Structured Additive Quantile Regression for Assessing the Determinants of Childhood Anemia in Rwanda

Mothers' experience of losing infants by death and its predictors in Ethiopia

BACKGROUND

Although infant deaths worldwide have reduced, many children die before their first birthday. Infant deaths are widespread in low-income countries, and information about the cause of death is limited. In Ethiopia, 53% of infants' deaths occurred in their neonatal period, and 174 infants' deaths occurred from 3684 births. Hence, this study aimed to assess mothers' experiences with infant death and its predictors in Ethiopia.

METHODS

A total of 1730 weighted samples of mothers from the 2019 EDHS dataset, which was collected across the regions of Ethiopia, were included for analysis. A two-stage cluster sampling technique with a cross-sectional study design was used. All mothers whose children were under the age of 0-12 months were included in this study. Six count regression models were considered and compared using Akaike's information criteria and Bayesian information criterion with STATA version 15 software. The strength of the association between the number of infant deaths and possible predictors was determined at a P-value less than 0.05, with a 95% confidence interval. The findings were interpreted by using the incident rate ratio.

RESULTS

A total of 46.3% of mothers had lost at least one infant by death in the last five years before the 2019 EDHS survey was held. The mean and variance of infant deaths were 2.55 and 5.58, respectively. The histogram was extremely picked at the beginning, indicating that a large number of mothers did not lose their infants by death, and that shows the data had positive skewness. Mothers under 25-29 years of age (IRR: 1.75, 95% CI:1.48, 2.24), and 30-34 years of age (IRR: 1.42, 95% CI: 1.12, 2.82), Somali (IRR: 1.47, 95% CI: 1.02, 3.57), Gambela (IRR: 1.33, 95% CI: 1.10, 2.61), and Harari (IRR: 1.39, 95% CI: 1.02, 2.63) regions, rural resident mothers (IRR: 1.68, 95% CI: 1.09, 1.91, and Protestant (IRR = 1.43, 95% CI: 1.14, 2.96), and Muslim (IRR = 1.59, 95% CI: 1.07, 2.62) religion fellow of mothers were associated with a high risk of infants' deaths. Whereas, being rich IRR: 0.37, 95% CI: .27, .81) and adequate ANC visits (IRR: 0.28, 95% CI: .25, .83) were associated with a low risk of infant death.

CONCLUSION

Many mothers have experienced infant deaths, and the majority of infants' deaths occur after the first month of birth. Encouraging mothers to attend antenatal care visits, creating mothers' awareness about childcare, and ensuring equal health services distribution and utilization to rural residents are essential to minimize infant death. Educating lower-aged reproductive mothers would be a necessary intervention to prevent and control infant deaths.

Knowledge and practices in preventing nutritional anaemia of the urban poor adolescents in Kuala Lumpur, Malaysia

Background: Anaemia has been identified as a major public health problem that affects both developed and developing countries, including Malaysia. To prevent anaemia, knowledge is a key parameter for changing attitudes and practices. Aim: This present study aims to determine the association of knowledge and practices in preventing nutritional anaemia with anaemia status of urban poor adolescents in Kuala Lumpur, Malaysia. Methods: A total of 209 urban poor adolescents (50.7% males and 49.3% females) aged 10 to 17 years old were recruited from eight low-cost flats (People Housing Programme) in Kuala Lumpur, Malaysia. A self-administered questionnaire was used to assess the sociodemographic characteristics, knowledge and practices in preventing nutritional anaemia. Anaemia status from the haemoglobin level concentration was determined using HemoCue® 201  +  hemoglobinometer. Results: The prevalence of anaemia among urban poor adolescents was 58.4%, particularly prevalent among females (p < 0.001) and household size of six and above (p  =  0.036). Only 29.2% and 10.0% of them were found to have good levels of knowledge and practices in preventing nutritional anaemia, respectively. Adolescents with high knowledge level tended to be anaemic as compared to poor knowledge level (AOR(95% CI)  =  2.20 (1.02, 5.61), p < 0.05) after adjusting for sex, household size and monthly household income. Conclusion: Findings showed high prevalence of anaemia and low levels of knowledge and practices of nutritional anaemia prevention among the urban poor adolescents. Nutrition education and intervention are needed to improve the anaemia status of the urban poor adolescents.

