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Kofi Amegah A, Ayinemi R, Sewor C, Fenta HM, Yeboah K, Mohammed SA, Dwomoh D, Annim SK, Stranges S, Kandala NB. Birth weight mediates the association of maternal undernutrition with child undernutrition prevalence in West Africa. Eur J Clin Nutr 2024; 78:772-781. [PMID: 38806645 DOI: 10.1038/s41430-024-01453-5] [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: 11/23/2023] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Maternal nutritional status before and during pregnancy is an important determinant of foetal health. In West Africa, maternal and child undernutrition remains a major public health problem and it is important to establish the mechanistic pathway linking the two disorders to help address the problem. We therefore assessed the mediating role of low birth weight (LBW) in the relationship of maternal undernutrition with child undernutrition in West Africa. METHODS We included recent (2010-2019) DHS data from thirteen West African countries. Poisson regression model with robust standard errors was used to assess the relationship between maternal undernutrition (body mass index and anaemia) and child undernutrition (stunting, wasting, underweight, and anaemia). Structural equation modelling was used to conduct the mediation analysis. RESULTS Prevalence of stunting, wasting, underweight, and anaemia among under-five children in West Africa was found to be 32.4%, 8.1%, 20.1%, and 71.5%, respectively. We found children of underweight mothers to be more likely to be undernourished (stunted, wasted, and underweight) and anaemic compared to children of normal-weight mothers. Also, children of anaemic mothers were more likely to be stunted and anaemic but not wasted compared with children of non-anaemic mothers. LBW mediated the observed relationships between maternal BMI and childhood stunting (22.6%), and maternal anaemia and childhood stunting (24.9%), wasting (11.7), and anaemia (6.6%). CONCLUSION We found maternal undernutrition to be associated with child undernutrition in West Africa with LBW noted to be a mediator of the observed relationship. We recommend that, to address the child undernutrition problem in West Africa, governments and policymakers must integrate measures to address the burden of LBW.
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Affiliation(s)
- A Kofi Amegah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana.
| | - Roland Ayinemi
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Christian Sewor
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | | | - Kelvin Yeboah
- Public Health Research Group, Department of Biomedical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Seidu Awal Mohammed
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Samuel K Annim
- Department of Applied Economics, School of Economics, University of Cape Coast, Cape Coast, Ghana
- Ghana Statistical Service, Head Office Building, P.O. Box GP1098, Finance Close, Accra, Ghana
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Ngianga-Bakwin Kandala
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- University of the Witwatersrand, Division of Epidemiology and Biostatistics, School of Public Health, Johannesburg, South Africa
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Mal P, Saikia N. Disparity by caste and tribe: Understanding women's empowerment and health outcomes in India. Soc Sci Med 2024; 354:117074. [PMID: 38986229 DOI: 10.1016/j.socscimed.2024.117074] [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: 02/17/2023] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/12/2024]
Abstract
AIM Women's empowerment status varies greatly in India according to caste, class, ethnicity and region. This paper aims to investigate the caste/tribe disparity in women's empowerment by region, the main correlates of each domain of empowerment, and the association of women's empowerment with nutritional and health care access outcomes, specifically anaemia, menstrual hygiene, and institutional delivery. METHODOLOGY Using National Family Health Survey-5 (2019-2021) data, we have created a modified survey-based women's empowerment index (SWPER) using principal component analysis with Oblique varimax rotation. The first four components are interpreted as an attitude to violence, freedom of movement, decision-making power and social independence. Several multivariate regression models were used to understand the factor associated with empowerment and the association of women's empowerment with different health outcomes. RESULTS The results indicate that women from the forward castes are the most empowered in most domains except decision-making. However, after controlling other background variables, the forward castes women are found to be the most empowered in attitude to violence, whereas Scheduled Castes and Scheduled Tribes women were found to be the most empowered women in decision-making. With regards to social independence, deprived castes women are more empowered than the forward castes women. The likelihood of empowerment in social independence domain increases with increasing wealth. There are wide regional variations in empowerment level between different social groups. Caste/tribe identity plays a significant role in determining health outcomes in India. Among all empowerment domains, social independence emerges as the most significant associated factor with improved health across all caste/tribe groups. CONCLUSION The path to women's empowerment in India must recognize the intersectionality of caste/tribe identities, and address regional disparities. Social independence emerges as a critical determinant across all caste/tribe groups for improving health. Measures should be taken to empower women through the underlying factors of social independence.
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Affiliation(s)
- Piyasa Mal
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
| | - Nandita Saikia
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India.
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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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Gebreegziabher T, Sidibe S. Determinants of household-, maternal- and child-related factors associated with nutritional status among children under five in Mali: evidence from a Demographic and Health Survey, 2018. Public Health Nutr 2024; 27:e58. [PMID: 38311339 PMCID: PMC10882532 DOI: 10.1017/s1368980024000363] [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] [Indexed: 02/10/2024]
Abstract
OBJECTIVE The current study aims to determine household-, maternal- and child-related factors influencing nutritional status among children under five in Mali. DESIGN Quantitative cross-sectional study using secondary data extracted from Mali DHS-VI 2018. SETTING Urban and rural areas of Mali. PARTICIPANTS A total of 8908 children participated, with 3999 in the younger age group (0-24 months) and 4909 in the older age group (25-59 months). RESULTS In the younger age group, the prevalence of stunting, wasting and underweight was 18·8 % (95 % CI%: 17·5, 20·0), 24·6 % (95 % CI: 23·2, 26·0) and 13·2 % (95 % CI: 12·1, 14·3), respectively, while in the older age group, it was 24·9 % (95 % CI: 23·7, 26·2), 22·7 % (95 % CI: 21·5, 24·0) and 5·7 % (95 % CI: 5·0, 6·5), respectively. Being average or large size at birth, having piped source of water, receiving Zn, deworming, high maternal BMI, receiving Fe during pregnancy, higher maternal education and being rich were associated with lower odds of one or more form of undernutrition in both groups. On the other hand, children who were anaemic, drank from a bottle, maternal anaemia, current pregnancy of mothers and living in rural areas were associated with higher odds of stunting, wasting or underweight. Interestingly, children who received Fe supplementation had a higher odds of wasting in the younger group but lower odds of all forms of undernutrition in the older group. CONCLUSIONS This study emphasised the potential risk factors associated with undernutrition in children. Children who consume non-potable water, have mothers with lower levels of education and BMI and reside in rural areas are more likely to experience undernutrition.
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Affiliation(s)
- Tafere Gebreegziabher
- Food Science and Nutrition, Department of Health Sciences, Central Washington University, 400 E University Way, Ellensburg, WA98926, USA
| | - Saran Sidibe
- Food Science and Nutrition, Department of Health Sciences, Central Washington University, 400 E University Way, Ellensburg, WA98926, USA
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Gebreegziabher T, Sidibe S. Prevalence and contributing factors of anaemia among children aged 6-24 months and 25-59 months in Mali. J Nutr Sci 2023; 12:e112. [PMID: 37964977 PMCID: PMC10641697 DOI: 10.1017/jns.2023.93] [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: 07/19/2023] [Revised: 09/18/2023] [Accepted: 10/06/2023] [Indexed: 11/16/2023] Open
Abstract
Although considerable global initiatives have been undertaken to tackle anaemia, its prevalence continues to be high in sub-Saharan African nations. In Mali specifically, anaemia represents a significant and pressing public health issue. The purpose of the present study was to examine the key risk factors related to anaemia among children aged 6-24 months (younger age group) and 25-59 months (older age group). We used the Mali 2018 Demographic and Health Survey data, collected from 8861 mothers with children under five. Logistic regression was used to assess the risk factors for childhood anaemia. The results suggest that the prevalence of anaemia was 88 % in the younger and 76 % in the older age groups. The risk factors unique to the younger age group were malaria (OR 4⋅05; CI 0⋅95, 11⋅3) and place of residence (OR 0⋅55; CI 0⋅32, 0⋅94), while for the older age group, they were morbidity (OR 1⋅91; CI 1⋅12, 3⋅24), drinking from a bottle (OR 1⋅52; CI 1⋅04, 2⋅22), and micronutrient intake (OR 0⋅61; CI 0⋅40, 0⋅91). Risk factors that significantly contributed to both age groups include breastfeeding, deworming, maternal anaemia, maternal education, and wealth index. Anaemia also varied by region. The widespread prevalence of anaemia can be attributed to a multitude of factors. In addressing this issue, it is imperative to acknowledge the unique characteristics of specific regions and rural areas, where the incidence of anaemia surpasses the national average. Therefore, any intervention efforts should be tailored to the specific needs and challenges of these areas.
