1
|
Dessie G, Li J, Nghiem S, Doan T. Prevalence and Determinants of Stunting-Anemia and Wasting-Anemia Comorbidities and Micronutrient Deficiencies in Children Under 5 in the Least-Developed Countries: A Systematic Review and Meta-analysis. Nutr Rev 2024:nuae063. [PMID: 38820331 DOI: 10.1093/nutrit/nuae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
CONTEXT Despite shifting from addressing isolated forms of malnutrition to recognizing its multifaceted nature, evidence on the prevalence and determinants of micronutrient deficiencies, and their coexistence with undernutrition in children under 5, remains insufficient, unsystematic, and incohesive. OBJECTIVE The aim of this systematic review and meta-analysis was to assess the prevalence and determinants of stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies in children under 5 in the least-developed countries (LDCs). DATA SOURCES Electronic searches took place from January 15, 2023, to February 14, 2024, across multiple databases, including PubMed, Embase, Web of Science, SCOPUS, African Index Medicus (AIM), World Health Organization's Institutional Repository for Information Sharing (IRIS), and African Journals Online. The search spanned the years 2000 to 2024, yet it yielded eligible full-text English research articles from only 2005 to 2021 conducted in LDCs. Studies lacking quantitative data on malnutrition types and their determinants were excluded. DATA EXTRACTION Two independent authors assessed articles for bias and quality using Hoy et al's 10-item scale and Newcastle-Ottawa Scale (NOS) criteria. Prevalence and other details were extracted using a Joanna Briggs Institute Excel template. Authors extracted adjusted odds ratios (aORs) for determinant factors such as sex and vitamin A and iron supplementation. DATA ANALYSIS The search yielded 6248 articles from 46 LDCs. Sixty-nine articles, with a total sample size of 181 605, met inclusion criteria for the final meta-analysis. Vitamin A deficiency affected 16.32% of children, and iodine deficiency affected 43.41% of children. The pooled prevalence of wasting-anemia and stunting-anemia comorbidity was 5.44% and 19.47%, respectively. Stunting was associated with vitamin A deficiency (aOR: 1.54; 95% CI: 1.01-2.37), and not taking vitamin A supplementation was associated with iron-deficiency anemia (aOR: 1.37; 95% CI: 1.21-1.55). CONCLUSION A significant proportion of children under 5 in LDCs experienced stunting-anemia and wasting-anemia comorbidities and micronutrient deficiencies. This study underscores the urgent need to address factors driving these burdens. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023409483.
Collapse
Affiliation(s)
- Getenet Dessie
- College of Medicine and Health Science, Bahir Dar University, Bahir Dar, 79, Ethiopia,
- Department of Health, Economics, Wellbeing and Society, National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, 2601, Australia,
| | - Jinhu Li
- Department of Health, Economics, Wellbeing and Society, National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, 2601, Australia,
| | - Son Nghiem
- Department of Health, Economics, Wellbeing and Society, National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, 2601, Australia,
| | - Tinh Doan
- Department of Health, Economics, Wellbeing and Society, National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, 2601, Australia,
| |
Collapse
|
2
|
Zhu Y, He C, Gasparrini A, Vicedo-Cabrera AM, Liu C, Bachwenkizi J, Zhou L, Cheng Y, Kan L, Chen R, Kan H. Global warming may significantly increase childhood anemia burden in sub-Saharan Africa. ONE EARTH (CAMBRIDGE, MASS.) 2023; 6:1388-1399. [PMID: 37904727 PMCID: PMC7615260 DOI: 10.1016/j.oneear.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Childhood anemia constitutes a global public health problem, especially in low- and middle-income countries (LMICs). However, it remains unknown whether global warming has an impact on childhood anemia. Here, we examined the association between annual temperatures and childhood anemia prevalence in sub-Saharan Africa and then projected childhood anemia burden attributable to climate change. Each 1°C increment in annual temperature was associated with increased odds of childhood anemia (odd ratio = 1.138, 95% confidence interval: 1.134-1.142). Compared with the baseline period (1985-2014), the attributable childhood anemia cases would increase by 7,597 per 100,000 person-years under a high-emission scenario in the 2090s, which would be almost 2-fold and over 3-fold more than those projected in moderate- and low-emission scenarios. Our results reveal the vulnerabilities and inequalities of children for the excess burden of anemia due to climate warming and highlight the importance of climate mitigation and adaptation strategies in LMICs.
Collapse
Affiliation(s)
- Yixiang Zhu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Cheng He
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
- IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200438, China
- Helmholtz Zentrum Mu€nchen - German Research Center for Environmental Health (GmbH), Institute of Epidemiology, Neuherberg, Germany
| | - Antonio Gasparrini
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Statistical Methodology, London School of Hygiene and Tropical Medicine, London, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
- IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200438, China
| | - Jovine Bachwenkizi
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lu Zhou
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yuexin Cheng
- Department of Hematology, The First People’s Hospital of Yancheng, Yancheng Affiliated Hospital of Xuzhou Medical University, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Lena Kan
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
- IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200438, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
- IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200438, China
- Children’s Hospital of Fudan University, National Center for Children’s Health, Shanghai, China
| |
Collapse
|
3
|
Mutumba R, Mbabazi J, Pesu H, Greibe E, Olsen MF, Briend A, Mølgaard C, Ritz C, Mupere E, Filteau S, Friis H, Grenov B. Micronutrient Status and Other Correlates of Hemoglobin among Children with Stunting: A Cross-Sectional Study in Uganda. Nutrients 2023; 15:3785. [PMID: 37686816 PMCID: PMC10489905 DOI: 10.3390/nu15173785] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
In low-income countries, undernutrition and infections play a major role in childhood anemia. Stunted children may be at particular risk of anemia. In a cross-sectional study nested in a nutrition trial among 12-59-month-old stunted children in eastern Uganda, we measured hemoglobin (Hb) and markers of iron, cobalamin, folate and vitamin A status. We assessed low micronutrient status, socio-demography, stunting severity, inflammation and malaria as correlates of Hb and anemia using linear and logistic regression analyses, respectively. Of 750 stunted children, the mean ± SD age was 32.0 ± 11.7 months and 55% (n = 412) were male. The mean Hb was 104 ± 15 g/L and 65% had anemia, Hb < 110 g/L. In a multivariable model with age, sex and inflammation, the following were associated with lower Hb: serum ferritin < 12 µg/L (-5.6 g/L, 95% CI: -8.6; -2.6), transferrin receptors > 8.3 mg/L (-6.2 g/L, 95% CI: -8.4; -4.0), plasma folate <20 nmol/L (-4.6 g/L, 95% CI: -8.1;-1.1), cobalamin < 222 pmol/L (-3.0 g/L, 95% CI: -5.4; -0.7) and serum retinol-binding protein < 0.7 µmol/L (-2.0 g/L, 95% CI: -4.1; 0.2). In addition, severe stunting, inflammation and malaria were negative correlates. Anemia is common among stunted children in eastern Uganda; micronutrient deficiencies, inflammation and malaria are associated with low Hb.
Collapse
Affiliation(s)
- Rolland Mutumba
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Joseph Mbabazi
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Hannah Pesu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, 8200 Aarhus N, Denmark;
| | - Mette F. Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - André Briend
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, 33100 Tampere, Finland
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - Christian Ritz
- National Institute of Public Health, University of Southern Denmark, 5230 Odense M, Denmark;
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda;
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| | - Benedikte Grenov
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg C, Denmark; (J.M.); (H.P.); (M.F.O.); (A.B.); (C.M.); (H.F.); (B.G.)
| |
Collapse
|
4
|
Fentaw W, Belachew T, Andargie A. Anemia and associated factors among 6 to 59 months age children attending health facilities in Kombolcha town, Northeast Ethiopia: a facility-based cross-sectional study. BMC Pediatr 2023; 23:209. [PMID: 37138229 PMCID: PMC10154745 DOI: 10.1186/s12887-023-04031-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Childhood anemia is an important public health problem in Ethiopia. The northeast part of the country is among the areas affected by recurrent drought. Despite its significance, studies are scarce on childhood anemia particularly, in the study area. This study aimed to assess the proportion and factors associated with anemia among under-five children in Kombolcha town. METHODS A facility-based cross-sectional study was conducted among 409 systematically selected 6 to 59 months aged children visited health institutions in Kombolcha town. Data were collected using structured questionnaires from mothers/caretakers. The data entry and analysis were done using EpiData version 3.1 and SPSS version 26 respectively. Binary logistic regression was fitted to identify factors associated with anemia. Statistical significance was declared at p-value ≤ 0.05. The effect size was reported using the adjusted odds ratio with its 95% confidence interval. RESULTS Of the participants, 213(53.9%) were males with a mean age of 26 months (SD ± 15.2). The proportion of anemia was 52.2% (95% CI, 46.8-57%). Being in the age of 6-11 months (AOR = 6.23, 95% CI: 2.44, 15.95), 12-23 months (AOR = 3.74, 95%CI: 1.63, 8.60), having low dietary diversity score (AOR = 2.61, 95% CI: 1.55, 4.38), having a history of diarrhea (AOR = 1.87, 95% CI: 1.12, 3.12) and having the lowest family monthly income (AOR = 16.97, 95% CI: 4.95, 58.20) were positively associated with anemia. Whereas, maternal age ≥ 30 years (AOR = 0.37 (0.18, 0.77) and exclusive breastfeeding until six months (AOR = 0.27, 95% CI: 0.16, 0.45) were negatively associated with anemia. CONCLUSIONS Childhood anemia was a public health problem in the study area. Child age, maternal age, exclusive breastfeeding, dietary diversity score, diarrhea, and family income were significantly associated with anemia.