Modeling the shared risks of malaria and anemia in Rwanda

In sub-Saharan Africa, malaria and anemia contribute substantially to the high burden of morbidity and mortality among under-five children. In Rwanda, both diseases have remained public health challenge over the years in spite of the numerous intervention programs and policies put in place. This study aimed at understanding the geographical variations between the joint and specific risks of both diseases in the country while quantifying the effects of some socio-demographic and climatic factors. Using data extracted from Rwanda Demographic and Health Survey, a shared component model was conceived and inference was based on integrated nested Laplace approximation. The study findings revealed similar spatial patterns for the risk of malaria and the shared risks of both diseases, thus confirming the strong link between malaria and anaemia. The spatial patterns revealed that the risks for contracting both diseases are higher among children living in the districts of Rutsiro, Nyabihu, Rusizi, Ruhango, and Gisagara. The risks for both diseases are significantly associated with type of place of residence, sex of household head, ownership of bed net, wealth index and mother's educational attainment. Temperature and precipitation also have substantial association with both diseases. When developing malaria intervention programs and policies, it is important to take into account climatic and environmental variability in Rwanda. Also, potential intervention initiatives focusing on the lowest wealth index, children of uneducated mothers, and high risky regions need to be reinforced.

Determinants of coexistence of undernutrition and anemia among under-five children in Rwanda; evidence from 2019/20 demographic health survey: Application of bivariate binary logistic regression model

BACKGROUND

Undernutrition and anemia are significant public health issues among under-5 children, with potential long-term consequences for growth, development, and overall health. Thus, this study aims to conduct a bivariate binary logistic regression model by accounting for the possible dependency of childhood undernutrition and anemia.

METHODS

The data came from the DHS program's measurement. A total of 3,206 under-five children were involved in this study. A single composite index measure was calculated for stunting, wasting, and underweight using principal component analysis. A bivariate binary logistic regression model is used to assess the association between undernutrition and anemia given the effect of other predictors.

RESULTS

Among 3,206 under-five children considered in this study, 1482 (46.2%) and 658 (20.5%) children were agonized by anemia and undernutrition, respectively. In bivariate binary logistic regression model; Urban children [AOR = 0.751, 96% CI: 0.573-0.984; AOR = 0.663, 95% CI: 0.456-0.995] and anemic mothers [AOR = 1.160, 95% CI: 1.104-1.218; AOR = 1.663, 95% CI: 1.242-2.225] were significantly associated with both childhood anemia and undernutrition, respectively. Improved water sources [AOR = 0.681, 95% CI: 0.446-0.996], average-sized children [AOR = 0.567, 95% CI: 0.462-0.696], and diarrhea [AOR = 1.134, 95% CI: 1.120-2.792] were significantly associated with childhood anemia. Large-sized children [AOR = 0.882, 95% CI: 0.791-0.853] and those with fever [AOR = 1.152, 95% CI: 1.312-2.981] were significantly associated with under-five children's undernutrition.

CONCLUSION

The prevalence of both undernutrition and anemia among under-five-year-old children was high in Rwanda. The following determinants are statistically associated with both childhood undernutrition and anemia: place of residence; source of drinking water; maternal anemia; being a twin; birth size of children; diarrhea; fever; and child age. Anemia and nutritional deficiencies must be treated concurrently under one program, with evidence-based policies aimed at vulnerable populations.

The application of machine learning approaches to determine the predictors of anemia among under five children in Ethiopia

Health professionals need a strong prediction system to reach appropriate disease diagnosis, particularly for under-five child with health problems like anemia. Diagnosis and treatment delay can potentially lead to devastating disease complications resulting in childhood mortality. However, the application of machine learning techniques using a large data set provides scientifically sounded information to solve such palpable critical health and health-related problems. Therefore, this study aimed to determine the predictors of anemia among under-5 year's age children in Ethiopia using a machine learning approach. A cross-sectional study design was done using the Ethiopian Demographic and Health Survey 2016 data set. A two-stage stratified cluster sampling technique was employed to select the samples. The data analysis was conducted using Statistical Package for Social Sciences/SPSS version 25 and R-software. Data were derived from Ethiopian Demographic and Health Survey. Boruta algorism was applied to select the features and determine the predictors of anemia among under-5 years-old children in Ethiopia. The machine learning algorism showed that number of children, distance to health facilities, health insurance coverage, youngest child's stool disposal, residence, mothers' wealth index, type of cooking fuel, number of family members, mothers' educational status and receiving rotavirus vaccine were the top ten important predictors for anemia among under-five children. Machine-learning algorithm was applied to determine the predictors of anemia among under- 5 year's age children in Ethiopia. We have identified the determinant factors by conducting a feature importance analysis with the Boruta algorithm. The most significant predictors were number of children, distance to health facility, health insurance coverage, youngest child's stool disposal, residence, mothers' wealth index, and type of cooking fuel. Machine learning model plays a paramount role for policy and intervention strategies related to anemia prevention and control among under-five children.

