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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.
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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,
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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.
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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
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Alamneh TS, Melesse AW, Gelaye KA. Determinants of anemia severity levels among children aged 6-59 months in Ethiopia: Multilevel Bayesian statistical approach. Sci Rep 2023; 13:4147. [PMID: 36914676 PMCID: PMC10011377 DOI: 10.1038/s41598-022-20381-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 09/13/2022] [Indexed: 03/16/2023] Open
Abstract
Anemia is a widespread public health problem that affects all stages of life particularly preschool children and pregnant mothers. Anemia among children had significant impact on their growth, development, school performance and mortality. Different strategies like deworming of young children, vitamin A supplementation for children aged 6-59 months, and ferrous sulphate supplementation and provision of insecticide treated bed net for pregnant women were designed to control and prevent anemia. Also, previous studies on anemia factors were conducted but they were not considering the ordered nature of anemia. Therefore, this study aimed to identify the factors of anemia severity levels among children aged 6-59 months in Ethiopia by using ordinal analysis based on Bayesian hierarchical statistical approach. A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 8483 weighted children were included. Due to the ordered nature of the anemia and nested nature of DHS data, ordinal logistic regression model based on hierarchical Bayesian statistical approach was employed to identify the determinants of anemia severity levels. In this study, moderate anemia level was found to be the commonest type which accounts around 29.4%. Female children, poorer, middle, and richest wealth index, primary maternal education and having ANC visit had lower risk of having higher order of anemia. Moderate maternal anemia and stunted children had higher chance of having higher order of anemia. Children age had significant different effect on mild and moderate anemia. Meanwhile, multiple birth/s and deworming had effect on moderate anemia. In addition, normal birth weight had also significant and different effect on mild and severe anemia and history of feverlike illness on mild anemia. The prevalence of anemia among children aged 6-59 months anemia was found to be a severe public health problem. Children age, sex, maternal education, child stunting, history of fever, multiple birth, birth weight, provision of deworming and maternal anemia was found to be the most important factors for child anemia severity levels. Therefore, intervention efforts to control and prevent anemia in Ethiopia requires targeting of these hindering factors.
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Affiliation(s)
- Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alemakef Wagnew Melesse
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abuga KM, Nairz M, MacLennan CA, Atkinson SH. Severe anaemia, iron deficiency, and susceptibility to invasive bacterial infections. Wellcome Open Res 2023; 8:48. [PMID: 37600584 PMCID: PMC10439361 DOI: 10.12688/wellcomeopenres.18829.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 08/22/2023] Open
Abstract
Severe anaemia and invasive bacterial infections remain important causes of hospitalization and death among young African children. The emergence and spread of antimicrobial resistance demand better understanding of bacteraemia risk factors to inform prevention strategies. Epidemiological studies have reported an association between severe anaemia and bacteraemia. In this review, we explore evidence that severe anaemia is associated with increased risk of invasive bacterial infections in young children. We describe mechanisms of iron dysregulation in severe anaemia that might contribute to increased risk and pathogenesis of invasive bacteria, recent advances in knowledge of how iron deficiency and severe anaemia impair immune responses to bacterial infections and vaccines, and the gaps in our understanding of mechanisms underlying severe anaemia, iron deficiency, and the risk of invasive bacterial infections.
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Affiliation(s)
- Kelvin M. Abuga
- Kenya Medical Research Institute (KEMRI) Centre for Geographical Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Open University, KEMRI-Wellcome Trust Research Programme – Accredited Research Centre, Kilifi, 80108, Kenya
| | - Manfred Nairz
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, 6020, Austria
| | - Calman A. MacLennan
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Sarah H. Atkinson
- Kenya Medical Research Institute (KEMRI) Centre for Geographical Medicine Research-Coast, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Department of Paediatrics, University of Oxford, Oxford, OX3 9DU, UK
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Ehouman MA, N’Goran KE, Coulibaly G. Malaria and anemia in children under 7 years of age in the western region of Côte d’Ivoire. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.957166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BackgroundAnemia is a major public health problem, affecting nearly one-quarter of the world’s population. It is defined as a reduction in the hemoglobin level in the peripheral blood to below the normal threshold set for a particular population. Very often in the subtropics, helminths or malaria co-infect an individual, causing morbidities that vary by age and region. This study aims to characterize the type of anemia observed in children under 7 years of age infected with malaria in the western region of Côte d’Ivoire, to recommend a better strategy of care.MethodsThe study was carried out from March 2020 to May 2021 in 22 villages in Man, Tonkpi Region, with a cohort of 451 children, both male and female, aged from 3 months to 6 years. The children provided venous blood samples for the diagnosis and characterization of anemia (full blood count), and Giemsa staining (GS) (thick and thin smears) and rapid diagnostic tests (RDTs) were used for the diagnosis of malaria. Risk factors and morbidity profiles were assessed using a questionnaire. Logistic regressions models were employed to identify independent risk factors and morbidity patterns associated with Plasmodium falciparum mono-infection and co-infections.ResultsOf the 451 children who completed the study, 221 (49.0%) were female and 230 (51.0%) were male. The prevalence of anemia was 55.0%, distributed as 30.7% mild, 66.1% moderate, and 3.2% severe anemia. The characterization of anemia revealed that hypochromic microcytic anemia (HMA) was the predominant type, being found in 195 (78.63%) children. It was followed by normochromic microcytic anemia (29 children, 11.69%), normochromic normocytic anemia (14 children, 5.65%), and, finally, hypochromic normocytic anemia (10 children, 4.03%). The prevalence of malaria was 66.7% and 78.3% based on GS and RDTs, respectively. The closed association between malaria (Plasmodium) and anemia led to P. falciparum alone causing 56.7% of mild, 51.3% of moderate, and 37.5% of severe anemia in children.ConclusionMalaria infection was highly prevalent among children aged ≤ 7 years in both sex and in different age groups, although the number of Plasmodium parasites present during infections was greatest in younger children. Similarly, the prevalence of anemia was high, with moderate anemia and HMA being more prevalent in children ≤ 7 years of age in the western region of Côte d’Ivoire.
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Kuse KA, Jima DS, Chikako TU, Hagan JE, Seidu AA, Aboagye RG, Ahinkorah BO. Individual, Maternal, Household, and Community Level Variability in Determining Inequalities in Childhood Anaemia within Ethiopia: Four-Level Multilevel Analysis Approach. CHILDREN 2022; 9:children9091415. [PMID: 36138724 PMCID: PMC9497788 DOI: 10.3390/children9091415] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 12/01/2022]
Abstract
Background: Childhood anaemia is a major public health issue necessitating rapid attention due to its debilitating consequences on the child, family, and society. Previous studies have assessed the prevalence and contributing factors to childhood anaemia in many developing countries. Yet, little is known about the factors that contribute to childhood anaemia in Ethiopia. The study examined the factors associated with inequalities of childhood anaemia in Ethiopia. Methods: Data for the study were extracted from the 2016 Demographic and Health Survey of Ethiopia. A total of 7960 children were considered in the final study. Bivariate and multilevel ordinal logistic regression analyses were used to estimate determinants of inequalities of childhood anaemia status. Results: Overall, the prevalence of mild, moderate, and severe anaemia among the children were 24.5%, 28.4%, and 2.2%, respectively. The child’s age (in months), sex of the child, preceding birth interval (in months), mother’s educational level, antenatal care visit, wealth index of mothers, source of drinking water, type of toilet facility, place of residence, and region were significantly associated with childhood anaemia. The multilevel random coefficient model found that there is a variation of childhood anaemia among women (intra-cluster correlation [ICC] = 15.06%), households (ICC = 15.6%), and communities (ICC = 14.22%) in Ethiopia. Conclusions: This study showed that anaemia is common among Ethiopian children. Factors found to be associated with childhood anaemia were the sociodemographic characteristics of the child and their mothers. We recommend that existing programs and interventions to prevent and reduce childhood anaemia be strengthened. Moreover, a targeted intervention includes deworming, intensified year-round behavior change communication campaigns and testing using digital methods, and point-of-care treatment.
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Affiliation(s)
| | - Demie Seyoum Jima
- Department of Statistics, Bule Hora University, Bule Hora P.O.Box 144, Ethiopia
| | - Teshita Uke Chikako
- Wondo Genet College of Forestry and Natural Resource, Hawassa University, Hawassa P.O. Box 05, Ethiopia
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast PMB TF0494, Ghana
- Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Postfach 10 01 31, 33501 Bielefeld, Germany
- Correspondence:
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
- Centre for Gender, Takoradi Technical University, Takoradi P.O. Box 256, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Ho PMB 31, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
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Amegbor PM. Early-life environmental exposures and anaemia among children under age five in Sub-Saharan Africa: An insight from the Demographic & Health Surveys. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 832:154957. [PMID: 35367541 DOI: 10.1016/j.scitotenv.2022.154957] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Reports show that the majority (60%) of children under age five years in Sub-Saharan Africa are anaemic. Studies in the region have mainly focused on the effect of individual, maternal and household socioeconomic status on the prevalence of anaemia. Currently, there is limited understanding of the association between early-life environmental exposures and anaemia among children in Sub-Saharan Africa. OBJECTIVE The study examines the association between early-life environmental exposures and anaemia among children under five in Sub-Saharan Africa. METHODS The study used health and demographic data from the Demographic and Health Survey (DHS) program and environmental data from NASA's Geospatial Interactive Online Visualization ANd aNalysis Infrastructure (GIOVANNI) and Atmospheric Composition Analysis Group. Three exposure periods were defined for the study, namely: in-utero, post-utero and cumulative life exposures. Multilevel mixed-effect models were used to assess the associations between environmental exposures and anaemia in each exposure period. RESULTS The findings show that 63% of children in the study were anaemic. It also reveals that mean PM 2.5 exposure for in-utero (34.93 μgm-3), post-utero (35.23 μgm-3) and cumulative exposure (35.08 μgm-3) were seven times higher than the new air quality guideline WHO recommended. A 10 μgm-3 increase in in-utero, post-utero and cumulative PM 2.5 exposures was associated with 4% to 5% increase in the prevalence of anaemia among children. A 10ppbv increase in in-utero, post-utero and cumulative carbon monoxide exposures was associated with 1% increase in the prevalence of anaemia among children. The spatial risk distribution maps show that socioeconomic factors modify the spatial risk distribution pattern. CONCLUSION The findings of the study suggest that early-life exposure to ambient air pollution is significantly associated with anaemia among children in Sub-Saharan Africa. Thus, policies aimed at addressing air quality should be incorporated into targeted interventions for anaemia among children in the region.