Collapse
Affiliation(s)
- Wubshet Fentaw
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Assefa Andargie
- Department of Public Health, College of Medicine and Health Science, Injibara University, Injibara, Ethiopia.
| |
Collapse
|
5
|
Rawat A, Karlstrom J, Ameha A, Oulare M, Omer MD, Desta HH, Bahuguna S, Hsu K, Miller NP, Bati GT, Rasanathan K. The contribution of community health systems to resilience: Case study of the response to the drought in Ethiopia. J Glob Health 2022; 12:14001. [PMID: 36273279 PMCID: PMC9588157 DOI: 10.7189/jogh.12.14001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Ethiopia’s exposure to the El Niño drought (2015-2016) resulted in high malnutrition, internally displaced people, and epidemics of communicable diseases, all of which strained the health system. The drought was especially challenging for mothers and children. We aimed to identify salient factors that can improve health system resilience by exploring the successes and challenges experienced by a community-based health system during the drought response. Methods We collected data via key informant interviews and focus group discussions to capture diverse perspectives across the health system (eg, international, national, district, facility, and community perspectives). Data were collected from communities in drought-affected regions of: 1) Somali, Sitti Zone, 2) Hawassa, Southern Nations, Nationalities, and Peoples’ Region (SNNPR), and 3) Tigray, Eastern Zone. Data were analysed using a deductive-inductive approach using thematic content analysis applied to a conceptual framework. Results A total of 94 participants were included (71 from the communities and 23 from other levels). Key themes included the importance of: 1) organized community groups linked to the health system, 2) an effective community health workforce within strong health systems, 3) adaptable human resource structures and service delivery models, 4) training and preparedness, and 5) strong government leadership with decentralized decision making. Conclusions The results of this study provide insights from across the health system into the successes and challenges of building resilience in community-based health systems in Ethiopia during the drought. As climate change exacerbates extreme weather events, further research is needed to understand the determinants of building resilience from a variety of shocks in multiple contexts, especially focusing on harnessing the power of communities as reservoirs of resilience.
Collapse
Affiliation(s)
- Angeli Rawat
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Agazi Ameha
- UNICEF Ethiopia Country Office, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | - Gemu Tiru Bati
- Federal Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | | |
Collapse
|
6
|
Roro M, Deressa W, Lindtjørn B. Influence of intrauterine factors on birth weight and on child linear growth in rural Ethiopia: A prospective cohort study. PLoS One 2022; 17:e0272620. [PMID: 35930573 PMCID: PMC9355213 DOI: 10.1371/journal.pone.0272620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Little is known about the influence of intrauterine fetal factors on childhood growth in low-income countries. The objective of this study was to examine the influence of intrauterine fetal growth on child linear growth in rural Ethiopia. Methods We conducted a prospective community-based cohort study from July 2016 to October 2018. All pregnant women with gestational age of 24 weeks or below living in 13 kebeles, in central Ethiopia were enrolled. The fetuses were followed from pregnancy up to 11–24 months after birth. We measured biparietal diameter, head circumference, femoral length, and abdominal circumference at 26, 30 and 36 weeks of pregnancy. At birth, we measured infant weight. At 11–24 months of age, z-scores of length- for- age, and weight-for-length were calculated. A multilevel, mixed-effect, linear regression model was used to examine the influence of fetal, newborn, maternal, household factors and residence area on child linear growth. Results We included 554 children. The prevalence rate of stunting was 54.3% and that of wasting was 10.6%. Fetal biparietal diameter, head circumference, and abdominal circumference, were significantly associated with birth weight. Femoral length z-score in early pregnancy, gestational age at delivery and child age were significantly associated with length-for-age z-score. Family size was significantly associated with length-for-age z-score. Family size and maternal height were associated with weight-for-height z-score. There was a large variation in length-for-age z-score (Intra cluster correlation, or ρ (rho) = 0.30) and weight-for-length z-score (ρ = 0.22) than of birth weight of new-born (ρ = 0.11) in kebeles indicating heterogeneity in clusters for length-for-age z-score and weight-for-length z-score than birth weight. Conclusions Child linear growth was influenced by fetal growth, duration of pregnancy, maternal height, and family size. Environmental factors that are associated with the area of residence play a bigger role for linear growth than for birth weight.
Collapse
Affiliation(s)
- Meselech Roro
- Centre for International Health, University of Bergen, Bergen, Norway
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Wakgari Deressa
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
Exploration of the relationship between anemia and iron and zinc deficiencies in children under 5 years of age living in the malaria endemic area of South Kivu/Democratic Republic of Congo. Ann Hematol 2022; 101:1181-1189. [PMID: 35320403 DOI: 10.1007/s00277-022-04816-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/07/2022] [Indexed: 11/01/2022]
Abstract
The aim of this study was to explore the relationship of iron and zinc deficiencies and anemia in children aged under 5 years living in malaria endemic area of South Kivu/DRC. We conducted a cross-sectional study in the health zone of Miti Murhesa in South Kivu/DRC. A total of 1088 children in good general health were included in this study. Almost 40% of children were anemic. The prevalence of iron deficiency (ID) was found in 34.9% and 49.1% children based on ferritin or free erythrocyte protoporphyrin (FEP), respectively. If anemia is present, we found iron deficiency anemia (IDA) according to the WHO-criteria (ferritin) in 31%, and according to FEP in 66% of children. The overall prevalence of zinc deficiency was 17.6%. If anemia is present, zinc deficiency was found in 24.4% of children. Inflammation/infection, based upon CRP, was present in 39.7% children. The independent factors associated with anemia were recent illness, middle upper arm circumference, weight-for-height, ID according to FEP, zinc deficiency, and submicroscopic Plasmodium infection. A high prevalence of ID was observed in children in South Kivu according to FEP. Ferritin as acute phase protein was less suited in this population due to a high frequency of infection/inflammation. Iron and zinc deficiencies were found to be significantly associated with anemia in this population.
Collapse
|
8
|
Gaston RT, Habyarimana F, Ramroop S. Joint modelling of anaemia and stunting in children less than five years of age in Lesotho: a cross-sectional case study. BMC Public Health 2022; 22:285. [PMID: 35148690 PMCID: PMC8840695 DOI: 10.1186/s12889-022-12690-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 01/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia and stunting remain jointly a serious health issue worldwide especially in developing countries. In Lesotho, their prevalence is high, particularly among children less than 5 years of age. OBJECTIVES The primary objective was to determine the association between anaemia and stunting, and identify factors relating to both conditions among children younger than 5 years in Lesotho. METHODS This cross-sectional study used secondary data from 3112 children collected during the 2014 Lesotho Demographic Health Survey (LDHS). Haemoglobin (Hb) levels were adjusted for altitude and a level less than 11 g per deciliters (11 g/dl) was determined as the cutoff for being anaemic. A child with the height-for-age z score (HAZ) below minus two standard deviations (SD) was considered to have stunting. We linked factors relating to anaemia and stunting using a multivariate joint model under the scope of the generalized linear mixed model (GLMM). RESULTS The prevalence of anaemia and stunting in children younger than 5 years were 51% and 43% respectively. The multivariate results revealed a strong association between anaemia and stunting. In addition, maternal education, urban vs. rural residence, wealth index and childbirth weight significantly impacted childhood stunting or malnutrition, while having fever and/or diarrhoea was linked to anaemia. Lastly, age was shown to have a significant effect on both stunting and anaemia. CONCLUSION Anaemia and stunting or malnutrition showed linked longitudinal trajectories, suggesting both conditions could lead to synergetic improvements in overall child health. Demographic, socio-economic, and geographical characteristics were also important drivers of stunting and anaemia in children younger than 5 years. Thus, children living in similar resources settings as Lesotho could benefit from coordinated programs designed to address both malnutrition and anaemia.