Anemia prevalence and its predictors among children under-five years in Ghana. A multilevel analysis of the cross-sectional 2019 Ghana Malaria Indicator Survey

Background and Aims

Despite the implementation of anemia control interventions in Ghana, anemia prevalence is still high in children under-fives. Reducing the prevalence of anemia requires identifying and targeting associated critical risk factors. This study seeks to identify predictors of anemia among children under-fives in Ghana.

Methods

Nationally representative data from the 2019 Ghana Malaria Indicator Survey was used in this study. Both fixed and random effects (multilevel) logistic regression models were applied to 2434 children to identify critical factors associated with anemia.

Results

In this study, 54% (95% confidence interval [CI] 52.0-57.0) of children under-5 years were anemic. Infants were more likely to be anemic (66.7%) compared with other children below 5 years. In the multivariable multilevel model, the risk of anemia was found to be higher in younger children especially 6-11 months old (adjusted odds ratio [aOR] = 3.59, CI: 2.54-5.08) and 12-23 months old (aOR = 2.97, CI: 2.08-4.23), children who had malaria (aOR = 1.53, CI: 1.13-2.06), children whose mothers were not registered but not covered with health insurance (aOR = 1.45, CI: 1.21-1.74) or were not even registered for insurance (aOR = 1.49, CI: 1.15-1.93), children born to adolescent mothers (aOR = 2.21, CI: 1.36-3.57), children born to non-Christian mothers (Islam [aOR = 1.53, CI: 1.17-2.00]), children born to families of poorer households (poorest [aOR = 3.01, CI: 1.64-5.51]; poorer [aOR = 2.56, CI: 1.65-3.98]); middle (aOR = 2.03, CI: 1.32-3.11) and richer (aOR = 1.78, CI: 1.19-2.64), and children who lived in either Upper East (aOR = 2.03, CI: 1.26-3.26) or Central (aOR = 2.52, CI: 1.42-4.47) regions. Significant unobserved community-level differences in anemia prevalence were observed.

Conclusion

The probability of anemia in children under-fives differs substantially from one community to another, and the prevalence remains high. The identified critical risk factors should be addressed. Multifaceted and targeted approaches are needed to help reduce the anemia prevalence in this setting to achieve the multiple United Nation's Sustainable Development Goals, which are related to risk and prevalence of anemia by 2030.

Shared component modelling of early childhood anaemia and malaria in Kenya, Malawi, Tanzania and Uganda

Background

Malaria and anaemia contribute substantially to child morbidity and mortality. In this study, we sought to jointly model the residual spatial variation in the likelihood of these two correlated diseases, while controlling for individual-level, household-level and environmental characteristics.

Methods

A child-level shared component model was utilised to partition shared and disease-specific district-level spatial effects.

Results

The results indicated that the spatial variation in the likelihood of malaria was more prominent compared to that of anaemia, for both the shared and specific spatial components. In addition, approximately 30% of the districts were associated with an increased likelihood of anaemia but a decreased likelihood of malaria. This suggests that there are other drivers of anaemia in children in these districts, which warrants further investigation.

Conclusions

The maps of the shared and disease-specific spatial patterns provide a tool to allow for more targeted action in malaria and anaemia control and prevention, as well as for the targeted allocation of limited district health system resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03694-4.

