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Obasohan PE, Walters SJ, Jacques RM, Khatab K. The Risk Factors Associated with the Prevalence of Multimorbidity of Anaemia, Malaria, and Malnutrition among Children Aged 6-59 Months in Nigeria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:765. [PMID: 38929011 PMCID: PMC11203752 DOI: 10.3390/ijerph21060765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
In the last ten years, multimorbidity in children under the age of five years has become an emerging health issue in developing countries. The study of multimorbidity of anaemia, malaria, and malnutrition (MAMM) among children in Nigeria has not received significant attention. This study aims to investigate what risk factors are associated with the prevalence of multimorbidity among children aged 6 to 59 months in Nigeria. This study used two nationally representative cross-sectional surveys, the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report. A series of multilevel mixed-effect ordered logistic regression models were used to investigate the associations between child/parent/household variables (at level 1), community-related variables (at level 2) and area-related variables (at level 3), and the multimorbidity outcome (no disease, one disease only, two or more diseases). The results show that 48.3% (4917/10,184) of the sample of children aged 6-59 months display two or more of the disease outcomes. Being a female child, the maternal parent having completed higher education, the mother being anaemic, the household wealth quintile being in the richest category, the proportion of community wealth status being high, the region being in the south, and place of residence being rural were among the significant predictors of MAMM (p < 0.05). The prevalence of MAMM found in this study is unacceptably high. If suitable actions are not urgently taken, Nigeria's ability to actualise SDG-3 will be in grave danger. Therefore, suitable policies are necessary to pave the way for the creation/development of integrated care models to ameliorate this problem.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- School of Medicine and Population Health, Division of Population Health, University of Sheffield, Sheffield S1 4AD, UK; (S.J.W.); (R.M.J.)
- Department of Liberal Studies, College of Business and Administrative Studies, Niger State Polytechnic, Bida Campus, Bida 912231, Nigeria
| | - Stephen J. Walters
- School of Medicine and Population Health, Division of Population Health, University of Sheffield, Sheffield S1 4AD, UK; (S.J.W.); (R.M.J.)
| | - Richard M. Jacques
- School of Medicine and Population Health, Division of Population Health, University of Sheffield, Sheffield S1 4AD, UK; (S.J.W.); (R.M.J.)
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK;
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Shibeshi AH, Mare KU, Kase BF, Wubshet BZ, Tebeje TM, Asgedom YS, Asmare ZA, Asebe HA, Lombebo AA, Sabo KG, Fente BM, Seifu BL. The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model. PLoS One 2024; 19:e0298647. [PMID: 38771790 PMCID: PMC11108208 DOI: 10.1371/journal.pone.0298647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/30/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. OBJECTIVE To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. METHODS The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. RESULTS The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. CONCLUSION Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.
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Affiliation(s)
- Abdu Hailu Shibeshi
- Department of Statistics, College of Natural and Computational Science, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bizunesh Fantahun Kase
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Betel Zelalem Wubshet
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Tsion Mulat Tebeje
- School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia
| | - Yordanos Sisay Asgedom
- Department of Epidemiology and Biostatics, College of Health Sciences and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Zufan Alamrie Asmare
- Department of Ophthalmology, School of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Hiwot Altaye Asebe
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Afework Alemu Lombebo
- School of Medicine, College of Health Science and Medicine, Wolaita Sodo University, Soddo, Ethiopia
| | - Kebede Gemeda Sabo
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Sewor C, Jayalakshmi R. Trends of risk factors associated with childhood stunting and anaemia in Ghana: evidence from the Demographic Health Survey and Multiple Indicator Cluster Survey (2003-2017). Public Health Nutr 2024; 27:e29. [PMID: 38253537 PMCID: PMC10830376 DOI: 10.1017/s1368980023002951] [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: 03/14/2023] [Revised: 11/12/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study investigated the trend of effect estimates of the key risk factors of childhood stunting and anaemia between 2003 and 2017. DESIGN A secondary analysis of the Demographic Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data for the Ghanaian population between 2003 and 2017. Associations of selected socio-demographic (child age and gender; maternal age and education), economic (household wealth), environmental, dietary (minimum dietary diversity and iodine use) and health system (place of delivery and vaccination) factors were explored using the Poisson regression model. Trend analysis was explored using a fitted linear regression line on a time series plot. SETTING Ghana. PARTICIPANTS Children under 5 years. RESULTS The results showed a reduction in the prevalence of stunting and anaemia over the 15-year duration. These health outcomes were found to be negatively associated with a wide array of socio-demographic (child age and gender, maternal age and education, residency), economic (household wealth), dietary (iodised salt use) and health service (place of delivery and vaccination) factors; however, the most consistent statistically significant association was observed between child's age and belonging to the poor wealth quintile. CONCLUSION In order to prevent these indicators of child malnutrition, key consideration must be given to the early developmental stages of life. Child health policies must focus on addressing the key contextual factors of child malnutrition.