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Affiliation(s)
- Prince M Amegbor
- Big Data Centre for Environment and Health (BERTHA), Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, DK-4000 Roskilde, Denmark.
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Atalell KA, Tamir TT, Alemu TG, Techane MA. Spatial distributions and determinants of anaemia among adolescent girls in Ethiopia: a secondary analysis of EDHS 2016 - a cross-sectional study. BMJ Open 2022; 12:e059405. [PMID: 35618330 PMCID: PMC9137342 DOI: 10.1136/bmjopen-2021-059405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the spatial distributions and determinants of anaemia among adolescent girls in Ethiopia. Exploring the spatial epidemiology of anaemia and identifying the risk factors would inform policymakers to come up with evidence-based prevention strategies for anaemia, especially in adolescent girls, who are the most affected segment of the population. METHODS Secondary analysis of the Ethiopian Demographic and Health Survey 2016 was conducted. A total of 3172 adolescents were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify hotspot areas and the geospatial pattern and prediction of anaemia were mapped using ArcGIS V.10.8. A multilevel logistic regression model was fitted to identify factors associated with anaemia among adolescent girls. Adjusted OR with 95% CI was calculated and variables having a p value less than 0.05 were statistically significant factors of anaemia. RESULT The overall prevalence of anaemia among adolescent girls in Ethiopia was 23.8 (22.4 to 25.3), with significant spatial variations across the country. The SaTScan analysis identified a primary cluster in the eastern, northeastern and southeastern parts of Ethiopia (loglikelihood ratio=39, p<0.001). High anaemia prevalence was observed in eastern parts of the country. In the multivariable multilevel logistic regression analysis, no formal education (adjusted OR (AOR)=1.49, 95% CI 1.05 to 2.12), Afar (AOR=3.36, 95% CI 1.87 to 6.05), Somali (AOR=4.63, 95% CI 2.61 to 8.23), Harari (AOR=1.90, 95% CI 1.32 to 4.10), Dire Dawa (AOR=2.32, 95% CI 1.32 to 4.10) and high cluster altitude (AOR=1.37, 95% CI 1.03 to 1.82) were significantly associated with anaemia. CONCLUSION The national distributions of anaemia varied substantially across Ethiopia. Educational status, region and cluster altitude were significantly associated with anaemia in the multivariable logistic regression model. Thus, targeted public health interventions for adolescent girls should be implemented in the hotspot areas.
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Affiliation(s)
- Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Okyere J, Aboagye RG, Ahinkorah BO, Seidu AA, Ameyaw EK, Budu E, Zegeye B, Yaya S. High-risk fertility behaviour and childhood anaemia in sub-Saharan Africa. BMJ Open 2022; 12:e051921. [PMID: 35545380 PMCID: PMC9096488 DOI: 10.1136/bmjopen-2021-051921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/09/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study sought to examine the association between high-risk fertility behaviour and childhood anaemia in sub-Saharan Africa . DESIGN An analytical study was conducted using cross-sectional data from mothers with children under age 5 (n=64 512) from 28 sub-Saharan African countries. Multilevel logistic regression models were fitted to examine the association between high-risk fertility behaviour and childhood anaemia. The results were presented using adjusted odds ratios (aORs) with 95% confidence interval (CI). SETTING Twenty-eight sub-Saharan African countries. OUTCOME MEASURE Childhood anaemia. RESULTS The percentage of children with anaemia in the 28 countries was 66.7%. We found that age more than 34 at delivery and short birth interval had significant associations with childhood anaemia. Children of mothers whose most recent delivery occurred after 34 years were less likely to be anaemic compared with those whose most recent delivery occurred before age 34 (aOR=0.89; 95% CI 0.83 to 0.95). We found that children born to mothers with short birth intervals were more likely to be anaemic, compared with those with long birth intervals (aOR=1.08; 95% CI 1.01 to 1.16). CONCLUSIONS We, therefore, draw the attention of policy makers and programme implementers to invest in policies and programmes aimed at combating childhood anaemia in sub-Saharan Africa to focus on the population at risk, that is, women whose most recent delivery occurred at younger ages and those with short birth intervals. Encouraging contraceptive use and creating awareness about the importance of birth spacing among reproductive-age women would be more helpful.
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Affiliation(s)
- Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Richard Gyan Aboagye
- Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Bright Opoku Ahinkorah
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
| | - Edward Kwabena Ameyaw
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Aynalem M, Shiferaw E, Adane T, Gelaw Y, Enawgaw B. Anemia in African malnourished pre-school children: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221088433. [PMID: 35371481 PMCID: PMC8968978 DOI: 10.1177/20503121221088433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Generating accurate epidemiological data on the magnitude of anemia in malnourished children is a vital step for health policymakers. Therefore, this study is aimed to synthesize the overall magnitude of anemia in African malnourished pre-school children. We have searched the databases PubMed/MEDLINE, Embase, Scopus, Web of Science, Google Scholar, and Google to identify relevant articles. Joana Brigg’s Institute critical appraisal tool was used to assess the quality of articles. A random-effects model was applied to estimate the pooled prevalence of anemia in malnourished children. The I2 statistics were used to examine heterogeneity among the included studies. In the presence of heterogeneity, a subgroup analysis has been used. The funnel plot analysis and Egger’s tests were used to investigate the presence of publication bias. A total of 15 articles with 12,211 study participants were included in this study. Anemia was observed in 57.53% (95% CI: 47.05, 68.01) of African malnourished pre-school children. Moreover, the prevalence of anemia was 58.52% (95% CI: 43.04, 73.81) and 56.18% (95% CI: 40.24, 72.13) in HemoCue and auto-machine diagnosis method of anemia, respectively. This review showed that the magnitude of anemia was high among African malnourished pre-school children. Therefore, planning preventive measures to decrease anemia and its complications in malnourished children in Africa is an important step.
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Affiliation(s)
| | | | - Tiruneh Adane
- Tiruneh Adane, Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
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Endris BS, Dinant GJ, Gebreyesus SH, Spigt M. Risk factors of anemia among preschool children in Ethiopia: a Bayesian geo-statistical model. BMC Nutr 2022; 8:2. [PMID: 34996515 PMCID: PMC8740428 DOI: 10.1186/s40795-021-00495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The etiology and risk factors of anemia are multifactorial and varies across context. Due to the geospatial clustering of anemia, identifying risk factors for anemia should account for the geographic variability. Failure to adjust for spatial dependence whilst identifying risk factors of anemia could give spurious association. We aimed to identify risk factors of anemia using a Bayesian geo-statistical model. METHODS We analyzed the Ethiopian Demographic and Health Survey (EDHS) 2016 data. The sample was selected using a stratified, two- stage cluster sampling design. In this survey, 9268 children had undergone anemia testing. Hemoglobin level was measured using a HemoCue photometer and the results were recorded onsite. Based on the World Health Organization's cut-off points, a child was considered anaemic if their altitude adjusted haemoglobin (Hb) level was less than 11 g/dL. Risk factors for anemia were identified using a Bayesian geo-statistical model, which accounted for spatial dependency structure in the data. Posterior means and 95% credible interval (BCI) were used to report our findings. We used a statistically significant level at 0.05. RESULT The 9267 children in our study were between 6 and 59 months old. Fifty two percent (52%) of children were males. Thirteen percent (13%) of children were from the highest wealth quintile whereas 23% from the lowest wealth quintile. Most of them lived in rural areas (90%). The overall prevalence of anemia among preschool children was 57% (95% CI: 54.4-59.4). We found that child stunting (OR = 1.26, 95% BCI (1.14-1.39), wasting (OR = 1.35, 95% BCI (1.15-1.57), maternal anemia (OR = 1.61, 95% BCI (1.44-1.79), mothers having two under five children (OR = 1.2, 95% BCI (1.08-1.33) were risk factors associated with anemia among preschool children. Children from wealthy households had lower risk of anemia (AOR = 0.73, 95% BCI (0.62-0.85). CONCLUSION Using the Bayesian geospatial statistical modeling, we were able to account for spatial dependent structure in the data, which minimize spurious association. Childhood Malnutrition, maternal anemia, increased fertility, and poor wealth status were risk factors of anemia among preschool children in Ethiopia. The existing anaemia control programs such as IFA supplementation during pregnancy should be strengthened to halt intergenerational effect of anaemia. Furthermore, routine childhood anaemia screening and intervention program should be part of the Primary health care in Ethiopia.