How to Efficiently Reduce the Carbon Intensity of the Heavy Industry in China? Using Quantile Regression Approach

This decoupling between carbon dioxide emissions and the heavy industry is one of the main topics of government managers. This paper uses the quantile regression approach to investigate the carbon intensity of China's heavy industry, based on 2005-2019 panel data. The main findings are as follows: (1) incentive-based environmental regulations have the greater impact on the carbon intensity in Jiangsu, Shandong, Zhejiang, Henan, Liaoning, and Shaanxi, because these provinces invest more in environmental governance and levy higher resource taxes; (2) the impact of mandatory environmental regulations on carbon intensity in Beijing, Tianjin, and Guangdong provinces is smaller, since these three provinces have the fewest enacted environmental laws and rely mainly on market incentives; (3) conversely, foreign direct investment has contributed most to carbon intensity reduction in Tianjin, Beijing, and Guangdong provinces, because these three have attracted more technologically advanced foreign-funded enterprises; (4) technological progress contributes more to the carbon intensity in the low quantile provinces, because these provinces have more patented technologies; (5) the carbon intensity of Shaanxi, Shanxi, and Inner Mongolia provinces is most affected by energy consumption structures because of their over-reliance on highly polluting coal.

Spatial Variations and Determinants of Anemia among Under-five Children in Nepal, DHS (2006-2016)

Anemia among under-five children is the major health problem in Nepal. The lack of nutritional supplementation and lack of healthcare facilities are influential factors of anemia. Thus, the main objective of this study is to explore spatial variations and determinants of anemia among under-five children in Nepal. Nepal Demographic and Health Survey (NDHS) data from 2006 to 2016 were used in this study, which includes: household and individual-level data of 8555 under-five children, whose anemia was measured. In addition, a total of 260 (2006), 281 (2011), and 383 DHS clusters (2016) were taken in consideration for spatial analysis. The overall prevalence of anemia was 48.9%, 46.4%, and 52.2% in 2006, 2011, and 2016 respectively. The spatial analysis revealed a nonrandom spatial distribution, where statistically significant hotspots and coldspots were detected in different parts of the country. The results also identified mother’s age, mother’s educational level, socioeconomic status of household, number of under-5 children, household size, birth weight, underweight, stunting, diarrhea, and fever as associated factors of anemia among under-5 children. These findings may provide assistance to concerned health officials in adopting anemia-related programs and policies to address the anemia problems that plague Nepalese children under the age of five.

Prevalence and Triggering Factors of Childhood Anemia: An Application of Ordinal Logistic Regression Model

INTRODUCTION

Anemia is indeed a significant risk factor for children's health as it affects growth retardation and has severe short and prolonged effects that follow in morbidity and death. Notwithstanding such ways to tackle anemia, the prevalence remains high in India and poses a severe public health concern.

OBJECTIVES

The primary focus of this study was to find the prevalence and to determine the factors associated with the anemia of children under five years of age in India. Problem Statement. The increasing prevalence of childhood anemia and the life-threatening consequences for millions of children in India are a major concern. Knowing the relevant associated factors with childhood anemia is essential to reduce the frequency and severity level. Study design. For analysis purposes, this study utilized a cross-sectional study design. Methodology. Using the Indian Demographic and Health Survey 2015-16 data, we used chi-squared and gamma tests to find the association. Then, we utilized multinomial logistic regression and ordinal logistic regression to find the better model and the influencing factors of anemia in India.

RESULTS

In our study, we have found that children with highly educated mothers were 36.7% less likely (OR = 0.633, P ≤ 0.001, 95% CI: 0.608, 0.658) to be higher anemic than the children with not educated mother. Children with moderate and severe anemic mothers were 163.3% (OR = 2.633, P ≤ 0.001, 95% CI: 2.565, 7.704) more likely to be higher anemic than the children with not anemic mother. Not stunting children were 21.9% (OR = 0.781, P ≤ 0.001, 95% CI: 0 .764, 0.797) less likely to be higher anemic than the stunting children. Children aged 36-59 months were 73.9% (OR = 0.361, P ≤ 0.001, 95% CI: 0.353, 0.369) less likely to be higher anemic than the children aged 6-24 months. Again, the ACI value revealed that ordinal logistic regression was a better-fitted model for these data.

CONCLUSION

and contribution. The variables such as stunting, underweight, wasting, child age, size of the child, and source of drinking water were the most critical indicators for child anemia in India. In summary, our study result indicated the major socioeconomic and demographic factors associated with childhood anemia in India, which can help the policymaker to take quick decision to reduce the severity level.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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.