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Affiliation(s)
- Tafere Gebreegziabher
- Food Science and Nutrition, Department of Health Sciences, Central Washington University, 400 E University Way, Ellensburg, WA 98926-7571, USA
| | - Saran Sidibe
- Food Science and Nutrition, Department of Health Sciences, Central Washington University, 400 E University Way, Ellensburg, WA 98926-7571, USA
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Tezol Ö, Mammadova S. Mother's Nutrition Literacy and Offspring Anemia: A Comparison Study in a Single Center. Turk Arch Pediatr 2023; 58:638-645. [PMID: 37915272 PMCID: PMC10724721 DOI: 10.5152/turkarchpediatr.2023.23119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE It is known that mother's knowledge about nutrition is associated with the prevalence of anemia in their children. The aim of this study was to evaluate the frequency of iron deficiency without anemia (ID), iron deficiency anemia (IDA), and anemia in children according to the level of mother's nutrition literacy (NL). MATERIALS AND METHODS A cross-sectional study was conducted in a well-child outpatient clinic. The study included healthy children aged between 24 and 59 months and their mothers. Scores of the mothers on the Nutrition Literacy Assessment Tool for Adults and children's anthropometric z-scores, dietary diversity and Mediterranean Diet Quality Index scores, and children's hemoglobin and ferritin levels were collected. Two-group comparison analysis was performed. RESULTS Ninety mother-child pairs were included. While 36 mothers (40%) had borderline and 54 (60%) mothers had adequate NL, 15 children (16.7%) had ID, 5 (5.6%) children had IDA, and a total of 18 children (20%) had nutritional anemia. The percentage of wasted children was higher in the group with borderline NL (13.9% vs. 1.9%, P = .036). The percentage of children with ID, IDA, or other nutritional anemia was not different between the borderline and adequate NL groups (30.6% vs. 40.7%, P = .326). CONCLUSION The frequency of ID, IDA, or other nutritional anemia in children does not differ significantly between mothers with borderline and adequate NL. Increasing NL of mothers could be a step toward reducing the burden of child undernutrition.
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Affiliation(s)
- Özlem Tezol
- Department of Pediatrics, Mersin University, Faculty of Medicine, Mersin, Turkey
| | - Sakina Mammadova
- Department of Pediatrics, Mersin University, Faculty of Medicine, Mersin, Turkey
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Um S, Cope MR, Muir JA. Child anemia in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in children. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002082. [PMID: 37713392 PMCID: PMC10503718 DOI: 10.1371/journal.pgph.0002082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
Anemia in children remains a public health concern in many resource-limited countries. To better understand child anemia in Cambodia, we examined temporal and geospatial trends of childhood anemia and used logistic regression to analyze its association with individual and household characteristics using data from the Cambodia Demographic and Health Surveys for 2005, 2010, and 2014. The prevalence of childhood anemia decreased from 62.2% in 2005 to 56.6% in 2014. The prevalence of childhood anemia was highest in Pursat (84.3%) for 2005, Kampong Thom (67%) for 2010, and Preah Vihear and Steung Treng (68.6%) for 2014. After adjusting for other variables, factors positively associated with childhood anemia included having a mother who was anemic (adjusted odds ratio (AOR) = 1.77, 95% CI: 1.58-1.97); being male vs. female (AOR = 1.20, 95% CI: 1.07-1.33), underweight (AOR = 1.24, 95% CI: 1.14-1.57), or stunted (AOR = 1.24, 95% CI: 1.09-1.41); or having had a recent episode of fever (AOR = 1.16, 95% CI: 1.03-1.31). Children were less likely to have anemia if they were older than 12 months. They were also less likely to have anemia if they were from a wealthier household (AOR = 0.64; 95% CI: 0.50-0.84) or had taken medications for intestinal parasites (AOR = 0.86; 95% CI: 0.89-0.93). These associations were generally consistent across time and space. Public health interventions and policies to alleviate anemia should be prioritized to address these factors across geospatial divides. Anemia remains highly prevalent among children aged 6-59 months in Cambodia.
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Affiliation(s)
- Samnang Um
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Michael R. Cope
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Jonathan A. Muir
- The Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Singh SK, Lhungdim H, Shekhar C, Dwivedi LK, Pedgaonkar S, James KS. Key drivers of reversal of trend in childhood anaemia in India: evidence from Indian demographic and health surveys, 2016-21. BMC Public Health 2023; 23:1574. [PMID: 37596564 PMCID: PMC10436448 DOI: 10.1186/s12889-023-16398-w] [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: 06/19/2022] [Accepted: 07/25/2023] [Indexed: 08/20/2023] Open
Abstract
AIM Recent National Family Health Survey results portray striking improvements in most population and health indicators, including fertility, family planning, maternal and child health, gender treatment, household environments, and health insurance coverage of the Pradhan Mantri Jan Arogya Yojana (PM-JAY), with all India resonance. However, the prevalence of any anaemia (< 11 g/dl) among children under age five has exhibited a reversed trajectory in recent years. Therefore, the present study explores key drivers of the reversal of the trend in the prevalence of childhood anaemia between 2015 and2021. METHODS Data of four rounds of the National Family Health Survey (NFHS) were used to show the overall trend of anaemia among children. However, for the analysis of key drivers of the reversal trend of childhood anaemia, only the recent two rounds (NFHS-4 & NFHS-5) were used. Descriptive, bivariate multivariable analysis and Fairlie decomposition model were used to explore the drivers of the reversal of the trend in childhood anaemia. RESULTS During the past two decades, India has seen a decline in the prevalence of childhood anaemia (NFHS-2 to NFHS-4). However, a reversal of trend was observed recently. The prevalence of anaemia among children aged 6-59 months increased from 59 percent in NFHS-4 to 67 percent in NFHS-5. In addition, the prevalence of mild anaemia increased from 23.3 percent in NFHS-2 to 28.7 percent in NFHS-5. However, the prevalence of moderate and severe anaemia declined considerably from NFHS-2 (40 percent and 4.1 percent) to NFHS-4 (28.7 percent and 1.6 percent), but showed an increase in the prevalence in NFHS-5 (36.3 percent and 2.2 percent). Among others, mothers' educational attainment, anaemia status and socio-economic status emerge as the key drivers of the change in the prevalence of childhood anaemia. CONCLUSION These findings may have vital implications for the ongoing Anaemia Mukt Bharat Programme, one of the government's dream projects in India.
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Affiliation(s)
- S K Singh
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India.
| | - H Lhungdim
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Chander Shekhar
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India
| | - L K Dwivedi
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - S Pedgaonkar
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - K S James
- International Institute for Population Sciences, Mumbai, India
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Htay ZW, Swe T, Hninn TSS, Myar MT, Wai KM. Factors associated with syndemic anemia and stunting among children in Myanmar: A cross-sectional study from a positive deviance approach. Arch Pediatr 2023:S0929-693X(23)00058-1. [PMID: 37147158 DOI: 10.1016/j.arcped.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/12/2023] [Accepted: 03/25/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Anemia and stunting in children are detrimental to the prospects of a normal, healthy upbringing. Having similar risk factors and serious consequences, the syndemic aspect of these two ailments is mostly underrated, and positive deviant (PD) factors that ensure non-anemic status in stunted children have not been studied to date. METHODS This study aimed to identify PD factors that have potential to prevent syndemic anemia among stunted children aged 6-59 months in Myanmar. This was a cross-sectional secondary analysis of the Myanmar Demographic and Health Survey (DHS) data conducted in 2016, applying the PD concept, where children who were stunted without anemia were considered as PDs. RESULTS Among 1248 stunted children, those who had the syndemic condition were compared with their PD peers in terms of maternal characteristics as well as socioeconomic and health-related factors. Multivariable logistic regression analyses were used to identify the determinants of syndemic state. The results showed that three out of every five stunted children were anemic. The syndemic risk was decreased among children of maternal age groups 20-34 years and 35-44 years: [aOR] = 0.19, 95% CI = 0.05-0.69; p = 0.012, and aOR = 0.19, 95% CI = 0.05-0.75; p = 0.018, respectively. Moderately stunted children (aOR = 0.53, 95% CI = 0.34-0.81; p = 0.004) and children who were not currently breastfed (aOR = 1.56, 95% CI = 1.01-2.41; p = 0.044) were less likely to develop the syndemic condition. CONCLUSION Maternal age, stunting severity, breastfeeding duration, and maternal anemic status are strong predictors in determining hemoglobin concentrations among stunted children. This study suggests that nutritional interventions targeting PD factors could represent syndemic action in improving child health.
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Affiliation(s)
- Zin Wai Htay
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thinzar Swe
- Pre-clinical Department, University of Medicine 2, Yangon, Myanmar
| | | | - Maw Thoe Myar
- Pre-clinical Department, University of Medicine Taunggyi, Taunggyi, Myanmar
| | - Kyi Mar Wai
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan.