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Affiliation(s)
- Bilal Shikur Endris
- School of Public Health, Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Geert-Jan Dinant
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Seifu H Gebreyesus
- School of Public Health, Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa, Ethiopia
| | - 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
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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.
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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.
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13
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Endris BS, Dinant GJ, Gebreyesus SH, Spigt M. Geospatial inequality of anaemia among children in Ethiopia. GEOSPATIAL HEALTH 2021; 16. [PMID: 34726035 DOI: 10.4081/gh.2021.1036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
Anaemia remains a severe public health problem among children in Ethiopia and targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. An analysis was performed using Ethiopia Demographic and Health Survey 2016 data. Blood specimens for anaemia testing were collected from 9268 children aged 6-59 months. A child was considered as anaemic if the bloodhaemoglobin count was less than 11.0 g/dL. We applied Kulldorf's spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran the local indicator of spatial association and the Getis-Ord Gi* statistics to detect and locate hotspots and multilevel multivariable analysis to identify risk factors for anaemia clustering. More than half of children aged 6-59 months (57%) were found to be anaemic in Ethiopia. We found significant geospatial inequality of anaemia among children and identified clusters (hotspots) in the eastern part of Ethiopia. The odds of anaemia among children found within the identified cluster was 1.5 times higher than children found outside the cluster. Women anaemia, stunting and high fertility were associated with anaemia clustering.
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Affiliation(s)
- Bilal Shikur Endris
- School of Public Health, Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa.
| | - Geert-Jan Dinant
- School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht.
| | - Seifu H Gebreyesus
- School of Public Health, Department of Nutrition and Dietetics, Addis Ababa University, Addis Ababa.
| | - 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.
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An R, Man Y, Iram S, Kucukal E, Hasan MN, Huang Y, Goreke U, Bode A, Hill A, Cheng K, Sekyonda Z, Ahuja SP, Little JA, Hinczewski M, Gurkan UA. Point-of-care microchip electrophoresis for integrated anemia and hemoglobin variant testing. LAB ON A CHIP 2021; 21:3863-3875. [PMID: 34585199 PMCID: PMC9714341 DOI: 10.1039/d1lc00371b] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Anemia affects over 25% of the world's population with the heaviest burden borne by women and children. Genetic hemoglobin (Hb) variants, such as sickle cell disease, are among the major causes of anemia. Anemia and Hb variant are pathologically interrelated and have an overlapping geographical distribution. We present the first point-of-care (POC) platform to perform both anemia detection and Hb variant identification, using a single paper-based electrophoresis test. Feasibility of this new integrated diagnostic approach is demonstrated via testing individuals with anemia and/or sickle cell disease. Hemoglobin level determination is performed by an artificial neural network (ANN) based machine learning algorithm, which achieves a mean absolute error of 0.55 g dL-1 and a bias of -0.10 g dL-1 against the gold standard (95% limits of agreement: 1.5 g dL-1) from Bland-Altman analysis on the test set. Resultant anemia detection is achieved with 100% sensitivity and 92.3% specificity. With the same tests, subjects with sickle cell disease were identified with 100% sensitivity and specificity. Overall, the presented platform enabled, for the first time, integrated anemia detection and hemoglobin variant identification using a single point-of-care test.
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Affiliation(s)
- Ran An
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Shamreen Iram
- Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Erdem Kucukal
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Muhammad Noman Hasan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Yuning Huang
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Utku Goreke
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Allison Bode
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Ailis Hill
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Kevin Cheng
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Sanjay P Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Hinczewski
- Department of Physics, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Umut A Gurkan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA.
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH 44106, USA
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Pekin A, Rynhoud H, Brennan B, Soares Magalhães RJ. Dog bite Emergency department presentations in Brisbane metro south: Epidemiology and exploratory medical geography for targeted interventions. One Health 2020; 12:100204. [PMID: 33364297 PMCID: PMC7750554 DOI: 10.1016/j.onehlt.2020.100204] [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: 09/02/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 11/27/2022] Open
Abstract
Dog bites are a recognized public health issue due to their impact on human and animal health/welfare. This study aimed to investigate demographic and geographic disparities in the epidemiology of dog bites presentations reported to the emergency departments of the four main public hospitals in the Metro South region of Brisbane, Queensland, Australia. Dog bite patient hospitalization data geolocated to the street address were collected from clinical records management systems from the four main public hospitals in the Metro South Hospital Health Service region of Queensland for a 5-year period (ie. 01/07/2013 to 30/06/2017). We investigated the epidemiology of three clinical outcomes including probability of paediatric cases (paediatric vs. adult), probability of dog bites to the head (head injury vs. other injury), and probability of re-presentation to the ED following their initial dog bite (yes or no) by way of univariable then multivariable Bernoulli logistic regression models including patient postcode as a random effect. Residual semivariograms were created to identify spatial trends in the medical geography of dog bites and binomial geostatistical models were created to predict the probability of the outcomes of interest in Brisbane Metro south and surrounding suburbs. Our results demonstrate that compared to adult dog bite cases, paediatric dog bite cases were significantly associated with bites to the head or face or neck (OR 14.65, P < 0.001), bites to the lower body (OR 4.95, P = 0.035) and larger dogs (OR 0.25, P = 0.030 for small dogs). The probability of head injuries was greater in younger age groups (17-39 OR 0.25, P = 0.001; 40-64 OR 0.15, P = 0.001; 65-above OR 0.14, P = 0.029). Attacks by small dogs were more likely to inflict head wounds than large dogs (OR 6.12, P < 0.001). The probability of re-presentation was lower in patients bitten by medium sized dogs (OR 0.29, P = 0.027) than larger dogs. Our predictive maps showed significant clustering of paediatric case probability in the Logan city and Redlands councils associated with socioeconomic status of the places of residence. In conclusion, our findings demonstrate significant demographic and geographic heterogeneity in dog bite ED presentations. Public health interventions to reduce the burden of dog bites should be targeted to the populations most at-risk in the areas identified in this study.
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Affiliation(s)
- Alexander Pekin
- UQ Spatial Epidemiology Laboratory, The School of Veterinary Science, University of Queensland, Gatton, 4343, QLD, Australia
| | - Hester Rynhoud
- UQ Spatial Epidemiology Laboratory, The School of Veterinary Science, University of Queensland, Gatton, 4343, QLD, Australia
| | - Bradley Brennan
- Logan Hospital, Metro South Hospital Service, Logan, 4131, QLD, Australia
| | - Ricardo J Soares Magalhães
- UQ Spatial Epidemiology Laboratory, The School of Veterinary Science, University of Queensland, Gatton, 4343, QLD, Australia.,UQ Children's Health Research Centre, Children's Health and Environment Program, The University of Queensland, Gatton, 4343, QLD, Australia
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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.
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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.
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Affiliation(s)
| | - Lire Lemma Tirore
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Southern Nations Nationalities and peoples, Ethiopia
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How Severe Anaemia Might Influence the Risk of Invasive Bacterial Infections in African Children. Int J Mol Sci 2020; 21:ijms21186976. [PMID: 32972031 PMCID: PMC7555399 DOI: 10.3390/ijms21186976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
Severe anaemia and invasive bacterial infections are common causes of childhood sickness and death in sub-Saharan Africa. Accumulating evidence suggests that severely anaemic African children may have a higher risk of invasive bacterial infections. However, the mechanisms underlying this association remain poorly described. Severe anaemia is characterized by increased haemolysis, erythropoietic drive, gut permeability, and disruption of immune regulatory systems. These pathways are associated with dysregulation of iron homeostasis, including the downregulation of the hepatic hormone hepcidin. Increased haemolysis and low hepcidin levels potentially increase plasma, tissue and intracellular iron levels. Pathogenic bacteria require iron and/or haem to proliferate and have evolved numerous strategies to acquire labile and protein-bound iron/haem. In this review, we discuss how severe anaemia may mediate the risk of invasive bacterial infections through dysregulation of hepcidin and/or iron homeostasis, and potential studies that could be conducted to test this hypothesis.