Collapse
Affiliation(s)
- Rugiranka Tony Gaston
- School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg CampusScottsville, 3209, South Africa. .,Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Private Bag X01, Westville, 3629, South Africa.
| | - Faustin Habyarimana
- School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg CampusScottsville, 3209, South Africa
| | - Shaun Ramroop
- School of Mathematics, Statistics and Computer Sciences, University of KwaZulu-Natal, Private Bag X01, Pietermaritzburg CampusScottsville, 3209, South Africa
| |
Collapse
|
9
|
Eshete T, Anteneh K, Getahun F, Marie T, Sahile E, Kidane R, Bazezaw Y. Geographical pattern and associated factors of anemia among children aged 6–59 months in Ethiopia: Further analysis of Ethiopian demographic and health survey 2016. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
10
|
Jember TA, Teshome DF, Gezie LD, Agegnehu CD. Spatial variation and determinants of childhood anemia among children aged 6 to 59 months in Ethiopia: further analysis of Ethiopian demographic and health survey 2016. BMC Pediatr 2021; 21:497. [PMID: 34753442 PMCID: PMC8576906 DOI: 10.1186/s12887-021-02901-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/23/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The magnitude of childhood anemia was increased from time to time. Thus, Even if the Ethiopian government applied tremendous efforts, anemia in children continues as a major public health problem. There is limited evidence on the spatial variation of and determinant factors of childhood anemia at the national level. Therefore, this study aimed to explore spatial distribution and determinants of anemia among children aged 6 to 59 months in Ethiopia. METHOD A stratified two-stage cluster sampling technique was used in Ethiopian Demographic Health Survey 2016 data. In this study 8602 children aged 6-59 months were included. Bernoulli model was used to explore the presence of purely spatial clusters of Anemia in children in age 6-59 months using Sat scan. ArcGIS version 10.3 was used to know the distribution of anemia cases across the country. A mixed-effects Logistic regression model was used to identify determinant factors of anemia. RESULTS The finding indicates that the spatial distribution of childhood anemia was non-random in the country with Moran's I: 0.65, p < 0.001. The SaT scan analysis identified a total of 180 significant primary clusters located in the Somali and Afar regions (LLR = 14.47, P-value< 0.001, RR = 1.47). Age of child 12-23 months (AOR = 0, 68, 95%CI: 0.55, 0.85), 24-35 months (AOR = 0.38, 95%CI: 0.31, 0.47), and36-47 months (AOR = 0.25, 95%CI, 0.20, 0.31), working mother (AOR = 0.87, 95%CI: 0.76, 0.99), anemic mother (AOR = 1.53, 95%CI, 1.35, 1.73), had fever in the last 2 weeks (AOR = 1.36,95%CI:1.13, 1.65), moderate stunting (AOR = 1.31,95%CI: 1.13, 1.50),Severely stunting (AOR = 1.82,95%CI: 1.54, 2.16), religion, wealth index, and number of under-five children in the household were statistically significant associated with childhood anemia. CONCLUSION Spatial variation of childhood anemia across the country was non-random. Age of the child, wealth index, stunting, religion, number of under-five children in the household, fever in the last 2 weeks, anemic mother, and working status of the mother were determinants of childhood anemia. Therefore, interventions should be a priority concern for high-risk (hot spot) areas regarding allocation of resources and improved access to health facilities, and to reduce the consequence of anemia among the generation policymakers and concerned bodies should be implemented these specific determinant factors.
Collapse
Affiliation(s)
- Tiruneh Ayele Jember
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaw Fetene Teshome
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive specialized hospital, University of Gondar, Gondar, Ethiopia.
| |
Collapse
|
11
|
Asmall T, Abrams A, Röösli M, Cissé G, Carden K, Dalvie MA. The adverse health effects associated with drought in Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 793:148500. [PMID: 34174598 DOI: 10.1016/j.scitotenv.2021.148500] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Droughts are associated with several health effects and Africa is uniquely vulnerable. Despite this, there has been no previous review of the literature on the health effects of drought in Africa. This study systematically reviewed the epidemiological research on the association between drought and adverse health effects in Africa (2012-2019). A total of fifteen articles were included in the review after screening 1922 published (peer-reviewed) and unpublished articles. These studies were all conducted in 9 Sub-Saharan African countries. The drought-related health effects identified were on adverse nutritional health (n = 8) including malnutrition resulting in reduced body size and wasting, stunting and underweight, mortality from food insecurity, anaemia from food insecurity and nutrition-related disability from food insecurity; drought and diseases due to microbial contamination of water (n = 6) including cholera, diarrhoeal diseases, scabies, vector-borne diseases and malaria-related mortality; and drought and health behaviours (n = 1) including HIV prevention and care behaviours. The study found limited evidence of a high prevalence of malnutrition, an increased prevalence of anaemia, cholera, scabies, dengue and an increased incidence in child disabilities during periods of drought. Additionally, there was limited evidence on improved child nutritional health with improved water and sanitation access, and an increased prevalence of child wasting, stunting and underweight in drought-prone areas. No evidence of drought on other health outcomes was found. However, all the studies had more than one limitation including weak study design, a lack of comparison to a drought period, uncertainty on the onset and end of drought, lack of control for confounding, presence of contextual factors, weak outcome and/or exposure measure, small sample size and lack of generalizability. This review found weak evidence for all health outcomes measured but highlights key areas for further research and contextual factors which need to be considered for interventions.
Collapse
Affiliation(s)
- Taherah Asmall
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Amber Abrams
- Future Water Institute, University of Cape Town, Rondebosch, 7700, Cape Town, South Africa.
| | - Martin Röösli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland; University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Guéladio Cissé
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland; University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Kirsty Carden
- Future Water Institute, University of Cape Town, Rondebosch, 7700, Cape Town, South Africa.
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Future Water Institute, University of Cape Town, Rondebosch, 7700, Cape Town, South Africa.
| |
Collapse
|
12
|
Gari T, Solomon T, Lindtjørn B. Older children are at increased risk of Plasmodium vivax in south-central Ethiopia: a cohort study. Malar J 2021; 20:251. [PMID: 34092235 PMCID: PMC8183059 DOI: 10.1186/s12936-021-03790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Better understanding of the distribution of Plasmodium vivax and its risk factors could be used to prevent and control malaria infection. Therefore, the aim of this study was to characterize the distribution and risk factors of P. vivax, and to compare them with Plasmodium falciparum occurrence in south-central Ethiopia. METHODS A cohort of 34,548 individuals were followed for 121 weeks between 2014 and 2016 as part of larger cluster randomized controlled trial to evaluate the effect of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) on malaria prevention in Ethiopia. Weekly home visit (active search) and patient self- report to health post (passive search) between the weekly home visits were used to register malaria cases. A blood sample was collected by finger prick and malaria was diagnosed using rapid diagnostic test (RDT). Generalized estimating equation (GEE) Poisson model that accounts for repeated measure of malaria episodes was applied to assess the risk factors of P. vivax episode. RESULTS The overall incidence rate of P. vivax was 7.4 episodes per 1000 person-years of observation. The study showed households closer to the lake Zeway and Bulbula river (potential mosquito breeding sites) were more at risk of P. vivax infection (incidence rate ratio (IRR): 1.33; 95% CI = 1.23-1.45). Furthermore, the age group under 5 years (IRR: 1.40, 95% CI = 1.10-1.79), the age group 5-14 years (IRR: 1.27, 95% CI = 1.03-1.57), households with less educated household head (IRR: 1.63, 95% CI = 1.10-2.44) and house roof made of thatch/leaf (IRR: 1.35, 95% CI = 1.11-1.65) were at higher risk for P. vivax. Similar explanatory variables such as distance from the breeding sites, age group (under 5 years but not 5-14 years old), educational status and type of housing were also found to be the predictors of P. falciparum incidence. CONCLUSION Households living closer to a mosquito breeding site, age group under 15 years, less educated household heads and thatch/leaf roof housing were the risk factor for P. vivax. The result of this study can be used for tailored interventions for malaria control and prevention by prioritizing those living close to potential mosquito breeding site, enhancing bed net use of children less than 15 years of age, and improving housing.