Review of the Micronutrient Situation in Rwanda

BACKGROUND

Rwanda's commitment to reducing malnutrition is evident in their multisectoral nutrition policy and wide array of nutrition partners. However, the prevalence of micronutrient deficiencies and the suitability of current strategies to address existing deficiencies is unclear.

OBJECTIVE

To review the available evidence related to the prevalence of micronutrient deficiencies across the life cycle and strategies in place to address them.

METHODS

We reviewed scientific and grey literature on nutritional problems in Rwanda, emphasizing micronutrient deficiencies and anemia, and current strategies to address micronutrient malnutrition.

RESULTS

Overall, there is scant evidence related to the types and prevalence of micronutrient deficiencies among populations across the life cycle in Rwanda. Existing evidence is primarily limited to outdated or small regional surveys focusing on iron or vitamin A among women and young children. Surveys have assessed the prevalence of anemia and indicate that anemia is very high among young children and moderately high among other age-groups. However, there are limited data on the context-specific causes of anemia in Rwanda across population groups. Current nutrition strategies mainly target women and young children and are primarily designed to reduce vitamin A deficiency and/or anemia caused by micronutrient deficiencies.

CONCLUSIONS

Rwanda has many nutrition programs in place that address micronutrient deficiencies in young children and a few for women of reproductive age. However, gaps exist in knowledge of the extent of different types of micronutrient deficiencies among all populations across the life cycle and whether the delivery of nutrients through current programs is meeting actual needs.

Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005-2016

BACKGROUND

Anemia has severe public health significance in sub-Saharan Africa. In Ethiopia, anemia has been increasing in the last two decades, reaching the highest national level in 2016, however, the geospatial distribution and determinants of anemia in children weren't well explored at a national level.

METHODS

We used the Ethiopian Demographic and Health Survey(EDHS) data from 2005-2016. The data consists of samples of households (HHs) obtained through a two-stage stratified sampling procedure. Our analysis included 19,699 children. Descriptive statistics, geospatial analysis, and Generalized Linear Mixed Model (GLMMs) were used.

RESULTS

The overall prevalence of anemia was 51.5%; the spatial distribution of anemia significantly different across clusters in each survey. Children from 6 to 11 months had higher odds of anemia compared to 24-59 months (Adjusted Odds ratio (AOR) = 3.4, 95%Confidence level (CI): 2.99-3.76). Children with the first and second birth order were less likely to be anemic compared to fifth and above (AOR = 0.60, 95%CI: 0.38-0.95, and AOR = 0.83, 95%C: 0.73-0.93) respectively. Mothers' age 15 to 24 years was associated with higher odds of anemia compared to 35 to 49 years (AOR = 1.37, 95%CI: 1.20-1.55). Children from HHs with the poorest and poorer wealth category showed a higher odds of anemia compared to the richest (AOR = 1.67, 95%CI: 1.45-1.93, and AOR = 1.25, 95%CI: 1.08-1.45) respectively. Moreover, children from HHs with one to two under-five children were less likely to be anemic compared to those three and more (AOR = 0.83, 95%CI: 0.76-0.91).

CONCLUSIONS

The geospatial distribution of anemia among children varies in Ethiopia; it was highest in the East, Northeast, and Western regions of the country. Several factors were associated with anemia; therefore, interventions targeting the hotspots areas and specific determinant factors should be implemented by the concerned bodies to reduce the consequences of anemia on the generation.

District Effect Appraisal in East Sub-Saharan Africa: Combating Childhood Anaemia

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.

Determinants of long-lasting insecticidal net ownership and utilization in malaria transmission regions: evidence from Zimbabwe Demographic and Health Surveys

Background

Long-lasting insecticidal nets (LLINs) were first introduced in 2010 as a vector control intervention, to complement indoor residual spraying, to reduce malaria transmission in Zimbabwe. The objective of this study was to investigate factors that were associated with LLIN ownership and utilization among households in malaria transmission regions of Zimbabwe.

Methods

A secondary analysis of cross sectional data from the Zimbabwe demographic and health survey (ZDHS) conducted in 2010 and 2015 surveys round was conducted. The analysis used household-level datasets from across the country to generate evidence for the study. Univariate analysis was used to yield descriptive statistics. Principal component analysis (PCA) was used to calculate wealth quintiles. Binary logistic regression approach was used to identify determinants of LLIN ownership and utilization after controlling for other factors. Data analyses were conducted using STATA version 14 software.