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Dorsamy V, Bagwandeen C, Moodley J. The prevalence, risk factors and outcomes of anaemia in South African pregnant women: a protocol for a systematic review and meta-analysis. Syst Rev 2020; 9:209. [PMID: 32912318 PMCID: PMC7488455 DOI: 10.1186/s13643-020-01460-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A significant cause of morbidity and mortality during pregnancy is maternal anaemia. The causes of anaemia and the sequelae are varied, and the prevention and management are public health challenges, especially in resource-limited settings and certain geographic locations. South Africa is plagued by a quadruple burden of disease, with high maternal mortality rates affected by hypertensive disorders of pregnancy, HIV, tuberculosis and neglected tropical diseases. This is most prevalent in people of lower socio-economic status. Poor nutrition, chronic infections, lack of access to health care facilities and poor compliance with micronutrient supplementation all contribute to maternal anaemia. The aim of this study is to systematically map the literature to ascertain the pooled prevalence and associated causes of anaemia in the South African pregnant population, which will enable health care workers and other key stakeholders to more pertinently address Sustainable Development Goal 3 focussing on good health and reducing maternal mortality. METHODS PubMed, CINAHL, EMBASE, EBSCO, Ovid maternity and infant care databases, Cochrane Database of Systematic Reviews, Web of Science and SCOPUS will be searched using the keywords 'anaemia', 'haemoglobin', 'pregnancy', and 'South Africa' to conduct a systematic review and meta-analysis to explore, describe and map literature on the distribution and burden of anaemia in pregnant women in South Africa. The reference list of articles selected for review will be scanned for other articles of interest to our study question. Studies published in any language will be included in this review. As there may be differences in sampled populations in South Africa based on geography and sociodemographic factors, a weighted inverse-variance meta-analysis using a random-effects model will be carried out to generate a pooled prevalence estimate. A Funnel plot and Egger's regression test will be conducted to assess publication bias. Heterogeneity among studies will be checked using I2 to determine dispersion and meta-regression analysis will be performed to investigate the source of heterogeneity. The articles obtained by these searches will be analysed for causative factors, severity and outcomes by a parallel and independent review team, using suitable eligibility criteria. Screening, data extraction and quality appraisal will be conducted independently by two authors. Disagreement will be resolved by independent assessment by a third reviewer. Sub group analysis by region, stage of pregnancy, socio-economic status, severity and cause of anaemia will be conducted if sufficient data is available. Data will be analysed using statistical software and presented in evidence tables and in meta-analytic forest plots. DISCUSSION This protocol is developed to systematically review the literature on the prevalence and severity of anaemia, risk factors and outcomes in pregnant women in South Africa. Correlation of factors contributing to the development of anaemia and other disorders during pregnancy will facilitate exploration of appropriate medical and behavioural change interventions implemented within other countries or regions that mitigate risk. This study will assist local health systems to inform public health policies and practises for more favourable maternal and fetal outcomes. TRIAL REGISTRATION This protocol is registered with PROSPERO ( CRD42020157191 ).
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Affiliation(s)
- Vinogrin Dorsamy
- Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa.
| | - Chauntelle Bagwandeen
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Jagadesa Moodley
- Women's Health and HIV, School of Clinical Medicine, University of KwaZulu-Natal, KwaZulu-Natal, South Africa
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20
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Ssentongo P, Ba DM, Ssentongo AE, Ericson JE, Wang M, Liao D, Chinchilli VM. Associations of malaria, HIV, and coinfection, with anemia in pregnancy in sub-Saharan Africa: a population-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:379. [PMID: 32600355 PMCID: PMC7324981 DOI: 10.1186/s12884-020-03064-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malaria and HIV are common infections in Africa and cause substantial morbidity and mortality in pregnant women. We aimed to assess the association of malaria with anemia in pregnant women and to explore the joint effects of malaria and HIV infection on anemia in pregnant women. METHODS We used nationally representative, cross-sectional demographic and health surveys (DHS) that were conducted between 2012 and 2017 across 7 countries of sub-Saharan Africa (Burundi, the Democratic Republic of the Congo, Gambia, Ghana, Mali, Senegal and Togo). The outcome variables were anemia (defined as a hemoglobin concentration < 110 g/L), and hemoglobin concentration on a continuous scale, in pregnant women at the time of the interview. We used generalized linear mixed-effects models to account for the nested structure of the data. We adjusted models for individual covariates, with random effects of the primary sampling unit nested within a country. RESULTS A total of 947 pregnant women, ages, 15-49 y, were analyzed. Prevalence of malaria only, HIV only, and malaria- HIV coinfection in pregnant women was 31% (95% CI: 28.5 to 34.5%, n = 293), 1.3% (95% CI: 0.77 to 2.4%, n = 13) and 0.52% (95% CI: 0.02 to 1.3%, n = 5) respectively. Overall prevalence of anemia was 48.3% (95% CI: 45.1 to 51.5%). The anemia prevalence in pregnant women with malaria infection only was 56.0% (95% CI: 50.1 to 61.7%); HIV infection only, 62.5% (95% CI: 25.9 to 89.8%); malaria- HIV coinfection, 60.0 (95% CI: 17.0-92.7%) and without either infection, 44.6% (95% CI: 40.7 to 48.6%). In the fully adjusted models, malaria infection was associated with 27% higher prevalence of anemia (95% CI of prevalence ratio: 1.12 to 1.45; p = 0.004), and 3.4 g/L lower hemoglobin concentration (95% CI: - 5.01 to - 1.79; p = 0.03) compared to uninfected pregnant women. The prevalence of HIV infection and malaria-HIV coinfection was too low to allow meaningful analysis of their association with anemia or hemoglobin concentration. CONCLUSION Malaria was associated with an increased prevalence of anemia during pregnancy.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, Penn State University, University Park, PA USA
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
- Center for Applied Studies in Health Economics, Penn State College of Medicine, Hershey, PA USA
| | - Anna E. Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Jessica E. Ericson
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA USA
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA USA
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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Amugsi DA. Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data. Sci Rep 2020; 10:7175. [PMID: 32346023 PMCID: PMC7188845 DOI: 10.1038/s41598-020-64072-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/09/2020] [Indexed: 11/09/2022] Open
Abstract
Anaemia among children under 5, is a public health problem of serious concern. In Ghana, an estimated 8 out of every 10 children are anaemic. This study employed a novel approach to investigate the determinants of normal haemoglobin (Hb) concentration among children aged 6 to 59 months, using data from the Ghana Demographic and Health Surveys. The results showed that maternal schooling was positively associated with normal Hb concentration among children. Children of non-anaemic mothers were 1.67 (CI = 1.32, 2.10; P < 0.001) times more likely to have normal Hb concentration relative to children of anaemic mothers. Compared to mothers who had less than 4 antenatal care (ANC) visits, mothers who had at least 4 ANC visits increased the odds of their children having a normal Hb concentration by 1.62 (CI = 1.09, 2.40; P < 0.018). Children living in middle and rich households had respectively 1.48 (CI = 1.06, 2.07; p < 0.021) and 1.59 (CI = 1.08, 2.33; p < 0.018) increased odds of having a normal Hb concentration relative to those living in poor households. Maternal education, anaemia, ANC attendance, and household wealth index are strong determinants of normal Hb concentration among children in Ghana. Strategies aimed at addressing childhood anaemia should take into account maternal anaemia, education, poverty and ANC attendance.
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Affiliation(s)
- Dickson A Amugsi
- African Population and Health Research Center (APHRC), Nairobi, Kenya.
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Roberts DJ, Matthews G, Snow RW, Zewotir T, Sartorius B. Investigating the spatial variation and risk factors of childhood anaemia in four sub-Saharan African countries. BMC Public Health 2020; 20:126. [PMID: 31996196 PMCID: PMC6990548 DOI: 10.1186/s12889-020-8189-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/09/2020] [Indexed: 01/14/2023] Open
Abstract
Background The causes of childhood anaemia are multifactorial, interrelated and complex. Such causes vary from country to country, and within a country. Thus, strategies for anaemia control should be tailored to local conditions and take into account the specific etiology and prevalence of anaemia in a given setting and sub-population. In addition, policies and programmes for anaemia control that do not account for the spatial heterogeneity of anaemia in children may result in certain sub-populations being excluded, limiting the effectiveness of the programmes. This study investigated the demographic and socio-economic determinants as well as the spatial variation of anaemia in children aged 6 to 59 months in Kenya, Malawi, Tanzania and Uganda. Methods The study made use of data collected from nationally representative Malaria Indicator Surveys (MIS) and Demographic and Health Surveys (DHS) conducted in all four countries between 2015 and 2017. During these surveys, all children under the age of five years old in the sampled households were tested for malaria and anaemia. A child’s anaemia status was based on the World Health Organization’s cut-off points where a child was considered anaemic if their altitude adjusted haemoglobin (Hb) level was less than 11 g/dL. The explanatory variables considered comprised of individual, household and cluster level factors, including the child’s malaria status. A multivariable hierarchical Bayesian geoadditive model was used which included a spatial effect for district of child’s residence. Results Prevalence of childhood anaemia ranged from 36.4% to 61.9% across the four countries. Children with a positive malaria result had a significantly higher odds of anaemia [AOR = 4.401; 95% CrI: (3.979, 4.871)]. After adjusting for a child’s malaria status and other demographic, socio-economic and environmental factors, the study revealed distinct spatial variation in childhood anaemia within and between Malawi, Uganda and Tanzania. The spatial variation appeared predominantly due to unmeasured district-specific factors that do not transcend boundaries. Conclusions Anaemia control measures in Malawi, Tanzania and Uganda need to account for internal spatial heterogeneity evident in these countries. Efforts in assessing the local district-specific causes of childhood anaemia within each country should be focused on.
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Affiliation(s)
- Danielle J Roberts
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa.
| | - Glenda Matthews
- Department of Statistics, Durban University of Technology, Durban, South Africa
| | - Robert W Snow
- Population Health, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, South Africa
| | - Benn Sartorius
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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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.