Collapse
Affiliation(s)
- Taye Gari
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | - Tarekegn Solomon
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Bernt Lindtjørn
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
13
|
Prevalence of Anemia and Associated Factors among Infants and Young Children Aged 6-23 Months in Debre Berhan Town, North Shewa, Ethiopia. J Nutr Metab 2020; 2020:2956129. [PMID: 33414958 PMCID: PMC7768586 DOI: 10.1155/2020/2956129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/23/2020] [Accepted: 12/07/2020] [Indexed: 02/03/2023] Open
Abstract
Background Anemia is a problem of both the developed and developing world, which occurs in all age groups of the population. Half of the anemia cases are due to iron deficiency and affects physical growth and mental development. Nevertheless, there is a scarcity of information about anemia and associated factors among infants and young children aged 6 to 23 months in low-income countries like Ethiopia. Objective The aim of this study was to assess the prevalence of anemia and associated factors among infants and young children aged 6–23 months. Methods A community-based cross-sectional study design was used among 531 mothers/caregivers-children pairs in Debre Berhan Town, North Shewa, Ethiopia, from February 1 to March 2, 2018. The cluster sampling technique was used to select the study participants. Sociodemographic data were collected from mothers/caregivers using pretested structured questionnaires. Hemoglobin levels were measured using a HemoCue analyzer machine (HemoCue® Hb 301, Ängelholm, Sweden). All relevant data were described using descriptive statistics such as frequencies, proportions, mean, and standard deviation. Odds ratio and 95% CI were estimated using binary logistic regression to measure the strength of the association between anemia and explanatory variables. The level of statistical significance was declared at P < 0.05. Results The overall prevalence of anemia was 47.5% (95% CI: 43.1–51.4%) of which 18.3% were mildly anemic, 25% were moderately anemic, and 4.1% were severely anemic. In multivariable logistic regression analysis, household food insecurity (AOR = 2.7, 95% CI: 1.6–4.5), unmet minimum dietary diversity (AOR = 2.5, 95% CI: 1.4–4.3), stunting (AOR = 2.3, 95% CI: 1.2–4.3), and underweight (AOR = 2.7, 95% CI: 1.4–5.4) positively associated with anemia while having ≥4 antenatal care visits (AOR = 0.5, 95% CI: 0.3–0.9) and met minimum meal frequency (AOR = 0.25, 95% CI: 0.14–0.45) had a protective effect against anemia. Conclusion Generally, the study showed that anemia was a severe public health problem among infants and young children in the study setting. Antenatal care visit, meal frequency, dietary diversity, underweight, stunting, and food insecurity significantly associated with anemia. Therefore, efforts should be made to strengthen infant and young child feeding practices and antenatal care utilization and ensure household food security, thereby improving the nutritional status of children.
Collapse
|
14
|
Gebrie A, Alebel A. A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia. Afr Health Sci 2020; 20:2007-2021. [PMID: 34394267 PMCID: PMC8351872 DOI: 10.4314/ahs.v20i4.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Anemia is a wide-spread public health problem characterized by a decrease in hemoglobin concentration and/ or red blood cell volume below an established cut-off value. In developing countries including Ethiopia, about half of children are estimated to be anemic. Therefore, the purpose of this study was to determine the pooled prevalence of anemia and its predictor factors among children in Ethiopia. Method The studies were identified through explicit and exhaustive search of reputable databases (PubMed, Google scholar, Science Direct, EMBASE, Cochrane library, and the hand search of reference lists of previous prevalence studies to retrieve more related articles. Thirty-nine studies were selected based on a comprehensive list of inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistic and I2 tests were used. In our analysis, considerable heterogeneity was observed. Therefore, a random effect meta-analysis model was used to estimate the pooled prevalence of anemia. Moreover, the predictor factors of anemia were examined. Results The forest plot of 39 included studies revealed that the overall pooled prevalence of anemia among children in Ethiopia was 34.4% (95% CI: 29.1, 39.7%). Sub-group analysis showed that the highest anemia prevalence was observed in Somali Region with a prevalence of 49.4 % (95% CI: 20.9, 77.8). Also, anemia in children was found to be highest in the age group of less than five years (45.2, 95% CI: 39.6,50.8). Low literacy of families: 1.3 (95% CI: 1.1, 1.7), low family socioeconomic status: 1.9 (95% CI: 1.1,3.01.3), having housewife mothers or with no job: 1.5 (95% CI: 1.4, 1.9) and rural residence: 3.3 (95% CI: 1.7,6.1) were found to be predictors of anemia among children. Conclusion In this study, one in three children were anemic in Ethiopia. It is a moderate public health problem in children in this study. Low literacy, low socioeconomic status as well as rural residence of the families and helminthic infection of the children were found to be predictors of anemia in the children. Community and school-based interventions should be strengthened to improve the problem.
Collapse
Affiliation(s)
- Alemu Gebrie
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Animut Alebel
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| |
Collapse
|
15
|
Individual and community level factors associated with anemia among children 6-59 months of age in Ethiopia: A further analysis of 2016 Ethiopia demographic and health survey. PLoS One 2020; 15:e0241720. [PMID: 33186370 PMCID: PMC7665792 DOI: 10.1371/journal.pone.0241720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
Background Anemia is a global public health problem; but its burden is disproportionately borne among children in the African Regions. The 2016 Ethiopia Demographic and Health Survey report showed that the prevalence of anemia among children 6–59 months of age was 57%; far exceeding the national target of 25% set for 2015. Although studies have been conducted in Ethiopia, multilevel analysis has rarely been used to identify factors associated with anemia among children. Therefore, this study aimed to identify individual and community-level factors associated with anemia among children 6–59 months of age by fitting a multilevel logistic regression model. Methods The data was obtained from the 2016 Ethiopia Demographic and Health Survey, conducted from January to June 2016, and downloaded from the website http://www.DHSprogram.com. The sample was taken using two-stage stratified sampling. In stage one, 645 Enumeration Areas and in stage two 28 households per Enumeration Area were selected. A sample of 7790 children 6–59 months of age was included. Data were analyzed using STATA version 14. A multilevel logistic regression model was fitted and an adjusted odds ratio with a 95% confidence interval was obtained. Result From the individual-level factors, anemia was associated most strongly with child age, wealth index, maternal anemia and child stunting followed by child underweight, child fever and birth order whereas from the community-level, the strongest odds of anemia occurred among children from Somali, Harari, Dire Dawa and Afar region followed by Oromia and Addis Ababa. Low community-poverty is a protective factor for anemia. The odds of anemia were 0.81 (95% CI: 0.66, 0.99) times lower for children who were living in communities of lower poverty status than children who were living in communities of higher poverty status. Children from Somali and Dire Dawa had 3.38 (95% CI: 3.25, 5.07) and 2.22 (95% CI: 1.42, 3.48) times higher odds of anemia, respectively than children from the Tigray region. Conclusions This study shows that anemia among children 6–59 months of age is affected both by the individual and community level factors. It is better to strengthen the strategies of early detection and management of stunted and underweight children. At the same time, interventions should be strengthened to address maternal anemia, child fever and poverty, specifically targeting regions identified to have a high risk of anemia.
Collapse
|
16
|
Roberts DJ, Zewotir T. Copula geoadditive modelling of anaemia and malaria in young children in Kenya, Malawi, Tanzania and Uganda. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2020; 39:8. [PMID: 33158460 PMCID: PMC7648409 DOI: 10.1186/s41043-020-00217-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Anaemia and malaria are the leading causes of sub-Saharan African childhood morbidity and mortality. This study aimed to explore the complex relationship between anaemia and malaria in young children across the districts or counties of four contiguous sub-Saharan African countries, namely Kenya, Malawi, Tanzania and Uganda, while accounting for the effects of socio-economic, demographic and environmental factors. Geospatial maps were constructed to visualise the relationship between the two responses across the districts of the countries. METHODS A joint bivariate copula regression model was used, which estimates the correlation between the two responses conditional on the linear, non-linear and spatial effects of the explanatory variables considered. The copula framework allows the dependency structure between the responses to be isolated from their marginal distributions. The association between the two responses was set to vary according to the district of residence across the four countries. RESULTS The study revealed a positive association between anaemia and malaria throughout the districts, the strength of which varied across the districts of the four countries. Due to this heterogeneous association between anaemia and malaria, we further considered the joint probability of each combination of outcome of anaemia and malaria to further reveal more about the relationship between the responses. A considerable number of districts had a high joint probability of a child being anaemic but not having malaria. This might suggest the existence of other significant drivers of childhood anaemia in these districts. CONCLUSIONS This study presents an alternative technique to joint modelling of anaemia and malaria in young children which assists in understanding more about their relationship compared to techniques of multivariate modelling. The approach used in this study can aid in visualising the relationship through mapping of their correlation and joint probabilities. These maps produced can then help policy makers target the correct set of interventions, or prevent the use of incorrect interventions, particularly for childhood anaemia, the causes of which are multiple and complex.
