Multilevel analysis of anemia levels among reproductive age groups of women in Ethiopia

Prevalence and factors associated with anemia among HIV-infected women in sub-saharan Africa: a multilevel analysis of 18 countries

BACKGROUND

Despite the intended 50% reduction in anemia in women of reproductive age, this tendency has only worsened. Even though iron deficiency is the most prevalent cause of anemia, anemia and chronic illnesses like HIV are closely associated; in fact, 48.6% of people living with HIV who were 15 years of age or older had anemia. However, the burden of anemia among HIV-positive women in sub-Saharan African (SSA) countries is not well documented. Therefore, the goal of our research was to investigate anemia and the factors that are linked to it in SSA women who had HIV infections.

METHODS

A cross-sectional study was conducted using demographic and health survey datasets from 18 SSA countries. A total of 7823 weighted samples were included. STATA version 16 software was used for analysis. A multilevel logistic regression model was fitted. An adjusted odds ratio with a 95% CI and a p-value < 0.05 was used to declare significantly associated factors.

RESULT

The overall prevalence of anemia was found to be 45.1% [95% CI: 43.97-46.18%]. Of those 5.05%, 37.97%, and 56.97% were severely, moderately, and mildly anemic, respectively. Education level of primary [AOR = 0.74, 95% CI: 0.62, 0.89], secondary [AOR = 0.81, 95% CI: 0.68, 0.98], and higher [AOR = 0.74, 95% CI: 0.55, 0.99], as well as current contraceptive use [AOR = 0.74, 95% CI: 0.63, 0.87] were negatively associated with anemia. While pregnancy [AOR = 1.51, 95% CI: 1.17, 1.94], breast feeding [AOR = 1.38, 95% CI: 1.17, 1.64], health insurance [AOR = 1.50, 95% CI: 1.25, 1.80], and menstruation within six weeks prior to data collection [AOR = 1.36, 95% CI: 1.20, 1.54] had a significant positive relation with anemia among HIV-infected women in SSA countries.

CONCLUSION

Anemia is a serious public health problem among HIV-infected women in SSA countries. Pregnancy, breast feeding, health insurance, and menstruation within six weeks prior to data collection were significant risk factors. On the other education and current contraceptive use were significant protective factors for anemia among HIV-infected women in SSA countries. Therefore, strategies aimed at early identification of anemia may lead to an improvement in the health of HIV-infected women.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis

BACKGROUND

Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries.

METHODS

We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software.

RESULTS

The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception.

CONCLUSIONS

Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.

The Effect of Fresh Moringa Leaf Consumption During Pregnancy on Maternal Hemoglobin Level in Southern Ethiopia: Multilevel Analysis of a Comparative Cross-Sectional Study

Purpose

Anemia, especially iron-deficiency anemia during pregnancy, significantly impacts maternal health, fetal growth, and development. Moringa leaf is an iron-rich food that can overcome anemia, but there is a lack of evidence on the association between fresh moringa leaf consumption and maternal hemoglobin level during pregnancy. The aim of this study is to test the effect of fresh moringa leaf consumption during pregnancy on maternal hemoglobin levels in southern Ethiopia.

Methods

A community-based comparative cross-sectional study was conducted from May to June 2022 among 230 fresh moringa leaf consumers and 230 non-consumers pregnant women. Data were collected using an interviewer-administered structured questionnaire and hemoglobin level was determined by HemoCue Hb 301. Multivariate multilevel linear regression models were fitted using Statistical Software for Data Science (STATA) version 14.

Results

The overall mean hemoglobin level among pregnant women was 11.76 g/dl ± 1.47 [12.06 g/dl ± 1.22 among fresh moringa leaf consumers and 11.45 g/dl ± 1.64 among non-consumers] with a significant coefficient of association (β) of 0.90 g/dl [β = 0.90 g/dl, 95% CI: 0.54, 1.27]. A number of under-five children, bleeding during the current pregnancy, male-headed household, and current antenatal care visit were the individual-level factors. Distance from the nearest health facility and urban dweller was identified as the community-level factor associated with maternal hemoglobin level during pregnancy.