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Mutombo N, Landouré A, Man WY, Fenwick A, Dembélé R, Sacko M, Keita AD, Traoré MS, Webster JP, McLaws ML. The association between child Schistosoma spp. infections and morbidity in an irrigated rice region in Mali: A localized study. Acta Trop 2019; 199:105115. [PMID: 31356787 PMCID: PMC6995995 DOI: 10.1016/j.actatropica.2019.105115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 04/29/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
Background Schistosomiasis is one of the neglected tropical diseases endemic to Mali. There has been insufficient investigation of the morbidity burden in highly endemic irrigated rice areas with the ongoing mass drug administration with praziquantel. In February 2005, a year after an initial mass drug administration in 2004, we performed the first cross-sectional survey of schistosomiasis in the Kokry-Bozo village in the Office du Niger rice irrigation region. In the fourteen years since this survey, there has been almost no research into schistosomiasis morbidity in Mali due to lack of funding. Therefore, the 2005 survey supplies near-baseline data for any future research into the treatment impacts in the area. Methods One hundred and ninety-four children aged 6–14 years from two schools were assessed for bladder pathology by ultrasound, and for anaemia and micro-haematuria by laboratory tests. Schistosoma eggs were examined microscopically in fresh stool and urine samples. Multivariate logistic regression analysis quantified the association of Schistosoma infections with anaemia, bladder pathology and micro-haematuria. Akaike’s information criterion was used to test the assumption of linear effects of infection intensity classes and used to compare across models. Results The overall prevalence of schistosomiasis in 189 school children was 97%; 17% (33/189) had a single infection (S. mansoni,13%, or S. haematobium, 4%) and 80% (156/189) were co-infected with S. mansoni and S. haematobium. The overall prevalence of S. mansoni with light infection was 27% (53/194), moderate infection was 24% (47/194) and heavy infection was 42% (81/194). Of the 194 of children investigated for S. haematobium 59% (114/194) had light infection and 26% (50/194) had heavy infection. No hookworm eggs were detected. The level of abnormal bladder pathology was 18% (35/189) with the highest found in 10–14 year old children. The prevalence of anaemia was 91% (172/189) and was twice as likely to be associated (OR 2.0, 95% CI 1.1–3.9) with S. mansoni infections than in children without infection. As infection intensity with S. mansoni increased the risk of anaemia (OR 2.0, 95% CI 1.1–3.9) also increased. As infection intensity with S. haematobium increased bladder pathology (OR 2.4, 95%CI 1.3–4.5), haematuria (OR 6.7, 95%CI 3.3–13.6) and micro-haematuria increased (OR 2.4, 95%CI 1.3–4.5). Conclusion Our research contributes an important micro-geographical assessment of the heavy burden of schistosomiasis and associated morbidity in children who live in the rice irrigation regions. Our literature review found that there has been very limited research conducted on the impact of the treatment to control morbidity in the ON. Therefore, there is a need to do a comparable, but more extensive, study to identify any changes in morbidity and to indicate current requirements for the control programme. Our results from 2005 called for routine integration of iron supplementation, food fortification and diet diversification into the deworming program.
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Affiliation(s)
- Ngoy Mutombo
- Epidemiology and Hospital Infection Prevention and Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Australia; Centre for Biomedical Research, Burnet Institute, Australia
| | - Aly Landouré
- Institut National de Recherche en Santé Publique (INRSP), National Schistosomiasis Control Program, Bamako, Mali
| | - Wing Young Man
- Epidemiology and Hospital Infection Prevention and Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Australia
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Robert Dembélé
- Programme National de Lutte Contre la Schistosomiase, Ministère de la Santé, Bamako, Mali
| | - Moussa Sacko
- Institut National de Recherche en Santé Publique (INRSP), National Schistosomiasis Control Program, Bamako, Mali
| | - Adama D Keita
- Service de la Radiologie, Hôpital National du Point G, Bamako, Mali
| | - Mamadou S Traoré
- Institut National de Recherche en Santé Publique (INRSP), National Schistosomiasis Control Program, Bamako, Mali
| | - Joanne P Webster
- Centre for Emerging, Endemic and Exotic Diseases, Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, AL9 7TA, UK
| | - Mary-Louise McLaws
- Epidemiology and Hospital Infection Prevention and Control, School of Public Health and Community Medicine, UNSW Medicine, UNSW Sydney, Australia.
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Engidaye G, Melku M, Yalew A, Getaneh Z, Asrie F, Enawgaw B. Under nutrition, maternal anemia and household food insecurity are risk factors of anemia among preschool aged children in Menz Gera Midir district, Eastern Amhara, Ethiopia: a community based cross-sectional study. BMC Public Health 2019; 19:968. [PMID: 31324244 PMCID: PMC6642588 DOI: 10.1186/s12889-019-7293-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Ethiopian, the prevalence of anemia among preschool aged children widely varied across regions. Since anemia adversely affects the cognitive and physical development of the children, it is important to determine its burden for implementing appropriate measurements. Therefore, this study was aimed at determining the anemia prevalence and associated factors among preschool aged children. METHOD A community based cross-sectional study was conducted on a total of 432 preschool children in Menz Gera Midir district from January to May, 2017. A multi stage sampling procedure was applied to select the target groups. Hemocue analyzer for Haemoglobin determination; anthropometric measurements for assessment nutritional status, structured questionnaires for socio-demographic and economic variables were used for data collection. The morphological appearance of red blood cell was assessed microscopically to determine type of anemia. Descriptive statistics were employed to summarize the data and binary logistic regression was used for inferential statistics. A p value less than 0.05 was considered as statistically significant. RESULT The overall prevalence of anemia was 123 (28.5%); of which 38 (30.9%) and 85 (69.1%) were moderate and mild, respectively. Morphologically about 50.4, 37.4 and 12.2% were microcytic hypochromic, normocytic normochromic and macrocytic anemias, respectively. Child age 6-11 months (COR: 5.67, 95% CI: 2.2, 14.86), child age 12-23 months (COR: 5.8, 95% CI: 2.3, 14.7), wasting (COR: 3.5, 95% CI: 1.2, 9.8), stunting (COR: 3.8, 95% CI: 1.92, 7.77), underweight (COR: 2.12, 95% CI: 1.07, 4.38), MUAC measurement below 13 cm (COR: 5.6, 95% CI: 2.83, 11.15), household headed by female (COR: 3.24, 95% CI: 1.1, 9.63), maternal anemia (COR: 4, 95% CI: 2.2, 7.23) and household food insecurity (COR: 2.12, 95% CI: 1.09, 4.12) were significantly associated with anemia. CONCLUSION The prevalence of anemia among the children was found to be high and associated with child age group, child nutritional status, house hold headed by female, maternal anemia and household food insecurity. Further studies on nutritional anemia, community based nutritional education, iron supplementation to children at risk should be promoted.
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Affiliation(s)
- Getabalew Engidaye
- Amhara Regional State Debre Berhan Health Science College, Debre Berhan, Ethiopia.,Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Melku
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aregawi Yalew
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zegeye Getaneh
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fikir Asrie
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology & Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
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Abstract
INTRODUCTION Different evaluations conducted on blood safety between 2004 and 2013 in Africa showed some progress in most countries. This paper describes the current status of the availability and access to safe blood in the Region. METHODS A cross-sectional survey was conducted from January to December 2018. Data were collected through a questionnaire prepared using key indicators of blood safety and analysis was done using Excel 2010 and results were compared to those of the 2013. RESULTS A total of 2,678 blood centres were reported including 244 (9%) stand-alone and 2,434 (91%) hospital based. Amongst these countries, 90.2% had a blood policy, 60.1% participated in an External Quality Assessment Scheme for Transfusion Transmissible Infections screening, 12% had accredited blood services, 73.2% had national guidelines on clinical use of blood and 78% had a government budget. The total number of blood units collected was 4,899,913 and the average proportion of voluntary blood donations was 71%. Plasma-derived medicinal products were included in the national essential medicines list in 52.6% of countries. The average proportion of units of blood tested for infections was 99.5% for HIV, 92.3% for HBV, 98.9% for HCV, 98.8% for syphilis. The percentage of whole blood separated into blood components was 63.4%. CONCLUSION Countries in the region continue to improve availability and access to safe blood, but challenges still remain and call for concrete actions required to reach universal access to quality and safe blood for transfusion throughout the region.
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Owada K, Nielsen M, Lau CL, Yakob L, Clements ACA, Leonardo L, Soares Magalhães RJ. Determinants of Spatial Heterogeneity of Functional Illiteracy among School-Aged Children in the Philippines: An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010137. [PMID: 30621052 PMCID: PMC6339103 DOI: 10.3390/ijerph16010137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 12/23/2018] [Accepted: 01/02/2019] [Indexed: 01/02/2023]
Abstract
Functional literacy is one of the targets of the Sustainable Development Goals (SDGs) of the United Nations. Functional literacy indicators are likely to vary between locations given the geographical variability of its major determinants. This property poses a challenge to decisions around efficient allocation of population services and resources to mitigate the impact of functional literacy in populations most in need. Using functional literacy indicators of 11,313 school-aged children collected in 2008 during the nationwide survey, the current study examined the association between functional literacy and geographical disparities in socioeconomic status (SES), water supply, sanitation and hygiene, household education stimuli, and environmental variables in all three regions of the Philippines (Luzon, the Visayas, and Mindanao). Three nested fixed-effects multinomial regression models were built to determine associations between functional literacy and a wide array of variables. Our results showed the general prevalence rate of functional illiteracy as being 4.7%, with the highest prevalence rate in the Visayas, followed by Mindanao and Luzon (7.5%, 6.9%, and 3.0%, respectively. Our results indicated that in Luzon prevalence of functional illiteracy was explained by variation in household education stimuli scores, sources of drinking water, and type of toilet facility. In Mindanao and the Visayas prevalence of functional illiteracy was primarily explained by geographical variation in SES, and natural environmental conditions. Our study highlights region-specific determinants of functional literacy and the need for geographically targeted, integrated interventions.