Collapse
Affiliation(s)
- Danielle J. Roberts
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
17
|
Gebrehaweria Gebremeskel M, Lemma Tirore L. Factors Associated with Anemia Among Children 6-23 Months of Age in Ethiopia: A Multilevel Analysis of Data from the 2016 Ethiopia Demographic and Health Survey. Pediatric Health Med Ther 2020; 11:347-357. [PMID: 32982542 PMCID: PMC7508559 DOI: 10.2147/phmt.s258114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/21/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Anemia is disproportionately borne among children in the African regions including Ethiopia. In Ethiopia, there is limited information on the prevalence and factors associated with anemia among children aged 6-23 months. Therefore, the aim of this study was to identify individual- and community-level factors associated with anemia among children 6-23 months of age. METHODS The data were obtained from the 2016 Ethiopia Demographic and Health Survey, conducted from January to June 2016. A sample of 2554 children aged 6-23 months was included. Data were analyzed using STATA version 14. A multilevel ordinal logistic regression model was fitted and an adjusted odds ratio with a 95% confidence interval was obtained. RESULTS The prevalence of anemia among children 6-23 months of age was 72.3%; 27.5% mild, 41% moderate, and 3.8% severe anemia. child age 18-23 months (AOR: 0.76; 95%CI: 0.61-0.93), female sex (AOR: 0.84; 95%CI: 0.72-0.98), maternal anemia (AOR: 1.53; 95%CI: 1.28-1.82), exclusive breastfeeding (AOR: 0.73; 95%CI: 0.54-0.98), child fever (AOR: 1.41; 95%CI: 1.03-1.93), underweight children (AOR: 1.42; 95%CI: 1.17-1.73) and exposure to either newspaper, radio or television (AOR: 0.78; 95%CI: 0.61-0.99) were the individual-level factors associated with anemia. High community-poverty (AOR: 1.30; 95%CI: 1.01-1.67), living in the regions of Somali (AOR: 2.08; 95%CI: 1.31-3.29), Amhara (AOR: 0.65; 95%CI: 0.45-0.94), Benishangul (AOR: 0.39; 95%CI: 0.25- 0.61) and Harari (AOR: 1.97; 95%CI: 1.18-3.31) were the community-level factors associated with anemia. CONCLUSION This study showed that childhood anemia is affected both by the individual- and community-level factors. The strategies of promoting exclusive breastfeeding, addressing maternal anemia, child fever, giving special attention for underweight children, and targeting regions identified to have a high risk of anemia should be strengthened to reduce childhood anemia.
Collapse
Affiliation(s)
| | - Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Southern Nations Nationalities and peoples, Ethiopia
| |
Collapse
|
18
|
Heinrichs H, Endris BS, Dejene T, Dinant GJ, Spigt M. Anaemia and its determinants among young children aged 6-23 months in Ethiopia (2005-2016). MATERNAL AND CHILD NUTRITION 2020; 17:e13082. [PMID: 32969162 PMCID: PMC7988878 DOI: 10.1111/mcn.13082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
Anaemia in children remains a significant public health threat. Recent numbers from Ethiopia showed that more than two‐thirds of children under the age of 2 years were anaemic. This study aimed to investigate the determinants of anaemia throughout Ethiopia over 11 years, making use of the Ethiopian Demographic and Health Survey (EDHS) rounds 2005, 2011 and 2016. The EDHS made it possible to use data on blood tests and detailed questionnaires among infants and young children. Multivariable logistic regression was applied to assess the association of anaemia and different immediate and underlying determinants. A total of 7,324 children aged 6–23 months were included in the analysis, with prevalences of anaemia being 71% in 2005, 61% in 2011 and 72% in 2016. The following determinants were significantly associated with childhood anaemia throughout the entire period: children younger than 1 year, anaemic mothers and those growing up in pastoralist regions. Risk factors such as diet and infections were consistently not significantly associated with anaemia. Given the tremendous adverse health effects of anaemia in young children, urgent action is needed. Hence, this study recommends nationwide multisectoral interventions targeting pastoralist regions, maternal and child health, screening and treatment of risk groups that could reduce the prevalence of anaemia.
Collapse
Affiliation(s)
- Helen Heinrichs
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Tariku Dejene
- Center for Population Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geert-Jan Dinant
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,General Practice Research Unit, Department of Community Medicine, The Arctic University of Tromsø, Tromsø, Norway
| |
Collapse
|
19
|
Anaba EA, Abuosi AA, Azilaku JC, Nkrumah J. Association between health insurance membership and anaemia among children under-five years. Evidence from Ghana. PLoS One 2020; 15:e0238792. [PMID: 32925931 PMCID: PMC7489557 DOI: 10.1371/journal.pone.0238792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/23/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction Anaemia is prevalent among children in developing countries. The main objective of this study was to assess the association between health insurance membership and anaemia among Ghanaian children under-five years. Methods We obtained Ghana’s Multiple Indicators Cluster Survey, 2011 dataset from the United Nations International Children’s Emergency Fund. Data were analyzed with the aid of Stata/IC, version 15. Results The prevalence of anaemia among Ghanaian children under-five years was estimated to be 57%. Majority (73%) of the children were not insured. Health insurance membership was found to be a significant predictor of anaemia among children under-five years. Conclusion Health insurance membership is a protective factor against anaemia among children under-five years. In the quest to eradicate anaemia among children, stakeholders would have to review the benefit package of the National Health Insurance Scheme coupled with prioritizing anaemia prevention interventions among more vulnerable children.
Collapse
Affiliation(s)
- Emmanuel Anongeba Anaba
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana
- * E-mail:
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | | | - Jacqueline Nkrumah
- Department of Health Administration and Education, University of Education-Winneba, Winneba, Ghana
| |
Collapse
|
20
|
Wasihun AG, Teferi M, Negash L, Marugán J, Yemane D, McGuigan KG, Conroy RM, Abebe HT, Dejene TA. Intestinal parasitosis, anaemia and risk factors among pre-school children in Tigray region, northern Ethiopia. BMC Infect Dis 2020; 20:379. [PMID: 32460777 PMCID: PMC7251880 DOI: 10.1186/s12879-020-05101-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 05/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Intestinal parasitic infections (IPIs) and anaemia are major health problems. This study assessed the prevalence of intestinal parasitic infections, anaemia and associated factors among pre-school children in rural areas of the Tigray region, northern Ethiopia. METHODS A community based cross-sectional study was conducted among 610 pre-school children in rural communities of Northern Ethiopia from June 2017 to August 2017. Stool specimens were examined for the presence of trophozoites, cysts, oocysts, and ova using direct, formal-ethyl acetate concentration, Kato-Katz, and Ziehl-Neelsen techniques. Haemoglobin was measured using a HemoCue spectrometer. RESULTS Among the 610 participating pre-school children in the study, the prevalence of IPIs and anaemia were 58% (95% conference interval (CI): 54.1-61.9%) and 21.6% (95% CI: 18.5-25.1%), respectively. Single, double, and triple parasitic infections were seen in 249 (41, 95% CI: 37-45%), 83 (14, 95% CI: 11-17%), and 22 (3.6, 95% CI: 2.4-5.4%) children, respectively. Of the seven intestinal parasitic organisms recorded from the participants, Entamoeba histolytica/dispar was the most prevalent 220 (36.1%) followed by Giardia lamblia 128 (20.1%), and Hymenolepis nana 102 (16.7%). Mixed infections were common among G. lamblia, E. histolytica/dispar and Cryptosporidium spp. oocyst. Intestinal parasitic infection prevalence increased from 47% in children aged 6-11 months to 66% in those aged 48-59 months; the prevalence ratio (PR) associated with a one-year increase in age was 1.08 (95% CI: 1.02-1.14, p = 0.009). Age-adjusted prevalence was higher in children who had been dewormed (PR = 1.2; 95% CI: 1.00-1.4, p = 0.045), and lower in households having two or more children aged under five (PR = 0.76, 95% CI: 0.61-0.95, p = 0.015). Anaemia rose from 28% in children aged 6-11 months to 43% in those aged 12-23 months, then fell continuously with age, reaching 7% in those aged 48-59 months. Age adjusted, anaemia was more prevalent in households using proper disposal of solid waste (PR = 1.5, 95% CI: 0.1-2.10, p = 0.009) while eating raw meat (PR = 0.49, 95% CI: 0.45-0.54, p = 0.000), any maternal education (PR = 0.64 95% CI: 0.52-0.79, p = 0.000), and household water treatment (PR = 0.75, 95% CI: 0.56-1.0, p = 0.044) were associated with lower prevalence of anaemia. CONCLUSIONS More than half of the children were infected with intestinal parasites, while anaemia prevalence was concentrated in the 12-23 month age group. This study has identified a number of potentially modifiable risk factors to address the significant prevalence of IPIs and anaemia in these children. Improvements in sanitation, clean water, hand hygiene, maternal education could address both short and long-term consequences of these conditions in this vulnerable population.