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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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Murtaza SF, Lee LJ, Usaini NN, Gan WY, Sulaiman N. Factors Associated With Anemia Among Orang Asli Children Aged Two to Six Years in Negeri Sembilan, Malaysia. Cureus 2023; 15:e35511. [PMID: 37007386 PMCID: PMC10050992 DOI: 10.7759/cureus.35511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/02/2023] Open
Abstract
Background Anemia is a global public health problem that needs urgent attention, especially in early childhood. Young children living in remote indigenous communities are vulnerable to anemia. This study aimed to determine factors associated with anemia among children of the Orang Asli (OA) community, aged two to six years old. Methods A cross-sectional study was conducted among 269 OA children, together with their biological non-pregnant mothers. Their mothers were interviewed using a structured questionnaire to gather information on sociodemographic characteristics, sanitation facility and personal hygiene, food security, and dietary diversity. Anthropometric and biochemical assessments were measured using standard protocols. Results One in five of the OA children was anemic (21.2%) and had a low birth weight (20.4%). About 27.7% of the children were underweight, 35.2 % were stunted, 6.1% were wasted, and 5.7% were overweight. One-third of them (35.0%) had parasitic infections and almost all were food-insecure (96.3%). As for the mothers, more than one-third of them were anemic (39.0%), 58.9% had abdominal obesity, and 61.8% were overweight and obese. Parasitic infections (adjusted OR (AOR)=2.49, 95%CI=1.23-5.06), not wearing shoes outside the house (AOR=2.95, 95%CI=1.39-6.27), and mothers with anemia (AOR=2.62, 95%CI=1.30-5.28) were associated with increased risk of anemia among OA children. Conclusion Preventing maternal anemia and strengthening knowledge on sanitation and hygiene could be incorporated into nutrition intervention programs to address anemia issues among OA children.
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Sunuwar DR, Singh DR, Pradhan PMS, Shrestha V, Rai P, Shah SK, Adhikari B. Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis. BMC Public Health 2023; 23:343. [PMID: 36793012 PMCID: PMC9933407 DOI: 10.1186/s12889-023-15265-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND South and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore the individual and community- level factors associated with childhood anemia across the six selected SSEA countries. METHODS Demographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, and Nepal) conducted between 2011 and 2016 were analyzed. A total of 167,017 children aged 6-59 months were included in the analysis. Multivariable multilevel logistic regression analysis was used to identify independent predictors of anemia. RESULTS The combined prevalence of childhood anemia across six SSEA countries was 57.3% (95% CI: 56.9-57.7%). At the individual level, childhood anemia was significantly higher among (1) mothers with anemia compared to non-anemic mothers (Bangladesh: aOR = 1.66, Cambodia: aOR = 1.56, India: aOR = 1.62, Maldives: aOR = 1.44, Myanmar: aOR = 1.59, and Nepal: aOR = 1.71); (2) children with a history of fever in the last two weeks compared to those without a history of fever (Cambodia: aOR = 1.29, India: aOR = 1.03, Myanmar: aOR = 1.08), and; (3) stunted children compared to those who were not (Bangladesh: aOR = 1.33, Cambodia: aOR = 1.42, India: aOR = 1.29, and Nepal: aOR = 1.27). In terms of community-level factors, children with mothers in communities with a high percentage of community maternal anemia had higher odds of childhood anemia in all countries (Bangladesh: aOR = 1.21, Cambodia: aOR = 1.31, India: aOR = 1.72, Maldives: aOR = 1.35, Myanmar: aOR = 1.33, and Nepal: aOR = 1.72). CONCLUSION Children with anemic mothers and stunted growth were found vulnerable to developing childhood anemia. Individual and community-level factors identified in this study can be considered to develop effective anemia control and prevention strategies.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
- Research and Innovation Section, Southeast Asia Development Action Network (SADAN), Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
- Nepalese Society of Community Medicine, Kathmandu, Nepal
| | | | - Pushpa Rai
- Department of Nursing, Patan Academy of Health Sciences (PAHS), Lalitpur, Nepal
| | - Sunil Kumar Shah
- Public Health and Nutrition Section, Bagmati Welfare Society Nepal, Sarlahi, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Traore SS, Bo Y, Kou G, Lyu Q. Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age: a study from Sub-Saharan Africa. BMC Pregnancy Childbirth 2023; 23:63. [PMID: 36698082 PMCID: PMC9875517 DOI: 10.1186/s12884-023-05399-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, infant anemia, stunting and low birth weight remains major public health problems. It is unclear whether prenatal iron supplementation and/or deworming can reduce the risk of infant stunting, anemia and low birth weight. The aim of this study was to investigate the relationship between iron supplementation and/or deworming and stunting, anemia, and low birth weight in infants under two years of age in sub-Saharan Africa. METHODS Our studies examined pooled data from Demographic and Health Surveys (DHS) in twenty-three African countries collected between 2014 and 2020. childhood anemia and stunting in infants under the age of two were the primary outcomes. Iron supplementation and deworming during prenatal visits were the main exposure variables. A multivariate logistic regression model was used to investigate these relationships. RESULTS The prevalence of stunting was 29.9%, severe stunting was 10.6%, childhood anemia was 74.3%, childhood severe anemia was 3.2%, and low birth weight was 16.4%, respectively. The use of prenatal iron supplementation alone was associated with a significant reduction of childhood anemia [aOR (95% CI) = 0.9 (0.8-1.0)]. Prenatal deworming alone was associated with a significantly reduced risk of stunting [aOR (95% CI) = 0.7 (0.8-1.0)], childhood anemia [aOR (95% CI) = 0.7 (0.8-0.9)], and low birth weight [aOR (95% CI) = 0.7 (0.8-1.0)]. Prenatal iron supplementation plus deworming or iron supplementation (with or without deworming) were not associated with childhood anemia, infant stunting and low birth weight. CONCLUSIONS In Sub-Saharan Africa, prenatal deworming alone has the potential to improve infants' outcomes. Childhood anemia was improved with prenatal iron supplementation alone. Our recent findings indicate the necessity for prospective studies on the association between prenatal iron supplementation plus deworming and childhood anemia, stunting and low birth weight.
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Affiliation(s)
- Stanislav Seydou Traore
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yacong Bo
- grid.10784.3a0000 0004 1937 0482Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, 999077 China
| | - Guangning Kou
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China ,grid.207374.50000 0001 2189 3846Centre of Sport Nutrition and Health, School of Physical Education, Zhengzhou University, Zhengzhou, 450001 China
| | - Quanjun Lyu
- grid.207374.50000 0001 2189 3846Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China ,grid.412633.10000 0004 1799 0733Department of Nutrition, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052 China
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Wiafe MA, Ayenu J, Eli-Cophie D. A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries. Anemia 2023; 2023:6406286. [PMID: 36636253 PMCID: PMC9831712 DOI: 10.1155/2023/6406286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/15/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Identifying the root causes of iron deficiency anaemia is a prerequisite for effective management and prevention in adolescents. This systematic review assessed risk factors of iron deficiency anaemia among adolescents living in developing countries. Method Electronic databases such as PubMed, Cochrane Library, Science Direct, Google Scholar, and SCOPUS were comprehensively searched for studies published between 1990 and 2020 that involved risk factors of iron deficiency anaemia among adolescents living in developing countries. The quality of the included studies was assessed using the American Dietetic Association Quality Criteria Checklist. Results A total of 2,252 publications were reviewed, and only fifteen cross-sectional studies were eligible for inclusion, eight of which focused on female adolescents and seven on both genders. Direct risk factors contributing to anaemia among adolescents included food intake practices (n = 10 studies), female adolescents (n = 8 studies), menstruation (n = 5 studies), and parasitic infection (n = 6 studies). Indirect risk factors found to be associated with anaemia among adolescents included low educational status (n = 4 studies) and low socioeconomic status (n = 3 studies). All fifteen studies were of good quality. Conclusion Food intake practices, female adolescents, menstruation, parasitic infection, and low educational status were the leading risk factors of iron deficiency anaemia among adolescents. Further research should concentrate on assessing the effectiveness and efficacy of existing interventions aimed at preventing iron deficiency among vulnerable groups in developing countries.