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Affiliation(s)
- Christian Sewor
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, KL671316, India
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Rajeev Jayalakshmi
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, KL671316, India
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SUI Z. Analysis of risk factors and changes in myocardial biomarker levels in 122 cases of early neonatal anemia. Turk J Med Sci 2023; 54:275-279. [PMID: 38812621 PMCID: PMC11031178 DOI: 10.55730/1300-0144.5788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/15/2024] [Accepted: 12/18/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Anemia in the first week after birth, which could affect growth, development, and organ function, should be an important warning sign to clinicians. The aim of this study was to assess the related risk factors of early neonatal anemia and to analyze the effect of anemia on the expression levels of myocardial markers in newborns. Materials and methods Clinical data from 122 confirmed cases of anemic newborns and 108 nonanemic newborns were collected to analyze the independent risk factors for early anemia using logistic regression analyses. Blood samples were collected from both groups for the detection of myocardial markers, including the protein marker cardiac troponin T (cTnT), as well as enzyme markers creatine kinase isoenzyme MB (CK-MB) and lactate dehydrogenase (LDH). Results Multivariate logistic regression analysis revealed that preterm birth (OR: 3.589 [1.119-11.506], p < 0.05), multiple pregnancy (OR: 4.117 [1.021-16.611], p < 0.05), and abnormal placenta (OR: 4.712 [1.077-20.625], p < 0.05) were independent risk factors for early neonatal anemia. The levels of myocardial markers, including cTnT (303.1 ± 244.7 vs. 44.2 ± 55.41 ng/L), CK-MB (6.803 ± 8.971 vs. 2.5326 ± 2.927 μkat/L), and LDH (32.42 ± 35.26 vs. 19.73 ± 17.13 μkat/L), were significantly higher in the anemic group than in the nonanemic group. Conclusion Multiple pregnancy, preterm birth, and abnormal placenta were identified as risk factors for early neonatal anemia. The occurrence of early neonatal anemia was associated with increased levels of myocardial markers.
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Affiliation(s)
- Zhenhua SUI
- Department of Clinical Laboratory, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin,
China
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Robert BN, Cherono A, Mumo E, Mwandawiro C, Okoyo C, Gichuki PM, Blanford JL, Snow RW, Okiro EA. Spatial variation and clustering of anaemia prevalence in school-aged children in Western Kenya. PLoS One 2023; 18:e0282382. [PMID: 38011142 PMCID: PMC10681207 DOI: 10.1371/journal.pone.0282382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/08/2023] [Indexed: 11/29/2023] Open
Abstract
Anaemia surveillance has overlooked school-aged children (SAC), hence information on this age group is scarce. This study examined the spatial variation of anaemia prevalence among SAC (5-14 years) in western Kenya, a region associated with high malaria infection rates. A total of 8051 SAC were examined from 82 schools across eight counties in Western Kenya in February 2022. Haemoglobin (Hb) concentrations were assessed at the school and village level and anaemia defined as Hb<11.5g/dl for age 5-11yrs and Hb <12.0g/dl for 12-14yrs after adjusting for altitude. Moran's I analysis was used to measure spatial autocorrelation, and local clusters of anaemia were mapped using spatial scan statistics and local indices of spatial association (LISA). The prevalence of anaemia among SAC was 27.8%. The spatial variation of anaemia was non-random, with Global Moran's I 0.2 (p-value < 0.002). Two significant anaemia cluster windows were identified: Cluster 1 (LLR = 38.9, RR = 1.4, prevalence = 32.0%) and cluster 2 (LLR = 23.6, RR = 1.6, prevalence = 45.5%) at schools and cluster 1 (LLR = 41.3, RR = 1.4, prevalence = 33.3%) and cluster 2 (LLR = 24.5, RR = 1.6, prevalence = 36.8%) at villages. Additionally, LISA analysis identified ten school catchments as anaemia hotspots corresponding geographically to SatScan clusters. Anaemia in the SAC is a public health problem in the Western region of Kenya with some localised areas presenting greater risk relative to others. Increasing coverage of interventions, geographically targeting the prevention of anaemia in the SAC, including malaria, is required to alleviate the burden among children attending school in Western Kenya.