Collapse
Affiliation(s)
- Araya Gebreyesus Wasihun
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
| | - Mekonen Teferi
- Department of Biology, College of Natural and Computational Sciences, Mekelle University, Tigray, Ethiopia
| | - Letemichal Negash
- Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Tigray, Ethiopia
| | - Javier Marugán
- Department of Chemical and Environmental Technology, Universidad Rey Juan Carlos, C/ Tulipán s/n, 28933 Móstoles, Madrid, Spain
| | - Dejen Yemane
- Department of Environmental Health, College of Health Sciences, School of Public Health, Mekelle University, Tigray, Ethiopia
| | - Kevin G McGuigan
- Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Ronan M Conroy
- Data Science Centre, Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - Haftu Temesgen Abebe
- Department of Bio Statistics, College of Health Sciences, School of Public Health, Mekelle University, Tigray, Ethiopia
| | - Tsehaye Asmelash Dejene
- Department of Medical Microbiology, College of Health Sciences, Aksum University, Tigray, Ethiopia
| |
Collapse
|
21
|
Determinants of Anemia among HIV-Positive Children on Highly Active Antiretroviral Therapy Attending Hospitals of North Wollo Zone, Amhara Region, Ethiopia, 2019: A Case-Control Study. Anemia 2020; 2020:3720572. [PMID: 32148954 PMCID: PMC7049326 DOI: 10.1155/2020/3720572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/10/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction. Anemia is one of the most commonly observed hematological abnormalities and an independent poor prognostic marker of HIV disease. The rate of progression and mortality in this subgroup of patients is high compared to nonanemic patients. WHO estimates that over two billion people are anemic worldwide and young children bear the world's highest prevalence rate of anemia. In Ethiopia, there is limited information about the determinant factors associated with anemia among HIV positive children. Thus, this study aimed to determine the determinant factors of anemia among HIV-infected children on HAART.
Collapse
|
22
|
Belachew A, Tewabe T. Under-five anemia and its associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia: systematic review and meta-analysis. Syst Rev 2020; 9:31. [PMID: 32051034 PMCID: PMC7017616 DOI: 10.1186/s13643-020-01289-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anemia is the most common hematologic disorder of children in the globe. There are fragmented and inconclusive study findings on under-five anemia in Ethiopia. Understanding the distribution of anemia is an important step for program planners and policymakers. Therefore, this systematic review was aimed to assess the pooled prevalence of anemia and associated factors with dietary diversity, food security, stunted, and deworming in Ethiopia. METHODS We searched through African journals of online, Google Scholar, CINHAL, PubMed, Web of Science, Cochrane library, and Scopus. Reviewers used standardized format to extract the data. The data was exported to Stata version 11 software for analysis after extracted by Microsoft excel. The DerSimonian-Laird random-effect model was used to assess the pooled prevalence of under-five anemia. Variation between studies (heterogeneity) was assessed by I2 statistic test. Publication bias was assessed by the Egger test. RESULT From 561 studies, 16 articles were included in this review. The pooled prevalence of under-five anemia in Ethiopia was 44.83%. In subgroup analysis, the higher pooled prevalence of anemia was observed from children's age less than 2 years old (50.36%) (95% CI 39.53, 61.18). Poor dietary diversity OR = 1.71 (1.10, 2.68), stunting OR = 2.59 (2.04, 3.28), food insecurity OR = 2.87 (1.25, 6.61), and not dewormed OR = 2.34 (1.77, 3.09) were predictors of under-five anemia. CONCLUSION The magnitude of under-five anemia in this study was extremely high. Therefore, increased coverage of supplementation and fortification programs, periodic deworming, feeding diversified food, supplement food for those who are stunted, and securing food in the households may all alleviate under-five anemia.
Collapse
Affiliation(s)
- Amare Belachew
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Tewabe
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| |
Collapse
|
23
|
Roro M, Deressa W, Lindtjørn B. Intrauterine growth patterns in rural Ethiopia compared with WHO and INTERGROWTH-21st growth standards: A community-based longitudinal study. PLoS One 2019; 14:e0226881. [PMID: 31891599 PMCID: PMC6938373 DOI: 10.1371/journal.pone.0226881] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/07/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Children's well-being is highly influenced by their fetal growth. Adequate intrauterine growth (IUG) is a basic feature of a healthy pregnancy. The aim of our study was to assess IUG patterns in a rural and drought-affected population in the Rift Valley area of the Adami Tullu district in Oromia, Ethiopia. METHODS We conducted a longitudinal, community-based study of IUG patterns utilizing serial ultrasound measurements. Data were collected for 17 months, from July 2016 to November 2017. We included 675 singleton foetuses ≤ 24 weeks old, based on ultrasound-derived estimates of gestational age, and followed them until delivery. We obtained head circumference, biparietal diameter, abdominal circumference, femur length, and estimated fetal weight at 26, 30, and 36 weeks. Fetal weight was estimated using the Hadlock algorithm, and the 5th, 10th, 25th, 50th, 75th, 90th, and 95th centiles were developed from this model. We compared the biometric measurements and fetal weight data from our study to the World Health Organization (WHO) and INTERGROWTH-21st fetal growth reference standards. RESULTS Distribution of the biometric measurements and estimated fetal weights in our study were similar to those for the WHO and INTERGROWTH-21st references. Most measurements were between -2 and +2 of the reference z-scores. Based on the smoothed percentiles, the 5th, 50th, and 95th percentiles of our study had similar distribution patterns to the WHO chart, and the 50th percentile had a similar pattern to the INTERGROWTH-21st chart. CONCLUSIONS Our study determined fetal growth patterns in a drought-affected rural community of Ethiopia using common ultrasound biometric measurements. We found similar IUG patterns to those indicated in the WHO and INTERGROWTH-21st fetal growth reference standards.
Collapse
Affiliation(s)
- Meselech Roro
- Centre for International Health, University of Bergen, Bergen, Norway
- Department of Reproductive Health and Health Service Management, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
24
|
District Effect Appraisal in East Sub-Saharan Africa: Combating Childhood Anaemia. Anemia 2019; 2019:1598920. [PMID: 31885912 PMCID: PMC6925720 DOI: 10.1155/2019/1598920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/26/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
Background Anaemia in children is a significant health problem that receives little attention. This study aimed at determining the factors significantly associated with anaemia in children aged 6 to 59 months in Kenya, Malawi, Tanzania, and Uganda while accounting for the spatial heterogeneity within and between the districts of the four countries. In addition, the performance of the districts with regard to their impact on anaemia was assessed and ranked. Methods A generalised additive mixed model with a spatial effect based on the geographical coordinates of the clusters was used. A district-level random effect was included to further account for the heterogeneity as well as to rank the performance of the districts based on the best linear unbiased prediction (BLUP). Results The results depicted significant spatial heterogeneity between and within the districts of the countries. After accounting for such spatial heterogeneity, child-level characteristics (gender, malaria test result, and mother's highest education level), household-level characteristics (household size, household's wealth index Z-score, the type of toilet facility available, and the type of place of residence), and the country of residence were found to be significantly associated with the child's anaemia status. There was a significant interaction between the type of place of residence and the country of residence. Based on the BLUP for the district-level random effect, the top 3 best- and worst-performing districts within each country were identified. Conclusion The ranking of the performance of the districts allows for the worst-performing districts to be targeted for further research in order to improve their anaemia control strategies, as well as for the best-performing districts to be identified to further determine why they are performing better and then to use these districts as role models in efforts to overcome childhood anaemia.
Collapse
|
25
|
Belesova K, Agabiirwe CN, Zou M, Phalkey R, Wilkinson P. Drought exposure as a risk factor for child undernutrition in low- and middle-income countries: A systematic review and assessment of empirical evidence. ENVIRONMENT INTERNATIONAL 2019; 131:104973. [PMID: 31400736 DOI: 10.1016/j.envint.2019.104973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Droughts affect around 52 million people globally each year, a figure that is likely to increase under climate change. OBJECTIVES To assess the strength of empirical evidence on drought exposure as a risk factor for undernutrition in children <5 years of age in low- and middle-income countries (LMICs). METHODS Systematic review of observational studies published between 1990 and 2018 in English and reporting undernutrition outcomes in children <5 years of age in relation to droughts in LMICs. The search was performed in the Global Health, Medline, Embase, and Scopus databases. We assessed the strength of evidence following the Navigation Guide. RESULTS 27 studies met our inclusion criteria. 12 reported prevalence estimates in drought-affected conditions without comparison to unaffected conditions. These showed high prevalence of chronic and mixed undernutrition and poor to critical levels of acute undernutrition. Only two studies were judged to have low risk of bias. Overall, the strength of evidence of drought as a risk factor was found to be limited, but the two studies with low risk of bias suggested positive associations of drought exposure with children being underweight and having anaemia. CONCLUSION Published evidence suggests high levels of all types of child undernutrition in drought-affected populations in low-income settings, but the extent to which these levels are attributable to drought has not been clearly quantified and may be context specific. This review offers suggestions for enhancing the quality of future studies to strengthen evidence on the potential magnitude, timing, and modifying factors of drought impacts.