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Affiliation(s)
- Michael Akenteng Wiafe
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Jessica Ayenu
- Department of Clinical Nutrition and Dietetics, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Divine Eli-Cophie
- Department of Sport Nutrition, University of Health and Allied Sciences, Ho, Ghana
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Tessema ZT, Tesema GA, Ahern S, Earnest A. 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] [MESH Headings] [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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Affiliation(s)
- Zemenu Tadesse Tessema
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Tadesse SE, Zerga AA, Mekonnen TC, Tadesse AW, Hussien FM, Feleke YW, Anagaw MY, Ayele FY. Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis. Anemia 2022; 2022:1382940. [PMID: 36134386 PMCID: PMC9482935 DOI: 10.1155/2022/1382940] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Globally, anemia among under-five children is a serious public health problem. Even if there are pocket studies here and there, there is limited evidence on the pooled prevalence of anemia among under-five children in Africa. Therefore, the aim of this study was to determine the pooled prevalence and determinants of anemia. Methods and Analysis. This systematic review and meta-analysis was done following the PRISMA guidelines. A comprehensive search was made in PubMed/MEDLINE, Cochrane Library, HINARI, and Ethiopian Journal of Health Development for studies published since 2009. It was supplemented with Google Scholar search. Study selection, data extraction, and quality of studies were assessed by eight reviewers. The Cochrane Q test and I 2 test statistic were used to test the heterogeneity of studies. A random-effects model of DerSimonian-Laird method was used. Result A total of 37 articles were included in this systematic review and meta-analysis. The pooled prevalence of anemia among under-five children in Africa was 59% (95% CI: 55, 63). Being female (AOR = 0.71; 95% CI: 0.57, 0.87), maternal education (AOR = 1.47; 95% CI: 1.31, 1.66), residence (AOR = 0.80; 95% CI: 0.67, 0.95), and family size (AOR = 0.93; 95% CI: 0.89, 0.98) were the determinants of anemia among African under-five children. Conclusion and Recommendation. This pooled study revealed that anemia was a severe public health problem. Sex, maternal education, residence, and family size were the determinants of anemia. Therefore, anemia prevention strategy should include sex consideration, educating mothers through youth education, area specific intervention, and encouraging birth spacing.
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Affiliation(s)
- Sisay Eshete Tadesse
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aregash Abebayehu Zerga
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tefera Chane Mekonnen
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abay Woday Tadesse
- Department of Public Health, College of Health Sciences, Samara University, Samara, Ethiopia
| | - Fozia Mohammed Hussien
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitbarek Wasihun Feleke
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew Anagaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Fanos Yeshanew Ayele
- Department of Nutrition and Dietetics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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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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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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Targeted and Population-Wide Interventions Are Needed to Address the Persistent Burden of Anemia among Women of Reproductive Age in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148401. [PMID: 35886253 PMCID: PMC9320440 DOI: 10.3390/ijerph19148401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022]
Abstract
Recent evidence suggests that 44.8% of women of reproductive age (WRA) in Tanzania suffer from anemia. Addressing this public health challenge calls for local evidence of its burden and determinants thereof for policy and tailored interventions. This secondary data analysis used Tanzania Demographic and Health Surveys (TDHS) 2004−2005 and 2015−2016 with a total of 23,203 WRA. Data were analyzed using descriptive statistics to characterize the burden of anemia, regression analyses to examine the adjusted change in the prevalence of anemia and remaining determinants thereof, and the Global Information System (GIS) to map the differences in the burden of anemia in Tanzania over the period of one decade. Considering the risk factors of anemia observed in our study, WRA in Tanzania should have been 15% less likely to suffer from anemia in 2015 compared to 2005. However, a small decline (3.6%) was not evenly distributed across the regions in Tanzania. Factors that remained significantly associated with anemia among WRA in the latest survey include age above 35 years (AOR = 1.564, p = 0.007), education level (AOR = 0.720, p = 0.001), pregnancy status (AOR = 1.973, p < 0.001), and use of contraception (AOR of 0.489, p < 0.001). Our findings suggest that WRA in Tanzania aged above 35 should be the target population to accept the more tailored interventions.
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Hasan MM, Soares Magalhaes RJ, Garnett SP, Fatima Y, Tariqujjaman M, Pervin S, Ahmed S, Mamun AA. Anaemia in women of reproductive age in low- and middle-income countries: progress towards the 2025 global nutrition target. Bull World Health Organ 2022; 100:196-204. [PMID: 35261408 PMCID: PMC8886255 DOI: 10.2471/blt.20.280180] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/14/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To examine trends in, and projections of, the prevalence of anaemia in women of reproductive age in low- and middle-income countries at national and subpopulation levels. Methods We used nationally representative data from repeated cross-sectional Demographic and Health Surveys (DHS) on 1 092 512 women of reproductive age (15-49 years) from 15 low- and middle-income countries. We defined anaemia as haemoglobin < 11 g/dL for pregnant women and < 12 g/dL for non-pregnant women. We analysed data using Bayesian linear regression analyses. Findings During 2000-2018, the prevalence of anaemia in women of reproductive age decreased in nine countries, with the highest decrease in Malawi (-2.5%), and increased in six countries, with the highest increase in Burundi (10.9%). All countries are projected to have a prevalence of anaemia ≥ 15% in 2025, with the highest level in Burundi (66.8%). The prevalence of anaemia and projection of prevalence varied between and within countries. Women's education, family wealth and place of residence had the highest impact on the current and projected prevalence rates of anaemia. Seven countries had a prevalence of anaemia ≥ 40%, which we defined as a severe public health problem, in the earliest and latest DHS and this prevalence is projected to persist in 2025. Conclusion None of the 15 countries is likely to meet the global nutrition target of a 50% reduction in the prevalence of anaemia in women of reproductive age by 2025. Global and country leaders should reconsider nutrition policies and reallocate resources targeting countries and communities at risk.
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Affiliation(s)
- Md Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Long Pocket Precinct, Indooroopilly, Queensland 4068, Australia
| | - Ricardo J Soares Magalhaes
- Spatial Epidemiology Laboratory, School of Veterinary Science, The University of Queensland, Gatton, Australia
| | - Sarah P Garnett
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, Australia
| | - Yaqoot Fatima
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Long Pocket Precinct, Indooroopilly, Queensland 4068, Australia
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sonia Pervin
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Long Pocket Precinct, Indooroopilly, Queensland 4068, Australia
| | - Saifuddin Ahmed
- Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Abdullah A Mamun
- Institute for Social Science Research, The University of Queensland, 80 Meiers Road, Long Pocket Precinct, Indooroopilly, Queensland 4068, Australia
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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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Islam MA, Afroja S, Khan MS, Alauddin S, Nahar MT, Talukder A. Prevalence and Triggering Factors of Childhood Anemia: An Application of Ordinal Logistic Regression Model. Int J Clin Pract 2022; 2022:2212624. [PMID: 35685513 PMCID: PMC9159194 DOI: 10.1155/2022/2212624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Md. Akhtarul Islam
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Sohani Afroja
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Md. Salauddin Khan
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Sharlene Alauddin
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Mst. Tanmin Nahar
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
| | - Ashis Talukder
- Statistics Discipline, Science Engineering and Technology School, Khulna University, Khulna 9208, Bangladesh
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Wu B, Choy CC, Rivara AC, Soti-Ulberg C, Naseri T, Reupena MS, Duckham RL, Hawley NL. Persistence of anaemia among Samoan preschool age children: a longitudinal study. Public Health Nutr 2021; 24:5995-6006. [PMID: 34521497 PMCID: PMC8608721 DOI: 10.1017/s1368980021003980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/27/2021] [Accepted: 09/10/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To characterise the prevalence and persistence of anaemia among Samoan children over a 2-3-year period. DESIGN Data were from two consecutive waves (2015 and 2017-2018) of the Ola Tuputupua'e 'Growing up' study. Anaemia (Hb < 11·0 or 11·5 g/dl for 2-4 and ≥ 5 years old, respectively) was considered 'transient' when it occurred at only one wave or 'persistent' if it was present at two consecutive waves. Child, maternal and household correlates of anaemia were examined using log-binomial and modified Poisson regressions. SETTING Eleven Samoan villages. PARTICIPANTS Mother-child pairs (n 257) recruited in 2015 and reassessed in 2017-2018. RESULTS Anaemia prevalence was 33·9 % in 2015 and 28·0 % in 2017-2018; 35·6 % of cases identified in 2015 were persistent. Risk of anaemia at only one wave was lower among children who were older in 2015 (age 4 v. 2 years, adjusted relative risk (aRR) = 0·54, (95 % CI 0·35, 0·84), P = 0·007), had older mothers (≥ 40 v. 18-29 years, aRR = 0·61, (95 % CI 0·39, 0·95), P = 0·029) and had higher daily sodium intake (for every 100 mg/d, aRR = 0·97, (95 % CI 0·95, 0·99), P = 0·003) than children with no anaemia. Children whose anaemia persisted were more likely to have had a mother with anaemia (aRR = 2·13, (95 % CI 1·17, 3·89), P = 0·013) and had higher daily dietary iron intake (for every 10 mg/d, aRR = 4·69, (95 % CI 1·33, 16·49), P = 0·016) than those with no anaemia. CONCLUSIONS Alongside broadly targeted prevention efforts, which are warranted given the moderate-high anaemia prevalence observed, specific attention should be paid to children with risk factors for persistent anaemia. Routine screening of children whose mothers have anaemia should be encouraged.
