increased since the preceding report (EDHS 2011), and remains the main public health concern in Ethiopia. Comprehensive intervention strategies should be put in place and tailored to different levels of government (national, regional, and district) including household- and individual-level interventions for combating childhood anemia by focusing on the identified risk factors.
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Affiliation(s)
| | | | - Abraham Aregay Desta
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Kiros Fenta Ajemu
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Asfawosen Aregay Berhe
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Nega Mamo Bezabih
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
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Yimgang DP, Buchwald AG, Coalson JE, Walldorf JA, Bauleni A, Kapito-Tembo A, Mathanga DP, Taylor TE, Laufer MK, Cohee LM. Population Attributable Fraction of Anemia Associated with P. falciparum Infection in Children in Southern Malawi. Am J Trop Med Hyg 2021; 104:1013-1017. [PMID: 33399043 DOI: 10.4269/ajtmh.20-1120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/16/2020] [Indexed: 01/09/2023] Open
Abstract
Anemia is a leading cause of morbidity in sub-Saharan Africa. The etiologies of anemia are multifactorial, and it is unclear what proportion of anemia is attributable to malaria in children of different ages in Malawi. We evaluated the population attributable fraction (PAF) of anemia due to malaria using multiple cross-sectional surveys in southern Malawi. We found a high prevalence of anemia, with the greatest proportion attributable to malaria among school-age children (5-15 years) in the rainy season (PAF = 18.8% [95% CI: 16.3, 21.0], compared with PAF = 5.2% [95% CI: 4.0, 6.2] among young children pooled across season [< 5 years] and PAF = 9.7% [95% CI: 6.5, 12.4] among school-age children in the dry season). Malaria control interventions will likely lead to decreases in anemia, especially among school-age children.
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Affiliation(s)
- Doris P Yimgang
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea G Buchwald
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jenna E Coalson
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Jenny A Walldorf
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andy Bauleni
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Atupele Kapito-Tembo
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Don P Mathanga
- Malaria Alert Center, University of Malawi College of Medicine, Blantyre, Malawi
| | - Terrie E Taylor
- Department of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland
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Shimanda PP, Amukugo HJ, Norström F. Socioeconomic factors associated with anemia among children aged 6-59 months in Namibia. J Public Health Afr 2020; 11:1131. [PMID: 33209233 PMCID: PMC7649727 DOI: 10.4081/jphia.2020.1131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 10/17/2019] [Indexed: 11/23/2022] Open
Abstract
Anemia remains a public health concern, and its prevalence varies between countries as well as between age, sex and levels of poverty. This study aims at examining the association between socio-demographic factors and anemia among children aged 6–59 months in Namibia. Data was extracted from the 2013 Namibian Demographic Health Survey. The association between anemia and other factors was examined with logistic regression. Results are reported in odds ratio (OR), with 95% confidence intervals (CI). In total, 1,383 children aged 6–59 months had complete data and included in the analyses. Our study shows that there is a statistically significantly increased risk of anemia among children from poorer households compared with the richest quintile. Also, there was a statistically significance supporting anemia being more common among boys than girls. There was also a statistically significant negative effect related to age. Our study shows that young children, boys and children in poorer households have an increased risk of anemia. Considering the adverse impact of anemia on child development, policies must prioritize factors exacerbating anemia risk.
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Affiliation(s)
- Panduleni Penipawa Shimanda
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Clara Barton School of Nursing, Welwitchia Health Training Centre, Windhoek, Namibia
| | - Hans Justus Amukugo
- School of Nursing Science, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Fredrik Norström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Moschovis PP, Wiens MO, Arlington L, Antsygina O, Hayden D, Dzik W, Kiwanuka JP, Christiani DC, Hibberd PL. Individual, maternal and household risk factors for anaemia among young children in sub-Saharan Africa: a cross-sectional study. BMJ Open 2018; 8:e019654. [PMID: 29764873 PMCID: PMC5961577 DOI: 10.1136/bmjopen-2017-019654] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Anaemia affects the majority of children in sub-Saharan Africa (SSA). Previous studies of risk factors for anaemia have been limited by sample size, geography and the association of many risk factors with poverty. In order to measure the relative impact of individual, maternal and household risk factors for anaemia in young children, we analysed data from all SSA countries that performed haemoglobin (Hb) testing in the Demographic and Health Surveys. DESIGN AND SETTING This cross-sectional study pooled household-level data from the most recent Demographic and Health Surveys conducted in 27 SSA between 2008 and 2014. PARTICIPANTS 96 804 children age 6-59 months. RESULTS The prevalence of childhood anaemia (defined as Hb <11 g/dL) across the region was 59.9%, ranging from 23.7% in Rwanda to 87.9% in Burkina Faso. In multivariable regression models, older age, female sex, greater wealth, fewer household members, greater height-for-age, older maternal age, higher maternal body mass index, current maternal pregnancy and higher maternal Hb, and absence of recent fever were associated with higher Hb in tested children. Demographic, socioeconomic factors, family structure, water/sanitation, growth, maternal health and recent illnesses were significantly associated with the presence of childhood anaemia. These risk factor groups explain a significant fraction of anaemia (ranging from 1.0% to 16.7%) at the population level. CONCLUSIONS The findings from our analysis of risk factors for anaemia in SSA underscore the importance of family and socioeconomic context in childhood anaemia. These data highlight the need for integrated programmes that address the multifactorial nature of childhood anaemia.
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Affiliation(s)
| | - Matthew O Wiens
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Olga Antsygina
- Scientific Research Institute of Healthcare Organization and Medical Management, Moscow, Russia
| | - Douglas Hayden
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Walter Dzik
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - David C Christiani
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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