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Affiliation(s)
- Kei Owada
- School of Medicine, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia.
| | - Mark Nielsen
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia.
- Faculty of Humanities, University of Johannesburg, Auckland Park 2006, South Africa.
| | - Colleen L Lau
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia.
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Archie C A Clements
- Research School of Population Health, Australian National University, Canberra, ACT 0200, Australia.
| | - Lydia Leonardo
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Manila 1000, Philippines.
| | - Ricardo J Soares Magalhães
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD 4101, Australia.
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD 4343, Australia.
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Tizeba YA, Mirambo MM, Kayange N, Mhada T, Ambrose EE, Smart LR, Mshana SE. Parvovirus B19 Is Associated with a Significant Decrease in Hemoglobin Level among Children <5 Years of Age with Anemia in Northwestern Tanzania. J Trop Pediatr 2018; 64:479-487. [PMID: 29244176 DOI: 10.1093/tropej/fmx099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Parvovirus B19 (B19) can cause transient aplastic crisis and lead to acute severe anemia. This study investigated the relationship between B19 and anemia among children <5 years old in the city of Mwanza, Tanzania. An enzyme immunoassay was used to detect B19 IgM- and IgG-specific antibodies among children with various categories of anemia according to the World Health Organization (WHO) guidelines. A total of 265 children with median age of 28.5 months (interquartile range 18-39.5) were investigated. Eighty-six children (32.5%) had severe anemia. B19-specific IgM and IgG antibodies were detected in 24 (9%) and 46 (17.4%) children, respectively. Low hemoglobin (Hb) level (p = 0.031), Plasmodium falciparum infection (p = 0.001) and residing in rural areas (p = 0.025) independently predicted B19 IgM seropositivity. Acute B19 infection decreased Hb level by 1.1 g/dl (p = 0.003). In malaria endemic areas, acute B19 infections should be considered among children with severe anemia from rural areas.
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Affiliation(s)
- Yustina A Tizeba
- Department of Pediatrics and Child health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Neema Kayange
- Department of Pediatrics and Child health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Tumaini Mhada
- Department of Pediatrics and Child health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Emmanuela E Ambrose
- Department of Pediatrics and Child health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
| | - Luke R Smart
- Department of Pediatrics and Child health, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania.,Department of Medicine, Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, P.O. Box 1464, Mwanza, Tanzania
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Jorgensen JM, Ashorn P, Ashorn U, Baldiviez LM, Gondwe A, Maleta K, Nkhoma M, Dewey KG. Effects of lipid-based nutrient supplements or multiple micronutrient supplements compared with iron and folic acid supplements during pregnancy on maternal haemoglobin and iron status. MATERNAL & CHILD NUTRITION 2018; 14:e12640. [PMID: 30047245 PMCID: PMC6175407 DOI: 10.1111/mcn.12640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 12/20/2022]
Abstract
We examined the effect of three types of prenatal supplements containing different amounts of iron on haemoglobin (Hb) and iron status (zinc protoporphyrin [ZPP] and soluble transferrin receptor [sTfR]) in late pregnancy among 1,379 women in rural Malawi. Participants were recruited at ≤20 gestational weeks (gw) and randomly assigned to consume daily (1) 60-mg iron and folic acid (IFA); (2) 20-mg iron plus 17 micronutrients in a capsule (MMN); or (3) lipid-based nutrient supplement (LNS; 118 kcal) with 20-mg iron plus 21 micronutrients, protein, and fat. We analysed differences between intervention groups in mean Hb, ZPP, and sTfR at 36 gw, and the proportion with anaemia (Hb < 100 g L-1 ) and iron deficiency (ZPP > 60 μmol mol-1 haem or sTfR > 6 mg L-1 ) at 36 gw. Women in the IFA group had higher Hb at 36 gw than women in the LNS group (P = 0.030) and higher iron status (lower ZPP and sTfR) than women in both the LNS (P < 0.001 for both ZPP and sTfR) and MMN (P = 0.025 and P = 0.046) groups. Results for anaemia and iron deficiency showed similar trends. Further research is needed to elucidate the appropriate amount of iron to improve Hb and iron status, while improving birth outcomes.
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Affiliation(s)
- Josh M. Jorgensen
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Per Ashorn
- Department of PaediatricsTampere University HospitalTampereFinland
- Faculty of Medicine and Life SciencesUniversity of TampereTampereFinland
| | - Ulla Ashorn
- Center for Child Health ResearchUniversity of Tampere School of Medicine and Tampere University HospitalTampereFinland
| | - Lacey M. Baldiviez
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
| | - Austrida Gondwe
- Department of Community HealthUniversity of Malawi College of MedicineBlantyreMalawi
| | - Ken Maleta
- Department of Community HealthUniversity of Malawi College of MedicineBlantyreMalawi
| | - Minyanga Nkhoma
- Department of Community HealthUniversity of Malawi College of MedicineBlantyreMalawi
| | - Kathryn G. Dewey
- Program in International and Community Nutrition, Department of NutritionUniversity of CaliforniaDavisCaliforniaUSA
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Multilevel Analysis of Determinants of Anemia Prevalence among Children Aged 6-59 Months in Ethiopia: Classical and Bayesian Approaches. Anemia 2018; 2018:3087354. [PMID: 29973986 PMCID: PMC6008921 DOI: 10.1155/2018/3087354] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/12/2018] [Accepted: 04/22/2018] [Indexed: 11/25/2022] Open
Abstract
Background Anemia is a widely spread public health problem and affects individuals at all levels. However, there is a considerable regional variation in its distribution. Objective Thus, this study aimed to assess and model the determinants of prevalence of anemia among children aged 6–59 months in Ethiopia. Data Cross-sectional data from Ethiopian Demographic and Health Survey was used for the analysis. It was implemented by the Central Statistical Agency from 27 December 2010 through June 2011 and the sampling technique employed was multistage. Method The statistical models that suit the hierarchical data such as variance components model, random intercept model, and random coefficients model were used to analyze the data. Likelihood and Bayesian approaches were used to estimate both fixed effects and random effects in multilevel analysis. Result This study revealed that the prevalence of anemia among children aged between 6 and 59 months in the country was around 42.8%. The multilevel binary logistic regression analysis was performed to investigate the variation of predictor variables of the prevalence of anemia among children aged between 6 and 59 months. Accordingly, it has been identified that the number of children under five in the household, wealth index, age of children, mothers' current working status, education level, given iron pills, size of child at birth, and source of drinking water have a significant effect on prevalence of anemia. It is found that variances related to the random term were statistically significant implying that there is variation in prevalence of anemia across regions. From the methodological aspect, it was found that random intercept model is better compared to the other two models in fitting the data well. Bayesian analysis gave consistent estimates with the respective multilevel models and additional solutions as posterior distribution of the parameters. Conclusion The current study confirmed that prevalence of anemia among children aged 6–59 months in Ethiopia was severe public health problem, where 42.8% of them are anemic. Thus, stakeholders should pay attention to all significant factors mentioned in the analysis of this study but wealth index/improving household income and availability of pure drinking water are the most influential factors that should be improved anyway.
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Spatiotemporal heterogeneity of malnutrition indicators in children under 5 years of age in Bangladesh, 1999–2011. Public Health Nutr 2018; 21:857-867. [DOI: 10.1017/s136898001700341x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveTo examine changes in the spatial clustering of malnutrition in children under 5 years of age (under-5s) for the period 1999 to 2011 in Bangladesh.DesignWe used data from four nationally representative Demographic and Health Surveys (DHS) conducted in 1999–2000, 2004, 2007 and 2011 in Bangladesh involving a total of 24 211 under-5s located in 1661 primary sampling units (PSU; geographical unit of analysis) throughout Bangladesh. The prevalence of stunting (height/length-for-age Z-score <−2), underweight (weight-for-age Z-score <−2) and wasting (weight-for-height/length Z-score <−2) at each PSU site and for each survey year were estimated based on the WHO child growth standard. The extent of spatial clustering was quantified using semivariograms.SettingWhole of Bangladesh.SubjectsChildren under 5 years of age.ResultsOur results demonstrate that in 1999–2000 most PSU throughout Bangladesh experienced stunting, underweight and wasting prevalence which exceeded the WHO thresholds. By 2011, this situation improved, although in two of the six divisions (Barisal and Sylhet) PSU still exhibited higher levels of malnutrition compared with other divisions of the country. The pattern of spatial clustering for stunting, underweight and wasting also changed between 1999 and 2011 both at national and sub-national (division) levels.ConclusionsWe identified divisions where malnutrition indicators (stunting, underweight and wasting) remain highly clustered and other divisions where they are more widely spread in Bangladesh. This has important implications on how interventions for malnutrition need to be delivered (geographically targeted interventions v. random interventions) within each division of the country.