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Affiliation(s)
- Bohao Wu
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT06510, USA
| | - Courtney C Choy
- Department of Epidemiology, International Health Institute, Brown University, School of Public Health, Providence, RI, USA
| | - Anna C Rivara
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT06510, USA
| | | | - Take Naseri
- Department of Epidemiology, International Health Institute, Brown University, School of Public Health, Providence, RI, USA
- Ministry of Health, Apia, Samoa
| | | | - Rachel L Duckham
- Institute of Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Sciences, Melbourne, VIC, Australia
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT06510, USA
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Inequities in childhood anaemia at provincial borders in Mozambique: cross-sectional study results from multilevel Bayesian analysis of 2018 National Malaria Indicator Survey. BMJ Open 2021. [PMCID: PMC8718414 DOI: 10.1136/bmjopen-2021-051395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives This study aims to identify the child-level, maternal-level, household-level and community-level determinants of anaemia among children aged 6–59 months, and determine the inequities of anaemia prevalence across communities in Mozambique. Design Cross-sectional study. Setting Mozambique. Participants This study used data of a weighted population of 3946 children, 6–59 months, delivered by women between 15 and 49 years of age, from the 2018 Mozambique Malaria Indicator Survey. Primary outcome measure Child’s anaemic status, measured as altitude-adjusted haemoglobin concentration (in g/L); the severity of anaemia was categorised based on predefined threshold values. Multilevel Bayesian linear regressions identified key determinants of childhood anaemia. Based on data availability and policy implications, spatial analysis was used to determine geographical variation of anaemia at the community level and areas with higher risks. Results The mean prevalence of childhood anaemia was 77.7% (SD: 5.5%). Provincially, Cabo Delgado province (86.2%) had the highest prevalence, Maputo province (70.2%) the lowest. Children with excess risk were mostly found in communities that had proximity to provincial borders: Niassa-Cabo Delgado-Nampula triprovincial border, Gaza-Inhambane border, Zambezia-Nampula border and provinces of Manica and Inhambane. Children with anaemia tended to be younger, males and at risk of having malaria because they were not sleeping under mosquito nets. In addition, children from poor families relative to children from wealthier households and those living in female-headed households were prone to anaemia. Conclusion Findings from this study provide evidence that spatial inequities in childhood anaemia exist in Mozambique, mostly concentrated in the communities living close to the provincial borders. Anaemia among children could be effectively reduced through malaria prevention, for example, bed netting. Interventions are needed that generate income for households, increase community support for households headed by women, improve malaria control, build capacity of healthcare workers to manage severely anaemic children and health education for mothers.
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Hailegebreal S, Nigatu AM, Mekonnen ZA, Endehabtu BF. Spatio-temporal distribution and associated factors of anaemia among children aged 6-59 months in Ethiopia: a spatial and multilevel analysis based on the EDHS 2005-2016. BMJ Open 2021; 11:e045544. [PMID: 34404697 PMCID: PMC8372819 DOI: 10.1136/bmjopen-2020-045544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Anaemia is a global public health problem with major health and socioeconomic consequences. Though childhood anaemia is a major public health problem in Ethiopia, there is limited evidence on the spatio-temporal variability of childhood anaemia over time in the country. Therefore, this study aimed to assess the spatio-temporal distribution and associated factors of childhood anaemia using the Ethiopian Demographic and Health Survey (EDHS) data from 2005 to 2016. DESIGN Survey-based cross-sectional study design was employed for the EDHS. SETTING Data were collected in all nine regions and two city administrations of Ethiopia in 2005, 2011 and 2016. PARTICIPANTS The source population for this study was all children in Ethiopia aged 6-59 months. A total of 21 302 children aged 6-59 months were included in this study. OUTCOME MEASURE The outcome variable was child anaemia status. RESULTS The prevalence of anaemia declined from 53.9% in 2005 to 44.6% in 2011, but it showed an increase in 2016 to 57.6%. The spatial analysis revealed that the spatial distribution of anaemia varied across the regions. The spatial scan statistics analysis indicated a total of 22 clusters (relative risk (RR)=1.5, p<0.01) in 2005, 180 clusters (RR=1.4, p<0.01) in 2011 and 219 clusters (RR=1.4, p<0. 0.01) in 2016, significant primary clusters were identified. The child's age, mother's age, maternal anaemia status, wealth index, birth order, fever, stunting, wasting status and region were significant predictors of childhood anaemia. CONCLUSIONS In this study, childhood anaemia remains a public health problem. The spatial distribution of childhood anaemia varied significantly across the country. Individual-level and community-level factors were associated with childhood anaemia. Therefore, in regions with a high risk of childhood anaemia, individual-level and community-level factors should be intensified by allocating additional resources and providing appropriate and tailored strategies.
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Affiliation(s)
- Samuel Hailegebreal
- Department of Health Informatics, Arba Minch University, Arba Minch, Southern Nations, Ethiopia
| | - Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | | | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Amadu I, Seidu AA, Afitiri AR, Ahinkorah BO, Yaya S. Household cooking fuel type and childhood anaemia in sub-Saharan Africa: analysis of cross-sectional surveys of 123, 186 children from 29 countries. BMJ Open 2021; 11:e048724. [PMID: 34285012 PMCID: PMC8292815 DOI: 10.1136/bmjopen-2021-048724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study sought to investigate the joint effect of household cooking fuel type and urbanicity (rural-urban residency) on anaemia among children under the age of five in sub-Saharan Africa. DESIGN We analysed cross-sectional data of 123, 186 children under the age of five from 29 sub-Saharan African countries gathered between 2010 and 2019 by the Demographic and Health Survey programme. Bivariate (χ2 test of independence) and multilevel logistic regression were used to examine the effect of urbanicity-household cooking fuel type on childhood anaemia. Results were reported as adjusted odds ratios (aORs) with 95% CIs at p<0.05. OUTCOME MEASURES Anaemia status of children. RESULTS More than half (64%) of children had anaemia. The percentage of children who suffered from anaemia was high in those born to mothers in Western Africa (75%) and low among those born in Southern Africa (54%). Children from rural households that depend on unclean cooking fuels (aOR=1.120; 95% CI 1.033 to 1.214) and rural households that depend on clean cooking fuels (aOR=1.256; 95% CI 1.080 to 1.460) were more likely to be anaemic as compared with children from urban households using clean cooking fuel. Child's age, sex of child, birth order, perceived birth size, age of mother, body mass index of mother, education, marital status, employment status, antenatal care, wealth quintile, household size, access to electricity, type of toilet facility, source of drinking water and geographic region had significant associations with childhood anaemia status. CONCLUSIONS Our study has established a joint effect of type of household cooking fuel and urbanicity on anaemia among children under the age of five in sub-Saharan Africa. It is therefore critical to promote the usage of clean cooking fuels among households and women in rural areas. These should be done taking into consideration the significant child, maternal, household, and contextual factors identified in this study.
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Affiliation(s)
- Iddrisu Amadu
- Department of Fisheries and Aquatic Sciences, University of Cape Coast, Cape Coast, Ghana
- Africa Centre of Excellence in Coastal Resilience, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, Queensland, Australia
- Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
| | | | | | - 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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Kumar P, Chauhan S, Patel R, Srivastava S. Anaemia among mother-father-child pairs in India: examining co-existence of triple burden of anaemia in a family. BMC Public Health 2021; 21:1341. [PMID: 34233628 PMCID: PMC8265002 DOI: 10.1186/s12889-021-11408-1] [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] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia is a global health concern and is also a common comorbidity in multiple medical conditions. Very limited research is available examining anaemia among family members in India and across various countries. The present study aimed to examine the co-existence of the triple burden of anaemia among mother-father-child pairs in a family. METHODS The data utilized was from the National Family Health Survey conducted in 2015-16. The effective sample size for the study was 26,910 couples, along with children aged 6-59 months. The bivariate and binary logistic regression analysis were applied to assess the factors associated with family-level anaemia. In bivariate analysis, a chi-square test was performed to determine the association of socio-demographic factors with anaemic family. RESULTS More than half of the mothers (57.5%) and their children (58%), along with 10% of fathers, were found to be anaemic; however, the co-existence of triple burden of anaemia among mother-father-child pairs was 4.7% in the study. The likelihood of family-level anaemia was low when both the parents were educated [OR: 0.69, CI: 0.58-0.81], and it was high when both the parents were employed [OR: 1.40 CI: 1.10-1.80]. Families from the Scheduled Tribe had a 62% higher likelihood to suffer from anaemia [OR: 1.62, CI: 1.33-1.97]. CONCLUSIONS The suggested interventions include early diagnosis, effective management, and treatment of anaemia. Moreover, adequate complementary feeding practices for children shall also be promoted. Parental education on nutrition is also required, and community interventions are needed to improve parental education on nutrition. At last, there is a need for greater policy and program attention to improving nutritional knowledge among mothers so as to tackle the triple burden of anaemia among mother-father-child pairs.