Conclusion

This study showed that the consumption of fresh moringa leaf during pregnancy increases the level of hemoglobin. So policymakers and maternal and child health program managers need to target moringa tree scale-up and encourage fresh moringa leaf consumption during pregnancy, but its use needs additional rigorous clinical trials. In addition to this, mark the above factors in their efforts to increase maternal hemoglobin levels during pregnancy.

Determinants of anaemia prevalence in women of reproductive age in Nigeria: A cross-sectional study using secondary data from Nigeria Demographic and Health Survey 2018

BACKGROUND

Anaemia disproportionately affects women of reproductive age in sub-Saharan Africa including Nigeria. Yet, community-based studies on the prevalence and determinants of anaemia among women of reproductive age are scarce in Nigeria.

DESIGN

A cross-sectional community-based survey using a nationally representative sample.

OBJECTIVES

This study described anaemia prevalence and its associated factors among women of reproductive age, pregnant women, and non-pregnant women in Nigeria.

METHODS

We analysed data from the 2018 Nigeria Demographic and Health Survey. Pregnant women with a haemoglobin level less than 11 g/dL and non-pregnant women with a haemoglobin level less than 12 g/dL were considered anaemic. Anaemia was also categorized as mild, moderate, and severe. Pearson's chi-square test was used to evaluate the association between anaemia status and independent variables. All variables with ρ ⩽ 0.25 in bivariate analyses were further analysed using complex sample logistic regression.

RESULTS

Anaemia prevalence was 57.8%, 57.4%, and 61.1% for women of reproductive age, non-pregnant women, and pregnant women, respectively. The prevalence of severe anaemia was 1.6%, 1.5%, and 2.3% for overall women of reproductive age, non-pregnant women, and pregnant women, correspondingly. The southern regions, rural residence, low education, unemployment, low wealth index, and non-use of modern contraceptives significantly increased the likelihood of anaemia and severe anaemia among women of reproductive age and non-pregnant women. The likelihood of being anaemic was significantly increased by large family size among women of reproductive age and by being underweight among non-pregnant women. The South-East region, rural residence, low education, and unemployment were significantly associated with anaemia among pregnant women. The South-South region and unemployment increased the likelihood of severe anaemia among pregnant women. Short stature significantly reduced the odds of being anaemic and severely anaemic among pregnant women.

CONCLUSIONS

Anaemia prevalence among all categories of women of reproductive age is high in Nigeria. Predictors of anaemia prevalence and severity should be considered in policies intended to reduce anaemia among women of reproductive age in Nigeria.

Determinants of anemia status among pregnant women in ethiopia: using 2016 ethiopian demographic and health survey data; application of ordinal logistic regression models

Background

Anemia is a serious public health problem that occurs when the blood contains fewer red blood cells than normal. In Ethiopia, the prevalence of anemia in pregnancy increased between 2005 and 2016. The aim of this study was to determine what factors influence the anemia status of pregnant women in Ethiopia.

Methods

Anemia status in a sample of 1053 pregnant women was studied using data from Ethiopia's Demographic and Health Survey 2016. Percentages and graphs were used to show the prevalence of anemia. The marginal probability effect was used to determine the contribution of each explanatory variable category to a single response category of anemia level. Ordinal logistic regression models were constructed, and the best-fitting model was selected to reveal significant anemia status variables.

Results

The prevalence of anemia in pregnant women was found to be 37.51% (3.04% severe, 17.28% moderate, and 17.1% mild anemic). The fitted partial proportional odds model revealed that anemia status of pregnant women was significantly associated with region afar (OR = 0.45; CI: 0.21–0.96), antenatal care visits above 4 (OR = 1.58; CI: 1.03–2.43), parity between 1–2 (OR = 0.47;CI: 0.26–0.85), iron taking (OR = 3.68;CI: 2.41–5.64), and higher education (OR = 4.75;CI: 2.29–9.85).

Conclusions

Anemia among pregnant women has been identified as a moderate public health issue in Ethiopia. The study revealed that the prevalence of anemia varied among regions which the highest (65.9%) and the lowest (9%) being from Somali and Addis Ababa, respectively. As a result, it is argued that treatments target iron consumption, maternal education, antenatal visits, and mothers' access to health care.