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Affiliation(s)
- Bibian N. Robert
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
| | - Anitah Cherono
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
| | - Eda Mumo
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
| | - Charles Mwandawiro
- Kenya Medical Research Institute, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, Kenya
| | - Collins Okoyo
- Kenya Medical Research Institute, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, Kenya
- Department of Epidemiology, Kenya Medical Research Institute, Statistics and Informatics (DESI), Nairobi, Kenya
| | - Paul M. Gichuki
- Kenya Medical Research Institute, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Nairobi, Kenya
| | - Justine l. Blanford
- Department of Earth Observation Sciences, University of Twente, Enschede, Netherlands
| | - Robert W. Snow
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Emelda A. Okiro
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Population and Health Impact Surveillance Group, Nairobi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Dwomoh D, Sewor C, Annim SK, Stranges S, Kandala NB, Amegah AK. Do dietary practices and household environmental quality mediate socio-economic inequalities in child undernutrition risk in West Africa? Public Health Nutr 2023; 26:1022-1033. [PMID: 36259140 PMCID: PMC10346084 DOI: 10.1017/s1368980022002269] [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: 01/14/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We investigated the relationship between socio-economic status and child undernutrition in West Africa (WA), and further examined the mediating role of dietary practices (measured as minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD)) and household environmental quality (HEQ) in the observed relationship. DESIGN Thirteen countries were included in the study. We leveraged the most recent Demographic and Health Surveys datasets ranging from 2010 to 2019. Poisson regression model with robust standard errors was used to estimate prevalence ratios and their corresponding 95 % CI. Structural equation modelling was used to conduct the mediation analysis. SETTING West Africa. PARTICIPANTS 132 448 under-five children born within 5 years preceding the survey were included. RESULTS Overall, 32·5 %, 8·2 %, 20·1 % and 71·7 % of WA children were stunted, wasted, underweight and anaemic, respectively. Prevalence of undernutrition decreased with increasing maternal education and household wealth (Trend P-values < 0·001). Secondary or higher maternal education and residence in rich households were associated with statistically significant decrease in the prevalence of stunting, wasting, underweight and anaemia among children in WA. MAD was found to mediate the association of low maternal education and poor household wealth with childhood stunting and underweight by 35·9 % to 44·5 %. MDD, MMF and HEQ did not mediate the observed relationship. CONCLUSIONS The study findings enables an evaluation and improvement of existing intervention strategies through a socio-economic lens to help address the high burden of child undernutrition in WA and other developing regions.
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Affiliation(s)
- Duah Dwomoh
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Christian Sewor
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel K Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics and Africa Institute, Western University, London, ON, Canada
- University of Warwick, Division of Health Sciences, Warwick Medical School, Coventry, UK
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
| | - A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
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Sere IS, Bado AR. Individual and Contextual Factors Associated With Malaria Among Children 6-59 Months in Burkina Faso. Int J Public Health 2023; 68:1605347. [PMID: 36814437 PMCID: PMC9939434 DOI: 10.3389/ijph.2023.1605347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/09/2023] [Indexed: 02/07/2023] Open
Abstract
Objective: This study aims to understand the individual and contextual factors associated with malaria among children aged 6-59 months in Burkina Faso. Methods: This cross-sectional study used secondary data extracted from the Burkina Faso Malaria Indicator Survey 2017-2018. Descriptive analysis was used to analyse socio-demographic characteristics. We performed a multilevel logistic regression model to highlight individual and contextual factors of children's exposure to malaria. Results: Our analysis included 5,822 children aged 6-59 months. Of these, 15% had a positive rapid diagnostic test. Factors associated with malaria among children 6-59 months were age, maternal education, household wealth, rural residence, and region. The variability in malaria exposure was 16% attributable to the strata level and 23% to the primary sampling unit level. Some factors, such as the family's socio-economic status, access to hospital care, and place of living, were positively associated withs malaria cases in children. Conclusion: The study identified some individual and contextual determinants of malaria among children aged 6-59 months in Burkina Faso. Taking them into account for the design and implementation of policies will undeniably help in the fight against malaria in Burkina Faso.