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Affiliation(s)
- Pradeep Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Shekhar Chauhan
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Ratna Patel
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
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Chienwittayakun K, Suteerojntrakool O, Techavichit P, Bongsebandhu-Phubhakdi C, Subchartanan J, Tempark T. Adherence to Screening for Anemia in 9-Month-Old Full-Term Infants in Bangkok, Thailand. J Trop Pediatr 2021; 67:5924407. [PMID: 33057692 DOI: 10.1093/tropej/fmaa054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To determine adherence to the screening for anemia in 9-month-old full-term infants and factors associated with non-adherence to the screening for anemia. METHODS A descriptive cross-sectional study was conducted in 9-month-old full-term healthy infants who visited the General Pediatric and Well Child Care Clinic, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Demographic data, adherence to the screening, and factors associated with non-adherence to the screening were analyzed using percentage, χ2 test, and bivariate logistic regression. RESULTS A total of 234 full-term infants, aged 9 months, were included in the study between January and December 2019. The prevalence of adherence to the screening for anemia was 76.1% (95% CI 0.70-0.81). The most common cause of non-adherence to the screening was the waiting time for laboratory results (39.3%). Factors associated with non-adherence to the screening were low education of caregiver (AOR 2.684; 95% CI 1.451-4.966), low socio-economic status (AOR 2.26; 95% CI 1.568-3.258), and inadequate complementary food (AOR 1.961; 95% CI 1.107-3.473). CONCLUSION The most common cause of non-adherence to the screening for anemia is the waiting time for laboratory results. Pediatricians and general practitioners should ensure the importance of anemia screening in infants and plan on anemia screening with parents.
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Affiliation(s)
| | - Orapa Suteerojntrakool
- Division of Ambulatory Pediatrics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.,Pediatric Nutrition STAR (Special Task Force for Activating Research), Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Piti Techavichit
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Chansuda Bongsebandhu-Phubhakdi
- Division of Ambulatory Pediatrics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jarujan Subchartanan
- Division of Ambulatory Pediatrics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Therdpong Tempark
- Division of Ambulatory Pediatrics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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Effect of Ferrous Fumarate Supplementation and Date (Phoenix dactylifera) Consumption on Hemoglobin Level of Women in the Third-Trimester of Pregnancy. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2021. [DOI: 10.52547/jgbfnm.18.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Tesema GA, Worku MG, Tessema ZT, Teshale AB, Alem AZ, Yeshaw Y, Alamneh TS, Liyew AM. Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis. PLoS One 2021; 16:e0249978. [PMID: 33891603 PMCID: PMC8064743 DOI: 10.1371/journal.pone.0249978] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/18/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa. METHODS This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤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 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia. RESULTS The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia. CONCLUSION Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.
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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
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, 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
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Anteneh ZA, Van Geertruyden JP. Spatial variations and determinants of anemia among under-five children in Ethiopia, EDHS 2005-2016. PLoS One 2021; 16:e0249412. [PMID: 33793640 PMCID: PMC8016260 DOI: 10.1371/journal.pone.0249412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 03/18/2021] [Indexed: 11/18/2022] Open
Abstract
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.
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Woldegebriel AG, Gebrehiwot GG, Desta AA, Ajemu KF, Berhe AA, Woldearegay TW, Bezabih NM. Identification of Factors Influencing Anemia among Children Aged 6-59 Months in Ethiopia Using Ethiopia Demographic and Health Survey 2016 Data. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:161-175. [PMID: 33824615 PMCID: PMC8018423 DOI: 10.2147/phmt.s283681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
Background Anemia is the most common nutritional problem and a widespread micronutrient-deficiency disorder on a global scale. In Ethiopia, childhood anemia is highly prevalent and a major public health concern. This study aimed to identify factors associated with anemia among children aged 6–59 months in Ethiopia. Methods Data weres extracted from the 2016 Ethiopia Demographic and Health Survey (EDHS). We found records for 8,603 children aged 6–59 months in the data set. After 448 had been excluded due to incomplete records, 8,155 children were included in the final analysis. Pearson’s χ2 was used to assess associations between each factor and categorical outcome variables. Multivariate logistic regression analyses were done to determine factors associated with anemia, and significant associations were declared at p≤0.05 for the final model. Results More than half (51.5%) the children were male and the overall mean age was 31.85±15.66 months. Mean hemoglobin concentration was 10.37±17.55 g/dL. The overall prevalence of anemia was 56.6%: 3.7%, 30.4%, and 22.5% severe, moderate, and mild anemia, respectively. Increased child age, decreased maternal age, lowest rung on wealth index, mother living alone, mother engaged in outside work, increased birth order, decreased birth interval, one antenatal care visit, severe stunting, and severe underweight were significantly associated with anemia. Conclusion The prevalence of anemia in this study was the highest of all EDHS reports. It had increased since the preceding report (EDHS 2011), and remains the main public health concern in Ethiopia. Comprehensive intervention strategies should be put in place and tailored to different levels of government (national, regional, and district) including household- and individual-level interventions for combating childhood anemia by focusing on the identified risk factors.
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Affiliation(s)
| | | | - Abraham Aregay Desta
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Kiros Fenta Ajemu
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | - Asfawosen Aregay Berhe
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
| | | | - Nega Mamo Bezabih
- Department of Human Nutrition, Tigray Health Research Institute, Mekelle, Tigray, Ethiopia
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Sunuwar DR, Singh DR, Adhikari B, Shrestha S, Pradhan PMS. Factors affecting anaemia among women of reproductive age in Nepal: a multilevel and spatial analysis. BMJ Open 2021; 11:e041982. [PMID: 33782019 PMCID: PMC8009228 DOI: 10.1136/bmjopen-2020-041982] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE The main objective of this study was to explore the factors affecting anaemia among women of reproductive age (WRA) in Nepal using spatial and multilevel epidemiological analysis. DESIGN This cross-sectional study analysed data from the 2016 Nepal Demographic and Health Survey. Spatial analysis was performed using ArcGIS software V.10.8 to identify the hot and cold spots of anaemia among WRA (15-49 years). Data were analysed using multilevel mixed-effect logistic regression analysis. SETTING Nepal. PARTICIPANTS A total of 6414 WRA were included in the analysis. MAIN OUTCOME MEASURE Anaemia defined by WHO as haemoglobin level less than 120 g/L in non-pregnant women and less than 110 g/L in pregnant women. RESULTS The spatial analysis showed that statistically significant hotspots of anaemia were in the southern Terai region (four districts in province 1, eight districts in province 2, one district in Bagmati province, two districts in province 5 and one district in Sudurpaschim province) of Nepal. At the individual level, women who underwent female sterilisation (adjusted OR, aOR: 3.61, 95% CI 1.10 to 11.84), with no education (aOR: 1.99, 95% CI: 1.17 to 3.39), and from middle socioeconomic class families (aOR: 1.65, 95% CI: 1.02 to 2.68) were more likely to be anaemic, whereas, older women (>35 years) (aOR: 0.51, 95% CI: 0.26 to 0.97) and those women who were using hormonal contraceptives (aOR: 0.63, 95% CI: 0.43 to 0.90) were less likely to be anaemic. At the community level, women from province 2 (aOR=2.97, 95% CI: 1.52 to 5.82) had higher odds of being anaemic. CONCLUSION WRA had higher odds of developing anaemia, and it varied by the geographical regions. Nutrition-specific and nutrition-sensitive interventions can be tailored based on the factors identified in this study to curb the high burden of anaemia.
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Affiliation(s)
- Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Armed Police Force Hospital, Kathmandu, Nepal
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Santosh Shrestha
- Agriculture Research, Agricultural Technology Center, Lalitpur, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
- Nepalese Society of Community Medicine (NESCOM), Kathmandu, Nepal
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Abu BAZ, Buttner N, Garror OD, Stefanic R, Sandow A, Pereko KA. Qualitative assessments of anemia-related programs in Ghana reveal gaps and implementation challenges. Ann N Y Acad Sci 2020; 1492:27-41. [PMID: 33368337 PMCID: PMC8246908 DOI: 10.1111/nyas.14538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/19/2020] [Accepted: 10/29/2020] [Indexed: 12/04/2022]
Abstract
In spite of multiple program efforts in Ghana, progress in reducing the burden of anemia is slow. The objective was to conduct multilevel assessments of existing childhood (<5 years) anemia prevention and treatment programs according to UNICEF's conceptual framework of malnutrition, and to elucidate implementation gaps in Ghana. Purposive and snowball sampling strategies recruited 25 program personnel from 20 organizations to participate in audiorecorded interviews conducted through in‐person, telephone, or email correspondence in August 2018. Interview guides constructed around UNICEF's conceptual framework of malnutrition identified context‐specific immediate, underlying, and basic causes of anemia, and corresponding programs. Interviews were transcribed, coded, and analyzed using the Dedoose software version 8.1.8. Few programs addressed identified basic causes of anemia, such as inadequate human resources, housing/water/toilet facilities, and poverty/poor access to financial resources. Organizations implemented programs addressing ≥1 underlying cause. Five organizations provided food rations and/or supplements to address immediate causes. A key food‐based gap identified was minimal education on fruit intake or antinutritive factors in foods; however, no interventions included vitamin C supplements. Food manufacturers mainly used cereals and grains in commercial food products. Multiple organizations worked in the same region on anemia with instances of an overlapping program focus. Food sources of vitamin C or supplements could be promoted in food‐based interventions to increase the absorption of nonheme iron consumed.