Collapse
Affiliation(s)
- Kristine Belesova
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Caroline Noel Agabiirwe
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Margaret Zou
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| | - Revati Phalkey
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg 69120, Germany.
| | - Paul Wilkinson
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.
| |
Collapse
|
26
|
Risk Factors of Anaemia among Children under Five Years in the Hohoe Municipality, Ghana: A Case Control Study. Anemia 2019; 2019:2139717. [PMID: 31341677 PMCID: PMC6614984 DOI: 10.1155/2019/2139717] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/28/2019] [Accepted: 06/09/2019] [Indexed: 11/18/2022] Open
Abstract
Background Anaemia is one of the major causes of death among children under five years in Ghana. We examined the risk factors of anaemia among children under five years in the Hohoe Municipality, Ghana. Methods This facility-based matched case control study recruited 210 children (70 cases and 140 controls) aged 6 to 59 months. Stratified and simple random sampling techniques were used to select mothers attending Child Welfare Clinic (CWC) for the screening of their children. Data were collected using a semistructured questionnaire. Finger prick blood was collected to estimate the haemoglobin (Hb) level and thick film was prepared to determine malaria parasitaemia. Axillary temperature was measured using an +electronic thermometer and anthropometric measurements were done using a weighing scale and inelastic tape measure. Continuous variables were presented as means and standard deviations and categorical variables as frequencies and proportions. Conditional logistic regression was used to determine the strength of association between the dependent and the independent variables. Statistical significance was considered at p value of <0.05. Results The prevalence of anaemia was high (53.8%), while children whose mothers received iron supplementation during pregnancy were 7.64 times more likely to be anaemic compared with those who did not [AOR=7.64 (95% CI:1.41-41.20.93); p=0.018]. Children with poor dietary diversity were 9.15 times more likely to have anaemia [AOR=9.15 (95% CI: 3.13-26.82); p< 0.001]; and children whose mothers were farmers and traders were 83% [AOR = 0.17 (95% CI: 0.05-0.60); p=0.006] and 79% [AOR=0.21 (95% CI: 0.06-0.74); p=0.014], respectively, less likely to have anaemia. Conclusion The biologic, intermediate, and underlying factors that were significantly associated with anaemia comprised maternal iron supplementation, poor dietary diversity, farmers, and traders. Given that iron supplementation during pregnancy did not protect children against anaemia, we recommend the child's nutritional dietary diversity is encouraged.
Collapse
|
27
|
Loha E, Deressa W, Gari T, Balkew M, Kenea O, Solomon T, Hailu A, Robberstad B, Assegid M, Overgaard HJ, Lindtjørn B. Long-lasting insecticidal nets and indoor residual spraying may not be sufficient to eliminate malaria in a low malaria incidence area: results from a cluster randomized controlled trial in Ethiopia. Malar J 2019; 18:141. [PMID: 30999957 PMCID: PMC6471954 DOI: 10.1186/s12936-019-2775-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 04/11/2019] [Indexed: 12/22/2022] Open
Abstract
Background Conflicting results exist on the added benefit of combining long-lasting insecticidal nets (LLINs) with indoor residual spraying (IRS) to control malaria infection. The main study objective was to evaluate whether the combined use of LLINs and IRS with propoxur provides additional protection against Plasmodium falciparum and/or Plasmodium vivax among all age groups compared to LLINs or IRS alone. Methods This cluster-randomized, controlled trial was conducted in the Rift Valley area of Ethiopia from September 2014 to January 2017 (121 weeks); 44 villages were allocated to each of four study arms: LLIN + IRS, IRS, LLIN, and control. Each week, 6071 households with 34,548 persons were surveyed by active and passive case detection for clinical malaria. Primary endpoints were the incidence of clinical malaria and anaemia prevalence. Results During the study, 1183 malaria episodes were identified, of which 55.1% were P. falciparum and 25.3% were P. vivax, and 19.6% were mixed infections of P. falciparum and P. vivax. The overall malaria incidence was 16.5 per 1000 person-years of observation time (PYO), and similar in the four arms with 17.2 per 1000 PYO in the LLIN + IRS arm, 16.1 in LLIN, 17.0 in IRS, and 15.6 in the control arm. There was no significant difference in risk of anaemia among the trial arms. Conclusions The clinical malaria incidence and anaemia prevalence were similar in the four study groups. In areas with low malaria incidence, using LLINs and IRS in combination or alone may not eliminate malaria. Complementary interventions that reduce residual malaria transmission should be explored in addition to LLINs and IRS to further reduce malaria transmission in such settings. Trial registration PACTR201411000882128 (08 September 2014) Electronic supplementary material The online version of this article (10.1186/s12936-019-2775-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eskindir Loha
- School of Public Health, Hawassa University, Hawassa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Gari
- School of Public Health, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Meshesha Balkew
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Oljira Kenea
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tarekegn Solomon
- School of Public Health, Hawassa University, Hawassa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Alemayehu Hailu
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Meselech Assegid
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway.
| |
Collapse
|
28
|
Solomon T, Loha E, Deressa W, Gari T, Overgaard HJ, Lindtjørn B. Low use of long-lasting insecticidal nets for malaria prevention in south-central Ethiopia: A community-based cohort study. PLoS One 2019; 14:e0210578. [PMID: 30629675 PMCID: PMC6328101 DOI: 10.1371/journal.pone.0210578] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction A decline in malaria morbidity and mortality has been documented in Ethiopia since 2005 following a scale-up of the distribution of long-lasting insecticidal nets (LLINs). However, universal access to LLINs ownership and use has not yet been achieved. This study aimed to determine ownership and use of LLINs over time in south-central Ethiopia. Methods A cohort of 17,142 individuals residing in 3,006 households was followed-up from October 2014 to January 2017 (121 weeks). New PermaNet2.0 LLINs were given to households in October 2014. Once per week, the LLIN use status was documented for each individual. A survey was conducted after 110 weeks of LLIN distribution to determine LLIN ownership. A multilevel negative binomial regression model was fitted to identify significant predictors of LLIN use. Results At baseline, the LLIN ownership was 100%. After 110 weeks only 233 (8%) of the households owned at least one LLIN. The median proportion of LLIN use per individuals during the study period was only 14%. During the first year (week 1–52) the average LLIN use per individuals was 36% and during the second year (week 53–104) it was 4.6%. More frequent LLIN use was reported among age group [5–14 years (adjusted IRR = 1.13, 95% CI 1.04–1.22), 15–24 years (adjusted IRR = 1.33, 95% CI 1.23–1.45), ≥25 years (adjusted IRR = 1.99, 95% CI 1.83–2.17)] compared to <5 years, and household head educational status [read and write (adjusted IRR = 1.17, 95% CI 1.09–1.26), primary (adjusted IRR = 1.20, 95% CI 1.12–1.27), secondary or above (adjusted IRR = 1.20, 95% CI (1.11–1.30)] compared to illiterate. Having a family size of over five persons (adjusted IRR = 0.78, 95% CI 0.73–0.84) was associated with less frequent use of LLINs compared to a family size of ≤5 persons. Conclusions The study showed a low LLIN ownership after 110 weeks and a low LLIN use during 121 weeks of follow-up, despite 100% LLIN coverage at baseline. The study highlights the need to design strategies to increase LLIN ownership and use for setting similar to those studied here.
Collapse
Affiliation(s)
- Tarekegn Solomon
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
- * E-mail:
| | - Eskindir Loha
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Taye Gari
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Hans J. Overgaard
- Faculty of Science and Technology, Norwegian University of Life Sciences, Akershus, Norway
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
29
|
Melku M, Alene KA, Terefe B, Enawgaw B, Biadgo B, Abebe M, Muchie KF, Kebede A, Melak T, Melku T. Anemia severity among children aged 6-59 months in Gondar town, Ethiopia: a community-based cross-sectional study. Ital J Pediatr 2018; 44:107. [PMID: 30176919 PMCID: PMC6122612 DOI: 10.1186/s13052-018-0547-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background Anemia is a public health problem affecting both developed and developing countries. Childhood anemia is associated with serious consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Hence, this study aimed at assessing the prevalence and factors associated with severity of anemia among children aged 6–59 months in Gondar town, northwest Ethiopia. Method A community-based cross-sectional study was conducted. A multi-stage sampling technique was employed to select study participants. Socio demographic and socioeconomic data were collected using a pre-tested structured questionnaire. Anthropometric measurements were taken as per WHO recommendation. Hemoglobin (Hb) concentration was measured using a portable HemoCue301 instrument (A Quest Diagnostic Company, Sweden). Mild anemia corresponds to a level of adjusted Hb of 10.0–10.9 g/dl; moderate anemia corresponds to a level of 7.0–9.9 g/dl, while severe anemia corresponds to a level less than 7.0 g/dl. Descriptive statistics were used to describe the study participants. Both bivariable and multivariable ordinal logistic regression were done, and proportional odds ratio (POR) with a 95% confidence interval (CI) was reported to show the strength of association. A p-value < 0.05 was considered statistically significant. Result Out of the total of 707 children included in this study, more than half (53.5%) of them were male. The median age of children was 30 months. Two hundred two (28.6%) of children were anemic: 124(17.5%) were mildly anemic, 73(10.3%) were moderately anemic, and 5 (0.7%) were severely anemic. The young age of the child, low frequency of child complementary feeding per day, primary maternal educational status, unmarried maternal marital status, and home delivery were factors associated with severity of childhood anemia. Conclusion Anemia among children aged 6–59 months in Gondar Town was a moderate public health problem. Improving access to education, providing regular health education about childcare and child feeding practices, strengthening the socioeconomic support for single-parent families and conducting regular community-based screening are recommended to reduce childhood anemia.