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Affiliation(s)
- Ibrahima Stephane Sere
- Service De Neurologie, Centre Hopitalier Universitaire Sourou Sanou, Bobo-Dioulasso, Burkina Faso
| | - Aristide Romaric Bado
- Research Institute for Health Sciences (IRSS), Ouagadougou, Burkina Faso,West African Health Organisation (WAHO), Bobo Dioulasso, Burkina Faso,*Correspondence: Aristide Romaric Bado,
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Bayesian spatio-temporal modelling of child anemia in Ethiopia using conditional autoregressive model. Sci Rep 2022; 12:20297. [PMID: 36434074 PMCID: PMC9700834 DOI: 10.1038/s41598-022-24475-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
Anemia is a common health problem for women and under five children in low income countries. According to the WHO, anemia is considered a serious public health problem when the prevalence is greater than 40%. The prevalence of anemia among children under five in Ethiopia changes over time, and is spatially correlated because it is influenced by environmental, socio-economic and other related factors. However, to our knowledge, there is no small area level estimates of anemia among children under five in Ethiopia. Therefore, this study aimed to assess zonal level estimates of anemia using a Bayesian spatio-temporal conditional autoregressive modeling approach. The data for the study was extracted from the Ethiopian Demographic and Health Surveys (EDHS) from 2005 to 2016. A sample of 18,939 children aged 6-59 months were considered for this study. A Bayesian spatio-temporal conditional autoregressive model was implemented to identify the risk of child anemia. Smoothed relative risks along with the 95% credible interval were reported. The queen's adjacency matrix method was used in spatial smoothing and in estimating the relative risk. The prevalence of anemia among children aged 6-59 months in Ethiopia was 54% in 2005, 44% in 2011 and 57% in 2016. This study showed that low maternal education, low socio-economic status of women, and maternal anemia at zone level were strongly associated with child anemia in Ethiopia. Therefore, enhancing education for women, improving women's socioeconomic status, and mitigating maternal anemia are crucial to reduce the prevalence of childhood anemia in Ethiopia.
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Nkurunziza JC, Nabukeera-Barungi N, Kalyango JN, Niyongabo A, Mwanja MM, Mupere E, Nankabirwa JI. Prevalence and factors associated with anaemia in children aged 6–24 months living a high malaria transmission setting in Burundi. PLoS One 2022; 17:e0273651. [PMID: 36054118 PMCID: PMC9439186 DOI: 10.1371/journal.pone.0273651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/13/2022] [Indexed: 11/19/2022] Open
Abstract
Background In very young children, anaemia has been linked to increased morbidity, mortality and poor cognitive development. Although Burundi has a high burden of anaemia, which may be worsened by the high burden of malaria, little is known about the extent of the problem in very young children who are most at risk of severe disease. We estimated the prevalence, and assessed the factors associated with anaemia in children aged 6–24 months using baseline data collected as part of an on-going study evaluating the effect of Micronutrient supplementation on anaemia and cognition among children in high malaria transmission settings in Burundi. Methods Between February and March 2020, surveys were conducted in 498 households within the catchment area of Mukenke Health Center. One child aged 6–24 months was selected per household to participate in the survey. Following written informed consent, we administered a questionnaire to the child’s primary caregiver to capture information on child’s demographics, nutritional status, food intake, health (status, and morbidity and treatment-seeking practices), as well as the household markers of wealth. A physical exam was conducted, and a blood sample was collected to: 1) assess for presence of plasmodium infection using a rapid diagnosis test; 2) estimate the haemoglobin levels using a portable haemocue machine. A stool sample was also collected to examine for the presence of helminth infections. Results The prevalence of anaemia was 74.3% (95% confidence interval [CI] 61.5%-84.0%), with most of the anaemic study participants classified as having moderate anaemia (59.2%). A total of 62 (12.5%) participants had positive malaria rapid diagnosis tests. Factors significantly associated with higher odds of developing anaemia included not receiving deworming medication (adjusted Odd ratio [aOR] = 3.54, 95% CI 1.79–6.99, p<0.001), the child’s home location (Mukenke II: aOR = 2.22, 95% CI 1.89–2.62, p<0.001; Mukenke: aOR = 2.76, 95% CI 2.46–3.10, p<0.001 and Budahunga: aOR = 3.12, 95% CI 2. 94–3.31, p<0.001) and the child’s age group (Children aged 6–11 months: aOR = 2.27, 95% CI 1.32–3.91, p<0.001). Education level was inversely associated with less odds of anaemia: child’s primary care giver with a secondary (aOR = 0.67; 95% CI: 0.47–0.95, p = 0,024) and tertiary education level (aOR = 0.48; 95% CI: 0.38–0.61, p<0.001). Conclusion Anaemia is highly prevalent among young children in high malaria transmission setting. Anaemia is more prevalent among children who not dewormed and those with malaria. To prevent the long-term adverse outcomes of the anaemia in children, policy makers should focus on improving uptake of the deworming and malaria prevention programs, promote preventive interventions and improve the education of women especially in families with very young children.