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Losso JN, Karki N, Muyonga J, Wu Y, Fusilier K, Jacob G, Yu Y, Rood JC, Finley JW, Greenway FL. Iron retention in iron-fortified rice and use of iron-fortified rice to treat women with iron deficiency: A pilot study. BBA CLINICAL 2017; 8:78-83. [PMID: 28966915 PMCID: PMC5608553 DOI: 10.1016/j.bbacli.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 11/08/2022]
Abstract
Objectives 1. Evaluate the effect of washing and cooking iron-fortified rice on iron retention and bioavailability. 2. Evaluate the effect of iron-fortified rice on women with iron deficiency anemia Methods 1. Iron-fortified rice (18 mg/100 g as FeSO4) was cooked in Baton Rouge, Louisiana (C), rinsed and cooked (RC), fried and cooked (FC), cooked with extra water (CW), or soaked and cooked with extra water (SCW), and iron retention was determined. 2. Rice samples were cooked in Kampala, Uganda in a lab (C-Uganda) and households using traditional cooking method (TC-Uganda) and iron retention were determined. 3. Seventeen women with iron deficiency (low iron and/or low ferritin) anemia were randomized to 100 g/d of rice (two cooked 0.75 cup servings) for two weeks containing 18 mg/d iron (supplemented) or 0.5 mg/d iron (un-supplemented). Hemoglobin and hematocrit were evaluated at baseline and 2 weeks with other measures of iron metabolism. Results 1. Iron retention, from highest to lowest, was (C), (RC), (FC), (C-Uganda), (CW), (SCW) and (TC-Uganda). 2. Seventeen women were randomized and 15 completed the study (hemoglobin 10.6 ± 1.6 g, hematocrit 33.7 ± 4.1%), 9 in the iron-fortified rice group and 6 in the un-fortified rice group. The iron-fortified group had a greater increase in hemoglobin (0.82 g, p = 0.0035) and Hematocrit (1.83%, p = 0.0248) with directional differences in other measures of iron metabolism favoring the iron-fortified group. Conclusions Iron-fortified rice increased hemoglobin and hematocrit in women with iron-deficient anemia. Iron deficiency and anemia are widespread in Southeast Asia and Africa and undermine development in these regions. Iron deficiency is prevalent engendering poor health and cognitive development. Iron deficiency can be treated effectively with iron fortification. Iron rinses in a rice-based diet have leached reducing fortification. An iron rinse resistant leaching during cooking is described. The leach-resistant iron rinse improved iron deficiency anemia in a clinical trial.
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Affiliation(s)
- J N Losso
- Louisiana State University, School of Nutrition and Food Sciences, Baton Rouge, LA, United States
| | - N Karki
- Louisiana State University, School of Nutrition and Food Sciences, Baton Rouge, LA, United States
| | - J Muyonga
- Makerere University, Kampala, Uganda
| | - Y Wu
- The Wright Group, Crowley, LA, United States
| | - K Fusilier
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - G Jacob
- Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Y Yu
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - J C Rood
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
| | - J W Finley
- Louisiana State University, School of Nutrition and Food Sciences, Baton Rouge, LA, United States
| | - F L Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA, United States
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Owada K, Nielsen M, Lau CL, Clements ACA, Yakob L, Soares Magalhães RJ. Measuring the Effect of Soil-Transmitted Helminth Infections on Cognitive Function in Children: Systematic Review and Critical Appraisal of Evidence. ADVANCES IN PARASITOLOGY 2017; 98:1-37. [PMID: 28942767 DOI: 10.1016/bs.apar.2017.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Recently the role of soil-transmitted helminth (STH) infections in children's cognitive developmental impairment has been under scrutiny. We conducted a systematic review of the evidence for associations between STH infections and cognitive function of children using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. We aimed to identify the domains of cognitive function in three age strata (<24months, 24-59months and ≥60months) and critically appraise the general design protocol of the studies, with a focus on the cognitive function measurement tools used. A total of 42 papers fulfilled the inclusion criteria, including 10 studies from a recent Cochrane review. Our findings demonstrate variation in tested domains, lack of consistency in the use of measurement tools and analysis of results. Cognitive function measures in children aged under 59months have been mainly limited to domains of gross motor, fine motor and language skills, whereas in children aged 60months and above most studies tested domains such as memory and processing speed. Even within the same age group the results on the association between STH infections and measures of cognitive development were often conflicting. The current study highlights the need for methodological consensus in the use of measurement tools and data analysis protocols if the effect of STH infections on cognitive function domains in children is to be correctly established. This will be an imperative next step to generate conclusive evidence of the role of STH infections in cognitive development in children.
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Affiliation(s)
- Kei Owada
- School of Medicine, The University of Queensland, South Brisbane, QLD, Australia; Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Mark Nielsen
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia; Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
| | - Colleen L Lau
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia; Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
| | - Archie C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Laith Yakob
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ricardo J Soares Magalhães
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia; Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, South Brisbane, QLD, Australia
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Muchie KF. Determinants of severity levels of anemia among children aged 6–59 months in Ethiopia: further analysis of the 2011 Ethiopian demographic and health survey. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0093-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ferrari G, Ntuku HMT, Ross A, Schmidlin S, Kalemwa DM, Tshefu AK, Lengeler C. Identifying risk factors for Plasmodium infection and anaemia in Kinshasa, Democratic Republic of Congo. Malar J 2016; 15:362. [PMID: 27417676 PMCID: PMC4946241 DOI: 10.1186/s12936-016-1412-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/01/2016] [Indexed: 12/02/2022] Open
Abstract
Background There is little data on the risk factors for malaria infection in large cities in central Africa and in all age groups. There may be different associations with the risk factors for areas with different malaria transmission intensities such as the effect of fever or age. This study aimed at identifying risk factors associated with Plasmodium infection and anaemia among children 6–59 months and individuals aged older than 5 years in Kinshasa, a large city with heterogeneity in malaria prevalence. Methods This study analysed data from 3342 children aged 6–59 months from 25 non-rural health zones (HZs) and for 816 individuals aged older than 5 years from two HZs in Kinshasa (non-rural), collected during a cross sectional malaria survey in 2011. Logistic regression with random effects was used to investigate predictors for malaria and anaemia. Differences in risk factors in areas with a prevalence of less than 10 and 10 % or greater were investigated. Results There was evidence of a different age-pattern in the two transmission settings. For children under 5 years, the highest prevalence of malaria was observed in the 48–59 months group in both transmission settings, but it increased more gently for the lower transmission HZs (p = 0.009). In a separate analysis in children over 5 years in two selected HZs, the peak prevalence was in 5–9 years old in the higher transmission setting and in 15–19 years old in the lower transmission setting. Reported fever was associated with malaria in both transmission strata, with no evidence of a difference in these associations (p = 0.71); however in children older than 5 years there was a significant interaction with a stronger association in the low transmission HZ. Insecticide-treated net (ITN) use was associated with a lower risk of malaria infection in children 6–59 months in the high transmission HZs. Similar estimates were found in children over 5 years and the lower transmission HZ but the associations there were not significant. There was no evidence of a difference in these associations by strata. The risk of anaemia decreased with increasing age in all strata, whereas it increased with malaria infection and reported fever. ITN use did not show evidence of protection against anaemia. Low socio-economic status was associated with malaria in high transmission setting in children 6–59 months and anaemia in low transmission setting. Conclusions This study shows that in areas of low transmission in Kinshasa, the peak prevalence occurs in older age groups however ITN use was highest in children under 5 years. Targeted distribution of ITN to all age groups should be continued. For most risk factors, there was no evidence of an interaction with transmission intensity however the associations with age and with fever in the last 2 weeks did vary significantly.
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Affiliation(s)
- Giovanfrancesco Ferrari
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Henry M T Ntuku
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Amanda Ross
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sandro Schmidlin
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Didier M Kalemwa
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Jones AD, Acharya Y, Galway LP. Urbanicity Gradients Are Associated with the Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa. J Nutr 2016; 146:1257-67. [PMID: 27170726 DOI: 10.3945/jn.115.226654] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/17/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The nutrition transition is advancing throughout sub-Saharan Africa (SSA). However, the nutritional risk across urbanicity gradients associated with this transition is not clear. OBJECTIVES We aimed to determine 1) the extent to which overweight and anemia in women of childbearing age (WCBA) and stunting in preschool-age children (PSC) are spatially correlated within countries of SSA; and 2) the association of urbanicity with the individual-level nutritional double burden (i.e., concurrent overweight and anemia within an individual WCBA), the household-level double burden (i.e., overweight WCBA and stunted PSC in the same household), and the 3 components of these double burdens (i.e., overweight, anemia, and stunting). METHODS We used Demographic and Health Surveys (DHS) data for 30 countries in SSA from 2006-2012. We calculated overweight [body mass index (BMI; in kg/m(2)) ≥25] and anemia (hemoglobin concentration <120 g/L) in WCBA, and stunting in PSC aged 12-59 mo (height-for-age z score <-2). We used population density, measured using a high-resolution population distribution dataset, to define gradients of urbanicity. We used geolocated DHS data to calculate cluster-level mean population densities and the Moran's I statistic to assess spatial autocorrelation. RESULTS Cluster-level BMI values and hemoglobin concentrations for WCBA were spatially correlated. The odds of overweight in WCBA were higher in periurban and urban areas than in rural areas (periurban, OR: 1.08; 95% CI: 1.01, 1.16; urban, OR: 1.26; 95% CI: 1.18, 1.36), as were the odds of stunting in PSC in periurban areas (OR: 1.13; 95% CI: 1.06, 1.22). The odds of both double burden conditions were higher in periurban and urban areas than in rural areas (individual-level-periurban, OR: 1.18; 95% CI: 1.05, 1.33; urban, OR: 1.43; 95% CI: 1.27, 1.61; household-level-periurban, OR: 1.24; 95% CI: 1.06, 1.44; urban, OR: 1.24; 95% CI: 1.06, 1.46). CONCLUSION Urban and periurban areas in SSA may be particularly vulnerable to the nutritional double burden compared with rural areas. Clearly differentiating urban environments is important for assessing changing patterns of nutritional risk associated with the nutrition transition in SSA.