Collapse
Affiliation(s)
- Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kefyalew Addis Alene
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Betelihem Terefe
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belete Biadgo
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asemarie Kebede
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Melak
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsedalu Melku
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
30
|
Melku M, Takele WW, Anlay DZ, Ekubagewargies DT, Getaneh Z, Abebe M, Abebe Z. Male and undernourished children were at high risk of anemia in Ethiopia: a systematic review and meta-analysis. Ital J Pediatr 2018; 44:79. [PMID: 29996879 PMCID: PMC6042228 DOI: 10.1186/s13052-018-0513-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/13/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Anemia is one of the global public health problems affecting more than one-third of the world population. It has been strongly associated with limited psychomotor development; and poor growth and performance in cognitive, social, and emotional function in children. Despite published data revealed that anemia is a public health problem among children in Ethiopia, there is no a pooled national estimate on the prevalence and associated risk factors of anemia. METHODS Published articles until December 31, 2017, were searched using comprehensive search strings through PubMed/Medline, EMBASE, SCOPUS, HINARI, Web of Science, Google Scholar and Google. Reference probing of published articles and hand searching were employed for grey literature. Two groups of review authors independently appraised the studies for eligibility and extracted the data. The quality of articles was assessed using Joana Brigg's institute critical appraisal checklist for prevalence and analytical studies. The pooled estimates were determined using random effect model. Heterogeneity between the included studies was assessed using the I2 statistics. Subgroup analysis was employed in the evidence of heterogeneity. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression test statistic. RESULTS Of the total 871 articles retrieved, 34 articles which involved 61,748 children were eligible for meta-analysis. The overall pooled prevalence of anemia using random effect model was 31.14% (95% CI: 24.62, 37.66%). In subgroup analysis, the pooled prevalence of anemia was higher among preschool-aged children (44.17%; 95% CI: 37.19, 51.15%) than school-aged children (22.19%; 95% CI: 17.54, 26.83%). Furthermore, the odds of anemia was higher among children who were male (OR = 1.11; 95% CI: 1.03, 1.19), stunted (OR = 1.95; 95% CI: 1.52, 2.51), and wasted (OR = 2.05; 95% CI: 1.36, 3.10). CONCLUSION The pooled prevalence of anemia among children was high, indicating that it had been continuing to be a public health problem. Therefore, there is a need to design a comprehensive prevention and control strategies to reduce its burden.
Collapse
Affiliation(s)
- Mulugeta Melku
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Wubet Worku Takele
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degefaye Zelalem Anlay
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Zegeye Getaneh
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Molla Abebe
- Department of Clinical Chemistry, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| | - Zegeye Abebe
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia
| |
Collapse
|
31
|
Gari T, Loha E, Deressa W, Solomon T, Lindtjørn B. Malaria increased the risk of stunting and wasting among young children in Ethiopia: Results of a cohort study. PLoS One 2018; 13:e0190983. [PMID: 29324840 PMCID: PMC5764317 DOI: 10.1371/journal.pone.0190983] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/22/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Given the high prevalence of malnutrition in a malaria-endemic setting, improving nutritional status could serve as a tool to prevent malaria. However, the relationship between the two conditions remains unclear. Therefore, this study assessed the association between under-nutrition and malaria among a cohort of children aged 6 to 59 months old. METHODS Two cohorts of children were followed for 89 weeks in a rural Rift Valley area of Ethiopia. In the first approach (malaria-malnutrition), a cohort of 2,330 non-stunted and 4,204 non-wasted children were included to assess under-nutrition (outcome) based on their previous malaria status (exposure). In the second approach (malnutrition-malaria), a cohort of 4,468 children were followed-up to measure malaria (outcome), taking under-nutrition as an exposure. A weekly home visit was carried out to identify malaria cases. Four anthropometry surveys were conducted, and generalized estimating equation (GEE) method was used to measure the association between undernutrition and malaria. RESULTS The prevalence of stunting was 44.9% in December 2014, 51.5% in August 2015, 50.7% in December 2015 and 48.1% in August 2016. We observed 103 cases with 118 episodes of malaria, 684 new stunting and 239 new wasting cases. The incidence rate per 10,000 weeks of observation was 3.8 for malaria, 50.4 for stunting and 8.2 for wasting. Children with malaria infection, [Adjusted Odds Ratio (AOR) = 1.9; 95% Confidence Interval (CI), 1.2-2.9)] and younger age (AOR = 1.3; 95% CI, 1.1-1.5) were more likely to be stunted. Furthermore, children with malaria infection (AOR = 8.5; 95% CI, 5.0-14.5) and young age group (AOR = 1.6; 95% CI, 1.2-2.1) were more likely to be wasted. However, stunting and wasting were not risk factors of subsequent malaria illness. CONCLUSIONS Malaria infection was a risk factor for stunting and wasting, but stunting or wasting was not associated with subsequent malaria illness. As our study shows that malaria is a risk factor for stunting and wasting, a close follow-up of the nutritional status of such children may be needed. TRIAL REGISTRATION PACT R2014 11000 882128 (8 September 2014).
Collapse
Affiliation(s)
- Taye Gari
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Eskindir Loha
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Wakgari Deressa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tarekegn Solomon
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Bernt Lindtjørn
- Centre for International Health, University of Bergen, Bergen, Norway
| |
Collapse
|
32
|
Birhanu Z, Yihdego YYE, Emana D, Feyissa D, Kenate S, Kebede E, Getahun K, Yewhalaw D. Relationship between exposure to malaria and haemoglobin level of children 2-9 years old in low malaria transmission settings. Acta Trop 2017; 173:1-10. [PMID: 28522274 DOI: 10.1016/j.actatropica.2017.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/12/2017] [Accepted: 05/14/2017] [Indexed: 11/29/2022]
Abstract
In the context of reduced transmission of malaria, it is essential to examine the association between exposure to malaria and haemoglobin level. This study measured the Haemoglobin level of children 2-9 years of age and examined its association with malariometric indices. A cross sectional study was conducted, during June 2016, on 763 children 2-9 years old, recruited from ten sites representing different malaria transmission settings in Ethiopia. Haemoglobin concentration was determined using HemoCue analyzer. Malariometric indices (splenomegaly rate, parasite rate and serological marker) were measured. The overall prevalence of anaemia was 17.3% (95% CI: 14.6-19.9) in the study population. Mild, moderate and severe anaemia accounted for 7.3%, 7.2% and 2.8% respectively. Of the children with anaemia (132), only 7 (5.3%) had malaria parasitaemia. The prevalence of malaria parasitaemia was 3.6% (2/56), 9.1% (5/55) and 0.0% (0/21) among children with mild, moderate and severe anaemia, respectively. Malaria reactive antibody and anaemia co-occurred in 3.13% (21/672) of the samples. Seroprevalence and parasitaemia did not have significant association with anaemia (p>0.05). However, splenomegaly was significantly associated with increased risk of anaemia (AOR=14.93; p=0.001). Anaemia was significantly higher among children 2-4 years old (22.2%), and children living in households without any insecticide treated bed net (34.0%). The prevalence of anaemia was lower by 55.0% among children living in households with at least one net (AOR=0.45, 95% CI: 0.21-0.96). Repeated exposure to malaria infections (seropositive) and parasitaemia was less likely to contribute to development of anaemia among children 2-9 years in this study setting. Thus, in low malaria endemic settings, anaemia prevention and control program required to reconsider the historical evidence that suggests malaria is one of the major risk factor for anaemia.
Collapse
Affiliation(s)
- Zewdie Birhanu
- Department of Health Education and Behavioral Sciences, Institute of Health, Jimma University, P.O. Box 378, Ethiopia.
| | | | - Daniel Emana
- Department of Medical Laboratory Sciences and Pathology, Institute of Health, Jimma University, Ethiopia.
| | - Damtew Feyissa
- Oromia Regional Health Bureau, Jimma Zone Health Department, Jimma, Ethiopia.
| | - Silashi Kenate
- Oromia Regional Health Bureau, Jimma Zone Health Department, Jimma, Ethiopia.
| | - Estifanos Kebede
- Department of Medical Laboratory Sciences and Pathology, Institute of Health, Jimma University, Ethiopia.
| | - Kefelegn Getahun
- College of Social Sciences and Humanities, Jimma University, Ethiopia.
| | - Delenasaw Yewhalaw
- Tropical and Infectious Diseases Research Center, Jimma University, Jimma, Ethiopia.
| |
Collapse
|