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Affiliation(s)
- Brenda A Z Abu
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Nicole Buttner
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Olivia D Garror
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Rachel Stefanic
- Rochester Institute of Technology, College of Health Sciences and Technology, Wegmans School of Health and Nutrition, Rochester, New York
| | - Adam Sandow
- Point Hope International, Ghana Program, Kasoa, Ghana
| | - Kinglsey A Pereko
- Community Medicine, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
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Obasohan PE, Walters SJ, Jacques R, Khatab K. A Scoping Review of the Risk Factors Associated with Anaemia among Children Under Five Years in Sub-Saharan African Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238829. [PMID: 33261060 PMCID: PMC7731158 DOI: 10.3390/ijerph17238829] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 01/29/2023]
Abstract
Background/Purpose: Globally, anaemia is a severe public health condition affecting over 24% of the world’s population. Children under five years old and pregnant women are the most vulnerable to this disease. This scoping review aimed to evaluate studies that used classical statistical regression methods on nationally representative health survey data to identify the individual socioeconomic, demographic and contextual risk factors associated with developing anaemia among children under five years of age in sub-Saharan Africa (SSA). Methods/Design: The reporting pattern followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The following databases were searched: MEDLINE, EMBASE (OVID platform), Web of Science, PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Cochrane library, African Journal of online (AJOL), Google Scholar and Measure DHS. Results: The review identified 20 relevant studies and the risk factors for anaemia were classified as child-related, parental/household-related and community- or area-related factors. The risk factors for anaemia identified included age, birth order, sex, comorbidities (such as fever, diarrhoea and acute respiratory infection), malnutrition or stunting, maternal education, maternal age, mother’s anaemia status, household wealth and place of residence. Conclusion: The outcome of this review is of significant value for health policy and planners to enable them to make informed decision that will correct any imbalances in anaemia across socioeconomic, demographic and contextual characteristics, with the view of making efficient distributions of health interventions.
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Affiliation(s)
- Phillips Edomwonyi Obasohan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.J.W.); (R.J.)
- Department of Liberal Studies, College of Administrative and Business Studies, Niger State Polytechnic, Bida Campus, Bida 912231, Nigeria
- Correspondence:
| | - Stephen J. Walters
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.J.W.); (R.J.)
| | - Richard Jacques
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.J.W.); (R.J.)
| | - Khaled Khatab
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield S10 2BP, UK;
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Li H, Xiao J, Liao M, Huang G, Zheng J, Wang H, Huang Q, Wang A. Anemia prevalence, severity and associated factors among children aged 6-71 months in rural Hunan Province, China: a community-based cross-sectional study. BMC Public Health 2020; 20:989. [PMID: 32576157 PMCID: PMC7310416 DOI: 10.1186/s12889-020-09129-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/16/2020] [Indexed: 11/28/2022] Open
Abstract
Background In recent 10 years, with the rapid socioeconomic development and the extensive implementation of children nutrition improvement projects, the previous epidemiological data cannot reflect the actual level of anemia among children in China, especially in rural areas. Therefore, this study analyzed the prevalence, severity and associated factors of anemia among children aged 6–71 months in rural Hunan Province. Methods A community-based cross-sectional study was conducted. Through multistage stratified cluster sampling, 5229 children aged 6 to 71 months and their caregivers were randomly selected from 72 villages across 24 towns in 12 counties from rural Hunan. The demographic characteristics of children and their caregivers, feeding practice, nutritional status of children, caregivers’ anemia-related feeding knowledge, and gestational conditions of mothers were acquired by using a unified questionnaire. Peripheral blood from the left-hand middle fingertip was sampled from each child, and hemoglobin concentration was measured using a HemoCue301 portable hemoglobin analyzer (Sweden). Associated factors analyses involving overall anemia and anemia severities were conducted on multivariate logistic regression models. Results The overall anemia prevalence was 8.8%, and the prevalence of mild, moderate and severe anemia was 6.3, 2.5 and 0.1%, respectively. Children age groups of 6–11 months, 12–23 months and 36–47 months, exclusive breast-feeding within 6 months after birth, and maternal moderate/severe anemia were significantly associated with an increased risk of overall anemia in children. Children age groups of 6–11 months and 12–23 months were significantly associated with an increased risk of mild anemia in children. Children age groups of 6–11 months, 12–23 months and 36–47 months, low caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia were significantly associated with an increased risk of moderate/severe anemia in children. Children who underwent regular physical examination were less likely to have moderate/severe anemia. The common protective factor for overall, mild and moderate/severe anemia in children was high family income. Conclusions The anemia status of preschool children in rural Hunan Province was a mild public health problem and associated with children age group, feeding practice, regular physical examination, family income, caregivers’ anemia-related feeding knowledge level, and maternal moderate/severe anemia.
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Affiliation(s)
- Huixia Li
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China.,NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - Juan Xiao
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China
| | - Minghui Liao
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China
| | - Guangwen Huang
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China.
| | - Jianfei Zheng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Hua Wang
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China. .,Department of Maternal Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China.
| | - Qun Huang
- Department of Child Health Care, Hunan Provincial Maternal and Child Health Care Hospital, No.53, Xiangchun Road, Kaifu District, Changsha, 410008, Hunan Province, China
| | - Aihua Wang
- Department of Information Management, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
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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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Yin S, Zhou Y, Li H, Cheng Z, Zhang Y, Zhang L, Liu J, Liu J. Association of maternal BMI during early pregnancy with infant anemia: a large Chinese birth cohort. Nutr Metab (Lond) 2020; 17:32. [PMID: 32328147 PMCID: PMC7169019 DOI: 10.1186/s12986-020-00448-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant anemia is prevalent in low- and middle-income countries. Maternal body mass index (BMI) is associated with serum ferritin in cord blood, but as yet has not been linked to infant anemia. The objective of this study was to examine the association of maternal BMI during early pregnancy with infant hemoglobin levels and anemia at 6 and 12 months in a Chinese birth cohort. METHODS The prospective cohort included 17,193 mother-infant pairs. Maternal weight and height prior to 20 gestational weeks as well as infant hemoglobin at 6 and 12 months were measured following standard procedures, and BMI was calculated as weight in kilograms divided by the square of height in meters. Women were categorized into underweight, normal weight (reference), overweight, and obesity. Infant anemia was defined as hemoglobin < 11.0 g/dl. Fractional polynomial regression was used to examine the relation between maternal BMI and infant hemoglobin, joinpoint regression to identify breakpoints, and logistic regression to estimate odds ratios (ORs). RESULTS In the cohort, 1160 (6.8%) were anemic at 6 months and 904 (5.3%) at 12 months. An inverse U-shaped relation of maternal BMI with infant hemoglobin was found at 6 months, at their maximum at maternal BMI of 22.4 kg/m2, and a similar relationship found again at 12 months. Maternal obesity rather than underweight was associated with an increased risk of anemia for infants at 6 months (adjusted OR 1.39, 95% CI 1.02, 1.88), but not at 12 months. Maternal anemia during mid-pregnancy augmented the risk at 6 months (adjusted OR 2.91, 95% CI 1.14, 7.46), but did not mediate the association (Z = - 1.102, P = 0.270). CONCLUSIONS Maternal BMI during early pregnancy is correlated with infant hemoglobin in an inverse U-shaped profile, and obesity increases infant anemia risk that is aggravated by maternal anemia during pregnancy. This study enriched the epidemiological evidence on the adverse effect of high maternal BMI on long-term health of offspring. Optimizing maternal weight in obstetric care is necessary to improve offspring health.