Results

There were no major changes in demographic characteristics of households sampled between 2010 and 2015 survey cycles. LLIN ownership increased significantly by 42 percentage points from 2010 to 2015. There was a tremendous increase in universal coverage of LLINs between 2010 and 2015. The overall utilization levels of LLINs among children under-5 years decreased by 11 percentage points between 2010 and 2015. LLIN usage amongst households followed the same trend with that of the under-fives. Using logistic regression model for 2015 data, region/province, type of place of residence, availability of electricity, radio, roof type, gender of head of household, having telephone, type of cooking fuel, presence of mobile phone, owning a bank account, IRS spraying in the previous 12 months, wealth index, and satellite television decorder were independently associated with net ownership among households. Type of place of residence, age of household head, type of cooking fuel, IRS in previous 12 months, and pregnancy were associated with LLIN utilization.

Conclusion

This study revealed increasing LLIN coverage and low usage in malaria-transmission regions of Zimbabwe. Strengthening of LLIN campaigns, social behaviour change communication (SBCC) interventions and programme routine monitoring are recommended.

Risk factors of morbidity among children under age five in Ethiopia

BACKGROUND

Childhood morbidities are a major cause of mortality of children in the developing countries particularly in Ethiopia. Regardless of the noticeable improvement in the reduction of under-five death in Ethiopia, childhood diarrhea and fever are still the leading cause of death. In Ethiopia, the burden of child mortality is alarming and calls for determined efforts in combating such health problems. Therefore, this study aimed to investigate the risk factors for childhood morbidity specifically for diarrhea and fever.

METHODS

To gain insight into children's health issues, the 2016 Ethiopian Demographic and Health Survey data were used. Among the marginal models, alternating logistic regression that is an extension of the generalized estimating equation model was used to investigate the risk factors of childhood morbidity explicitly for diarrhea and fever.

RESULTS

The results show that the child's sex, child's age, anemia level, husband education level, mother's work status, mother's marital status, breastfeeding status and region are all chosen significant risk factors related with childhood diarrhea disease and fever disease.

CONCLUSION

The study indicated that male children, 0-11 months aged children, 12-23 months aged children, anemic children, husband with a lower education, mothers paid employment, non-breastfed children, regions of Amhara, Afar, Dire Dawa, Benishangul, Gambela, Oromia, SNNPR, Somali and Tigray were significantly associated with higher odds of morbidity in Ethiopia. Therefore, there is a need for children morbidity interventions intended to improve child health outcomes in the country.

Stunting, food security, markets and food policy in Rwanda

BACKGROUND

Over the past two decades, Rwanda has experienced impressive economic growth, resulting in considerable improvements in living standards and poverty reduction. Despite these gains, progress on reducing the level of stunting in smallholder rural children, particularly boys, continues to be a serious concern.

METHODS

Policies, dietary diversity and socio-economic factors that may influence stunting in rural Rwandan children were evaluated using a logit model with clustered variance-covariance estimators based on village membership of the household.

RESULTS

Stunting of rural children was found to be multidimensionally related to the child's gender, weight and age; the dietary diversity, marriage status and education level of the head of household; mother's height; presence of a family garden or if they owned livestock; environmental factors such as altitude and soil fertility and location relative to a main road en route to a market; and a policy that promoted food production.

CONCLUSIONS

Findings suggest that agricultural policies may be subsidizing poor dietary behavior in that the aggregation of production encourages households to sell high quality nutritious food such as fruit and vegetables, for more voluminous amounts of nutritionally substandard goods, hence low dietary diversity. However, it is less clear if rural food markets are capable of supplying diverse and nutritious foods at affordable prices on a consistent basis, resulting in a lack of diversity and hence, low nutrient quality diets. Rwanda's next round of food security policies should focus on nutrition insecurity with special emphasis on the lack of protein, micronutrients and calories. Multipronged policies and programs focused on income growth, food security, enhanced access to markets and gender-related nutrition risks from inception through 2 years of age in the rural areas are required to improve rural household health outcomes, stunting in particular.