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Affiliation(s)
- Jean Claude Nkurunziza
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Community Medicine, Kamenge University Hospital Center (CHUK), University of Burundi, Bujumbura, Burundi
- * E-mail:
| | - Nicolette Nabukeera-Barungi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Joan Nakayaga Kalyango
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloys Niyongabo
- Department of Laboratory, Kamenge University Hospital Center (CHUK), University of Burundi, Bujumbura, Burundi
| | - Mercy Muwema Mwanja
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ezekiel Mupere
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | - Joaniter I. Nankabirwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
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Seifu BL, Tesema GA. Individual-and community-level factors associated with anemia among children aged 6–23 months in sub-Saharan Africa: evidence from 32 sub-Saharan African countries. Arch Public Health 2022; 80:183. [PMID: 35933419 PMCID: PMC9357302 DOI: 10.1186/s13690-022-00950-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Anemia among children aged 6–23 months is a major public health problem worldwide specifically in sub-Saharan Africa (SSA). Anemia during the childhood period causes significant short-and long-term health consequences. However, there is a paucity of evidence on Anemia among children aged 6–23 months in SSA. Therefore, this study examined the individual- and community-level factors associated with anemia among children aged 6–23 months in sub-Saharan Africa. Methods A secondary data analysis was done based on the most recent Demographic and Health Survey (DHS) of 32 sub-Saharan African countries. A total weighted sample of 51,044 children aged 6–23 months was included for analysis. We have used a multilevel proportional odds model to identify predictors of severity levels of anemia. Variables with p < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the association. Results In this study, about 76.6% (95% CI: 76.2%, 76.9%) of children aged 6–23 months in sub-Saharan Africa were anemic. In the multivariable multilevel proportional odds model, being female, being aged 18–23 months, higher level of maternal education, being larger size at birth, belonging to a wealthier household, getting four ANC visits and above, advanced maternal age, and belonging to a community with high maternal education were significantly associated with lower odds of higher levels of anemia. On the other hand, being twin birth, being smaller size at birth, being of a higher order of birth, having fever in the last two weeks, and distance to a health facility were significantly associated with higher odds of higher levels of anemia. Conclusion The study found that more than three-fourths of children aged 6–23 months in sub-Saharan Africa were anemic. This finding proved that the severity levels of anemia among children in sub-Saharan Africa remain a serious public health concern. Therefore, to curve this problem enhancing maternal education, promoting maternal health service utilization, and improving health care access is crucial. In addition, health care providers better give special emphasis to twin births, higher-order birth, and those belonging to poor households to reduce the incidence of anemia among children aged 6–23 months in SSA.