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Affiliation(s)
- Shaohua Yin
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yubo Zhou
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hongtian Li
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Zhihao Cheng
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yali Zhang
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Le Zhang
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jianmeng Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, No. 38 Xueyuan Rd, Haidian District, Beijing, 100191 China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
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Lancaster L, Barnes RFW, Correia M, Luis E, Boaventura I, Silva P, von Drygalski A. Maternal death and postpartum hemorrhage in sub-Saharan Africa - A pilot study in metropolitan Mozambique. Res Pract Thromb Haemost 2020; 4:402-412. [PMID: 32211574 PMCID: PMC7086466 DOI: 10.1002/rth2.12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Maternal mortality in sub-Saharan Africa is approximately 500 to 1000 per 100 000 births (vs. approximately 5-20 in developed countries). Postpartum hemorrhage (PPH) is deemed responsible for 30% to 50% of the deaths. OBJECTIVE To study PPH, risk factors, and mortality in metropolitan Mozambique to inform future studies and intervention strategies. MATERIALS/METHODS Retrospective cross-sectional data extraction from all charts available to us (n = 495) recording deliveries between January and June 2018 at Maputo Central Hospital. Data included age, maternal survival, HIV status, parity, delivery mode, complications, vital signs, laboratory values, and maternal/fetal data. PPH was determined by charted diagnosis, interventions for hemorrhaging, placental abruption, transfusion, or blood loss. Autopsy reports from all deceased patients (n = 35) were examined. RESULTS Median age was 29 years with 17% HIV prevalence. Risk factors for PPH (frequency, 12%) included parity (adjusted odds ratios (AORs) for 3+ versus nulliparity, 7.20 (95% confidence interval [CI], 2.46-21.10), gestation length (AOR, 0.86; CI, 0.81-0.92 per week), and body temperature (AOR, 1.10; CI, 1.04-1.16 per 0.1°C). Maternal mortality was strongly associated with PPH (AOR, 5.22; 95% CI, 2.26-12.08) and HIV (AOR, 11.66; 95% CI, 4.72-28.78). Laboratory values (n = 241) were available from mothers experiencing complications (approximately 50%). Anemia (prevalence 54%) was a strong predictor of PPH with an inverse relationship between hemoglobin levels on admission (AOR, 0.62; 95% CI, 0.50-0.77 per g/dL higher hemoglobin) and the probability of later suffering from PPH. Mothers who died following PPH had lower median hemoglobin (6.2 g/dL) than mothers who survived (9.2 g/dL). Protocols to estimate peripartum blood loss were not used; antifibrinolytics and/or cryoprecipitate were unavailable. CONCLUSION Postpartum hemorrhage is a serious problem even in metropolitan areas of sub-Saharan Africa, and anemia influenced bleeding and death substantially. To address this problem, it is critical to raise awareness and region-specific prevention and intervention protocols.
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Affiliation(s)
- Lian Lancaster
- Department of MedicineDivision of Hematology/Oncology, University of California San DiegoSan DiegoCAUSA
| | - Richard F. W. Barnes
- Department of MedicineDivision of Hematology/Oncology, University of California San DiegoSan DiegoCAUSA
| | - Momade Correia
- Universidade Eduardo Mondlane, Departments of Gynecology/Obstetrics and Hematology, Central Hospital of MaputoMaputoMozambique
| | - Elvira Luis
- Universidade Eduardo Mondlane, Departments of Gynecology/Obstetrics and Hematology, Central Hospital of MaputoMaputoMozambique
| | - Ines Boaventura
- Universidade Eduardo Mondlane, Departments of Gynecology/Obstetrics and Hematology, Central Hospital of MaputoMaputoMozambique
| | - Patricia Silva
- Universidade Eduardo Mondlane, Departments of Gynecology/Obstetrics and Hematology, Central Hospital of MaputoMaputoMozambique
| | - Annette von Drygalski
- Department of MedicineDivision of Hematology/Oncology, University of California San DiegoSan DiegoCAUSA
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Hakizimana D, Nisingizwe MP, Logan J, Wong R. Identifying risk factors of anemia among women of reproductive age in Rwanda - a cross-sectional study using secondary data from the Rwanda demographic and health survey 2014/2015. BMC Public Health 2019; 19:1662. [PMID: 31829161 PMCID: PMC6907339 DOI: 10.1186/s12889-019-8019-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/29/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anemia among Women of Reproductive Age (WRA) continues to be among the major public health problems in many developing countries, including Rwanda, where it increased in prevalence between the 2015 and 2010 Rwanda Demographic and Health Survey (RDHS) reports. A thorough understanding of its risk factors is necessary to design better interventions. However, to the best of our knowledge, no study has been conducted in Rwanda on a nationally representative sample to assess factors associated with anemia among WRA. Accordingly, this study was conducted to address such gap. METHODS A quantitative, cross-sectional study was conducted using data from the RDHS 2014-2015. The study population consisted of 6680 WRA who were tested for anemia during the survey. Anemia was defined as having a hemoglobin level equal to or below 10.9 g/dl for a pregnant woman, and hemoglobin level equal to or below 11.9 g/dl for a non-pregnant woman. Pearson's chi-squared test and multiple logistic regression were conducted for bivariate and multivariable analysis, respectively. RESULTS The prevalence of anemia among WRA was 19.2% (95% CI: 18.0-20.5). Four factors were found to be associated with lower odds of anemia, including being obese (OR: 0.61, 95% CI: 0.40-0.91), being in the rich category (OR: 0.74, 95% CI: 0.63-0.87), sleeping under a mosquito net (OR: 0.85, 95% CI: 0.74-0.98), and using hormonal contraceptives (OR: 0.61, 95% CI: 0.50-0.73). Five factors were associated with higher odds of anemia, including being underweight (OR: 1.39, 95% CI: 1.09-1.78), using an intrauterine device (OR: 1.98, 95% CI: 1.05-3.75), being separated or widowed (OR: 1.35, 95% CI: 1.09-1.67), and living in the Southern province (OR: 1.45, 95% CI: 1.11-1.89) or in the Eastern province (OR: 1.41, 95% CI: 1.06-1.88). CONCLUSION Anemia continues to pose public health challenges; novel public health interventions should consider geographic variations in anemia risk, seek to improve women's economic statuses, and strengthen iron supplementation especially for Intrauterine device users. Additionally, given the association between anemia and malaria, interventions to prevent malaria should be enhanced.
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Affiliation(s)
- Dieudonne Hakizimana
- Department of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda.
| | - Marie Paul Nisingizwe
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jenae Logan
- Department of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda
| | - Rex Wong
- Department of Global Health Delivery, University of Global Health Equity, Kigali, Rwanda.,School of Public Health, Yale University, New Haven, CT, USA
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Ntenda PAM, Chilumpha S, Mwenyenkulu ET, Kazambwe JF, El-Meidany W. Clinical malaria and the potential risk of anaemia among preschool-aged children: a population-based study of the 2015-2016 Malawi micronutrient survey. Infect Dis Poverty 2019; 8:95. [PMID: 31760954 PMCID: PMC6876103 DOI: 10.1186/s40249-019-0607-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Anaemia and malaria are common and life-threatening diseases among preschool-aged children in many tropical and subtropical areas, and Malawi is no exception. Accordingly, this study aimed to examine the association of referral clinical malaria with anemia (hemoglobin [Hb] < 110 g/L) in preschool-aged children in Malawi. Methods Using cross-sectional data obtained from the 2015–2016 Malawi Micronutrient Survey (MNS), multivariate logistic regression models were constructed using surveylogistic to account for the complex survey design. Blood samples of 1051 children aged 6–59 months were evaluated for malaria (using rapid diagnostic test [RDT] – SD BIOLINE Malaria Ag P.f/Pan test histidine-rich protein (HRP-II)™), Hb (using HemoCue 301), α-1-acid glycoprotein (AGP), and serum ferritin biomarkers (using simple sandwich enzyme-linked immunosorbent assay technique, ELISA) and inherited blood disorders from dry blood samples (DBS) using polymerize chain reaction (PCR). Diagnosis of clinical malaria was made on the basis of fever and a positive rapid diagnostic test (RDT). Results Of the 1051 PSC analysed, 29% had anaemia while 24.4% had a referral to the hospital due to malaria. After adjustments for known confounders, PSC with a history of referral clinical malaria had increased odds of being anaemic (adjusted odds ratio [aOR] = 4.63, 95% confidence interval [CI]: 2.90–7.40), P < 0.0001. Conclusions This study found that clinical malaria increased the risk of anaemia in PSC. Thus, elimination of malaria-causing parasites from the PSC’s blood should be rapid and complete in order to prevent the progression of uncomplicated malaria to a chronic infection that can lead to the development of malaria-related anaemia.
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Affiliation(s)
- Peter Austin Morton Ntenda
- Malaria Alert Centre, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Sosten Chilumpha
- Ministry of Health and Population, Department of Planning and Policy Development, PO Box 30377, Lilongwe, Malawi
| | | | - Jane Flora Kazambwe
- NBS Bank PLC, Head Office NBS House Corner Chipembere Highway & Johnstone Roads Ginnery Corner Blantyre, P.O. Box 32251, Chichiri, Blantyre 3, Malawi
| | - Walaa El-Meidany
- Department of Nutrition, High Institute of Public Health, Alexandria University, Hiph 65 El-Horreya Avenue. El-Ibrahimia, Alexandria, Egypt
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