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Affiliation(s)
| | - Yubraj Acharya
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI; and
| | - Lindsay P Galway
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
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Hamm NAS, Soares Magalhães RJ, Clements ACA. Earth Observation, Spatial Data Quality, and Neglected Tropical Diseases. PLoS Negl Trop Dis 2015; 9:e0004164. [PMID: 26678393 PMCID: PMC4683053 DOI: 10.1371/journal.pntd.0004164] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Earth observation (EO) is the use of remote sensing and in situ observations to gather data on the environment. It finds increasing application in the study of environmentally modulated neglected tropical diseases (NTDs). Obtaining and assuring the quality of the relevant spatially and temporally indexed EO data remain challenges. Our objective was to review the Earth observation products currently used in studies of NTD epidemiology and to discuss fundamental issues relating to spatial data quality (SDQ), which limit the utilization of EO and pose challenges for its more effective use. We searched Web of Science and PubMed for studies related to EO and echinococossis, leptospirosis, schistosomiasis, and soil-transmitted helminth infections. Relevant literature was also identified from the bibliographies of those papers. We found that extensive use is made of EO products in the study of NTD epidemiology; however, the quality of these products is usually given little explicit attention. We review key issues in SDQ concerning spatial and temporal scale, uncertainty, and the documentation and use of quality information. We give examples of how these issues may interact with uncertainty in NTD data to affect the output of an epidemiological analysis. We conclude that researchers should give careful attention to SDQ when designing NTD spatial-epidemiological studies. This should be used to inform uncertainty analysis in the epidemiological study. SDQ should be documented and made available to other researchers.
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Affiliation(s)
- Nicholas A. S. Hamm
- Faculty of Geo-Information Science and Earth Observation (ITC), University of Twente, Enschede, The Netherlands
- * E-mail:
| | - Ricardo J. Soares Magalhães
- School of Veterinary Science, University of Queensland, Brisbane, Australia
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Archie C. A. Clements
- Research School of Population Health, The Australian National University, Canberra, Australia
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Semedo RM, Santos MM, Baião MR, Luiz RR, da Veiga GV. Prevalence of anaemia and associated factors among children below five years of age in Cape Verde, West Africa. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2014; 32:646-657. [PMID: 25895198 PMCID: PMC4438695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study estimated the prevalence of anaemia and associated factors in a probability sample of 993 chil- dren aged 6-59 months in Cape Verde, West Africa. Odds ratio (OR) and 95% confidence interval (95% CI) were estimated from a hierarchical model for multiple analysis to assess the association between anaemia and explanatory variables. The prevalence of anaemia was 51.8% (95% CI 47.7-55.8). Children who resided within poor household conditions (OR 1.99; 95% CI 1.06-3.71) were below 24 months of age (OR 3.23; 95% CI 2.03-5.15) and recently experienced diarrhoea (OR 1.58; 95% CI 0.99-2.50) were at high risk of anaemia. Anaemia should be considered a serious public-health concern in Cape Verde, mainly for chil- dren below 24 months. Further, special consideration should be given to children who have experienced recent diarrhoea and belong to families residing in poor household conditions.
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Affiliation(s)
| | | | - Mirian R. Baião
- Department of Nutrition, Federal University of Rio de Janeiro
| | - Ronir R. Luiz
- Department of Public Health Studies, Federal University of Rio de Janeiro, Brazil
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Gebreegziabiher G, Etana B, Niggusie D. Determinants of Anemia among Children Aged 6-59 Months Living in Kilte Awulaelo Woreda, Northern Ethiopia. Anemia 2014; 2014:245870. [PMID: 25302116 PMCID: PMC4180192 DOI: 10.1155/2014/245870] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction. The aim of this study was to determine the prevalence of anemia and determinant factors among children aged 6-59 months living in Kilte Awulaelo Woreda, eastern zone. Method. A community based cross-sectional study was conducted during February 2013 among 6 tabias of Kilte Awulaelo Woreda, northern Ethiopia. A total of 568 children were selected by systematic random sampling method. Anthropometric data and blood sample were collected. Bivariate and multivariate logistic regression analyses were performed to identify factors related to anemia. Result. The mean hemoglobin level was 11.48 g/dl and about 37.3% of children were anemic. Children who were aged 6-23 months [AOR = 1.89: 95% CI (1.3, 2.8)], underweight [AOR = 2.05: 95% CI (1.3, 3.3)], having MUAC less than 12 cm [AOR = 3.35: 95% CI (2.1, 5.3)], and from households with annual income below 10,000 Ethiopian birr [AOR = 4.86: 95% CI (3.2, 7.3)] were more likely to become anemic. Conclusion. The prevalence of anemia among the children is found to be high. It was associated with annual household income, age, and nutritional status of the child. So, improving family income and increasing awareness of the mother/caregiver were important intervention.
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Affiliation(s)
| | - Belachew Etana
- School of Public Health, College of Health Science, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia
| | - Daniel Niggusie
- School of Public Health, College of Health Science, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia
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Reithinger R, Ngondi J, Graves P, Hwang J, Getachew A, Jima D. Risk factors for anemia in children under 6 years of age in Ethiopia: analysis of the data from the cross-sectional Malaria IndicatorSurvey, 2007. Trans R Soc Trop Med Hyg 2013; 107:769-76. [PMID: 24218415 PMCID: PMC10563508 DOI: 10.1093/trstmh/trt096] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Malaria is a leading cause of morbidity in Ethiopia. However, its transmission varies in both space and time, and large areas of the country are hypoendemic and epidemic-prone. The Ethiopia National Malaria Indicator Survey 2007 is a cross-sectional, nationally-representative household survey. The objective of the analyses presented here were to use the survey's data to identify factors associated with anemia presence in children under 6 years of age (U6); specifically, investigate the association between malaria and anemia; and discuss using anemia as a malaria proxy biomarker in the Ethiopian hypo-endemic transmission setting. METHODS The survey sampled 4185 households in 347 enumeration areas ≤2500 m above sea level. Primary outcome was increasing anemia severity in sampled children: no anemia (Hb: ≥11g/dl); mild anemia (Hb: ≥8g/dl and <11g/dl); and moderate-severe anemia (Hb: <8g/dl). Secondary outcomes were positive malaria rapid diagnostic test (RDT) or blood slide microscopy. RESULTS The analysis included 6054 (92.0%) children U6 in 3962 households. The proportion of children with no anemia, mild anemia, and moderate-severe anemia was 63.6%, 31.3%, and 5.1%, respectively. The overall prevalence of anemia (Hb <11g/dl) was 36.4% (95% CI 34.4-38.4). Factors independently associated with reduced relative odds of anemia categories were age (OR=0.7, 95% CI 0.7-0.7) and female sex (OR=0.9, 95% CI 0.8-1.0); malaria RDT positivity was associated with increased relative odds of a more severe anemia category (OR=5.8, 95% CI 3.7-9.2). CONCLUSIONS We conclude that at altitudes ≤2500 m malaria appears to be a significant risk factor for anemia; potentially anemia could be used as a useful proxy biomarker for malaria and its control in Ethiopia.
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Affiliation(s)
- R. Reithinger
- U.S. Agency for International Development, Addis Ababa, Ethiopia
- RTI International, Washington, DC, USA
| | - J.M. Ngondi
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
- RTI International, Dar-es-Salaam, Tanzania
- The Carter Center, Atlanta, GA, USA
| | - P.M. Graves
- The Carter Center, Atlanta, GA, USA
- School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Australia
| | - J. Hwang
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Global Health Group, University of California San Francisco, CA, USA
| | - A. Getachew
- Malaria Control and Evaluation Partnership in Africa (MACEPA), PATH, Addis Ababa, Ethiopia
| | - D. Jima
- Federal Ministry of Health, Addis Ababa, Ethiopia
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Haverkate M, Smits J, Meijerink H, van der Ven A. Socioeconomic determinants of haemoglobin levels of African women are less important in areas with more health facilities: a multilevel analysis. J Epidemiol Community Health 2013; 68:116-22. [PMID: 24098045 DOI: 10.1136/jech-2012-202336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence of anaemia in Africa is the highest in the world. Especially women are at risk because of blood loss during menstruation and increased iron requirements during pregnancy. This study examined determinants of the haemoglobin (Hb) level of African women at individual/household, cluster, district, and national level. Special attention was paid to socioeconomic factors and the presence of health facilities. METHODS Data were derived from Demographic and Health Surveys conducted between 2003 and 2010 in 21 African countries. We included all women aged 15-49 who participated in a women's survey and had a Hb measurement. Multilevel models were used to examine the influence of various factors at different hierarchical levels simultaneously. RESULTS 104 899 women were included in the study, of which 23.1% were anaemic (Hb<110 g/L). Socioeconomic factors were strongly related to the Hb level of women. Wealth, education, having a job, occupation of the partner, presence of a toilet facility, context educational level and preventive health measures were positively associated with the Hb level. Interaction analysis indicated that socioeconomic differences in the Hb level of women were reduced by the presence of health facilities. CONCLUSIONS Interventions aimed at improving the Hb level of African women should take socioeconomic and contextual aspects into account. Increasing availability of health facilities might be a tool for reducing socioeconomic differences.
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Affiliation(s)
- Manon Haverkate
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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