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Obasohan PE, Walters SJ, Jacques R, Khatab K. Individual, household and area predictors of anaemia among children aged 6–59 months in Nigeria. PUBLIC HEALTH IN PRACTICE 2022; 3:100229. [PMID: 36101749 PMCID: PMC9461611 DOI: 10.1016/j.puhip.2022.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/11/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022] Open
Abstract
Objectives This study aims to determine the prevalence of anaemia among children aged 6–59 months in all states of Nigeria, including the Federal Capital Territory (FCT), and to quantify the predicted probabilities by individual, household and area factors. Study design This study is a secondary analysis of data sets from two national representative cross-sectional surveys in Nigeria: the Nigeria Demographic and Health Survey (2018 NDHS) and the National Human Development Index (2018 NHDR). The state human development index (HDI) and the state multidimensional poverty index (MPI) from the 2018 NHDR were incorporated into the 2018 NDHS. Methods The study included a weighted sample of 10,222 children aged 6–59 months. Both univariate and bivariate analyses were computed to determine the prevalence and factors associated with anaemia status, respectively. Multiple binary logistic regression analyses with adjusted predicted probabilities (APPs) were performed to quantify the predictors’ probabilities. Results The prevalence of anaemia among children aged 6–59 months in Nigeria was 68.1% (6962/10,222). Zamfara state had the highest prevalence (84.0% [266/317]), while Kaduna state recorded the lowest (50.0% [283/572]). The APPs of being anaemic decreased from 82.9% (95% confidence interval [CI]: 80.0–85.8) for children aged 6–18 months to 60.6% (95% CI: 56.8–64.4) for children aged 43–59 months, when other predictors were held constant. The APP for a child of an anaemic mother is 10.2% points higher than the APP for a child whose mother is not anaemic. In addition, the APPs for children decreased as the age group of their mothers increased. A child from a state that is mildly deprived in the MPI has a lower APP (67.2% [95% CI: 62.2–72.2]) compared with a child from highly deprived MPI state (79.0% [95% CI: 73.4–84.5]). Conclusions Health strategies, including supplementation programmes, should be carried out at both ante-natal and post-natal clinics to reduce the prevalence of anaemia, especially in vulnerable population groups.
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Chouraqui JP. Dietary Approaches to Iron Deficiency Prevention in Childhood-A Critical Public Health Issue. Nutrients 2022; 14:1604. [PMID: 35458166 PMCID: PMC9026685 DOI: 10.3390/nu14081604] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Iron is an essential nutrient, and individual iron status is determined by the regulation of iron absorption, which is driven by iron requirements. Iron deficiency (ID) disproportionately affects infants, children, and adolescents, particularly those who live in areas with unfavorable socioeconomic conditions. The main reason for this is that diet provides insufficient bioavailable iron to meet their needs. The consequences of ID include poor immune function and response to vaccination, and moderate ID anemia is associated with depressed neurodevelopment and impaired cognitive and academic performances. The persistently high prevalence of ID worldwide leads to the need for effective measures of ID prevention. The main strategies include the dietary diversification of foods with more bioavailable iron and/or the use of iron-fortified staple foods such as formula or cereals. However, this strategy may be limited due to its cost, especially in low-income countries where biofortification is a promising approach. Another option is iron supplementation. In terms of health policy, the choice between mass and targeted ID prevention depends on local conditions. In any case, this remains a critical public health issue in many countries that must be taken into consideration, especially in children under 5 years of age.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Nutrition and Gastroenterology Unit, Woman, Mother and Child Department, University Hospital of Lausanne, 1011 Lausanne, Switzerland
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Tesema GA, Tessema ZT, Angaw DA, Tamirat KS, Teshale AB. Geographic weighted regression analysis of hot spots of anemia and its associated factors among children aged 6-59 months in Ethiopia: A geographic weighted regression analysis and multilevel robust Poisson regression analysis. PLoS One 2021; 16:e0259147. [PMID: 34735486 PMCID: PMC8568114 DOI: 10.1371/journal.pone.0259147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Anemia among children aged 6-59 months remains a major public health problem in low-and high-income countries including Ethiopia. Anemia is associated with significant consequences on the health of children such as under-five morbidity and mortality, increased risk of infection, and poor academic performance. The prevalence of anemia in Ethiopia has varied across areas. Therefore, this study aimed to investigate the geographic weighted regression analysis of anemia and its associated factors among children aged 6-59 months in Ethiopia. METHODS This study was based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 8482 children aged 6-59 months was included. For the spatial analysis, Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used. Spatial regression was done to identify factors associated with the hotspots of anemia and model comparison was based on adjusted R2 and Corrected Akaike Information Criteria (AICc). For the associated factors, the multilevel robust Poisson regression was fitted since the prevalence of anemia was greater than 10%. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association. RESULTS The prevalence of anemia among children aged 6-59 months was 57.56% (95%CI: 56.50%, 58.61%) with significant spatial variation across regions in Ethiopia. The significant hot spot areas of anemia among children aged 6-59 months were detected in the central, west, and east Afar, Somali, Dire Dawa, Harari, and northwest Gambella regions. Mothers who had anemia, a child aged 23-59 months, mothers aged 15-19 years, and coming from a household with a poorer or poorest household were significant predictors of the spatial variations of anemia among children aged 6-59 months. In the multilevel robust Poisson analysis, born to mothers aged 30-39 (APR = 0.84, 95% CI: 0.76, 0.92) and 40-49 years (APR = 0.73, 95% CI: 0.65, 0.83), mothers who didn't have formal education (APR = 1.10, 95% CI: 1.00, 1.20), Children in the poorest household wealth index (APR = 1.17, 95% CI: 1.06, 1.29), being 4-6 (APR = 1.08, 95% CI: 1.02, 1.13) and above 6 order of birth (APR = 1.15, 95% CI: 1.07, 1.23), children born to anemic mothers (APR = 1.24, 95% CI: 1.19, 1.29), children aged 24-59 months (APR = 0.70, 95% CI: 0.68, 0.73), stunted children (APR = 1.09, 95% CI: 1.04, 1.13) and underweight children (APR = 1.07, 95% CI: 1.03, 1.13) were significantly associated with anemia among children aged 6-59 months. CONCLUSION AND RECOMMENDATION Anemia is still a public health problem for children in Ethiopia. Residing in a geographic area where a high proportion of children born to mothers aged 15-19 years, a child aged 6-23 months, coming from a household with poorer or poorest wealth index, and mothers with anemia increased the risk of experiencing anemia among children aged 6-59 months. Maternal education, maternal age, child age, household wealth, stunting, underweight, birth order, and maternal anemia were significant predictors of anemia among children. The detailed map of anemia hot spots among children aged 6-59 months and its predictors could assist program planners and decision-makers to design targeted public health interventions.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Individual and Contextual Factors Associated with Malaria among Children 6-59 Months in Nigeria: A Multilevel Mixed Effect Logistic Model Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111234. [PMID: 34769754 PMCID: PMC8582856 DOI: 10.3390/ijerph182111234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/17/2021] [Accepted: 10/23/2021] [Indexed: 11/18/2022]
Abstract
Background/Purpose: Over the last two decades, malaria has remained a major public health concern worldwide, especially in developing countries leading to high morbidity and mortality among children. Nigeria is the world most burdened malaria endemic nation, contributing more than a quarter of global malaria cases. This study determined the prevalence of malaria among children at 6–59 months in Nigeria, and the effects of individual and contextual factors. Methods: This study utilized data from 2018 Nigeria Demographic and Health Survey (NDHS) involving a weighted sample size of 10,185 children who were tested for malaria using rapid diagnostic test (RDT). Given the hierarchical structure of the data set, such that children at Level-1 were nested in communities at Level-2, and nested in states and Federal Capital Territory (FCT) at Level-3, multilevel mixed effect logistic regression models were used for the analysis. Results: The proportion of children 6–59 months of age in Nigeria that had malaria fever positive as assessed by RDTs was 35.5% (3418/10,185), (CI: 33.9–37.1). Kebbi State had 77.7%, (CI: 70.2–83.5), which was the highest proportion of 6–59 months who were malaria positive, next in line was Katsina State with 55.5%, (CI: 47.7–63.1). The Federal Capital Territory (FCT), Abuja had the proportion of 29.6%, (CI: 21.6–39.0), malaria positive children of 6–59 months of age. Children between the age of 48 and 59 months were 2.68 times more likely to have malaria fever than children of ages 6–11 months (AOR = 2.68, 95% CI: 2.03–3.54). In addition, children from the rural area (AOR = 2.12, 95% CI: 1.75–2.57), were more likely to suffer from malaria infection compared to children from urban area. Conclusion: The study identified some individual and contextual predictors of malaria among children in Nigeria. These factors identified in this study are potential areas that need to be considered for policy designs and implementations toward control and total elimination of malaria-related morbidity and mortality among children in Nigeria.
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Govender I, Rangiah S, Kaswa R, Nzaumvila D. Malnutrition in children under the age of 5 years in a primary health care setting. S Afr Fam Pract (2004) 2021; 63:e1-e6. [PMID: 34677078 PMCID: PMC8517826 DOI: 10.4102/safp.v63i1.5337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 02/03/2023] Open
Abstract
In this study, we outlined the types of malnutrition amongst children, the causes of malnutrition intervention at the primary health care level and some recommendations to alleviate childhood malnutrition in South Africa.
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Affiliation(s)
- Indiran Govender
- Department of Family Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa.
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