Prevalence of anemia and associated factors among school children in Gondar town public primary schools, northwest Ethiopia: A school-based cross-sectional study

Anemia and Associated Factors among Public Elementary School Children in Asella Town, Southeast Ethiopia: A Facility-Based Cross-Sectional Study

Background

Anemia has a negative impact on school children, including poor physical growth and reduced mental performance. Children show poor attentiveness, behavior, and memory and reduced school performance. There is limited evidence of the magnitude of anemia and associated factors in school-age children in Ethiopia, including the study area.

Objective

To assess the magnitude of anemia and associated factors among public elementary school children in Asella Town, Southeast Ethiopia, in 2022.

Methods

A school-based cross-sectional study was conducted in Asella Town from April 5 to May 5, 2022. A total of 442 school children aged 7-14 years were included in the study using the multistage sampling method. Data were collected using a pretested and semistructured questionnaire through a face-to-face interview technique. The hemoglobin concentration was determined by using the HemoCue 301+ analyzer. Anthropometric data and stool examinations were collected from participants. Data were entered into EpiData version 4.6, transported, and analyzed by Statistical Package for Social Sciences version 26. Bivariable and multivariable logistic regression analyses were carried out. Adjusted odds ratios along with their 95% confidence interval were used, and a p value of ≤0.05 was used for declaring statistical significance.

Results

A total of 435 students with a mean age and standard deviation of 10.77 ± 2.21 years participated in the study. The magnitude of anemia was 78 (17.9%), with a 95% CI (14.3, 21.47). Of the participants, 63 (14.5%) were mild anemic and 15 (3.4%) were moderately anemic. Children whose mothers have no formal education (AOR = 3.94, 95% CI: 1.89, 8.21), underweight children (AOR = 3.83, 95% CI: 1.98, 7.40), and parasites in their stool (AOR = 3.72, 95% CI: 1.50, 9.20) were significantly associated with anemia in school-age children.

Conclusion

Anemia among school-age children was found to be a mild public health problem. Uneducated mothers, intestinal parasite infections, and underweight children were found to be determinants of anemia among school-age children. Health professionals should provide health education for mothers about child-feeding practices and the consumption of dietary sources of iron.

Application of machine learning methods for predicting childhood anaemia: Analysis of Ethiopian Demographic Health Survey of 2016

Childhood anaemia is a public health problem in Ethiopia. Machine learning (ML) is a growing in medicine field to predict diseases. Diagnosis of childhood anaemia is resource intensive. The aim of this study is to apply machine learning (ML) algorithm to predict childhood anaemia using socio-demographic, economic, and maternal and child related variables. The study used data from 2016 Ethiopian demographic health survey (EDHS). We used Python software version 3.11 to apply and test ML algorithms through logistic regression, Random Forest (RF), Decision Tree, and K-Nearest Neighbours (KNN). We evaluated the performance of each of the ML algorithms using discrimination and calibration parameters. The predictive performance of the algorithms was between 60% and 66%. The logistic regression model was the best predictive model of ML with accuracy (66%), sensitivity (82%), specificity (42%), and AUC (69%), followed by RF with accuracy (64%), sensitivity (79%), specificity (42%), and AUC (63%). The logistic regression and the RF models of ML showed poorest family, child age category between 6 and 23 months, uneducated mother, unemployed mother, and stunting as high importance predictors of childhood anaemia. Applying logistic regression and RF models of ML can detect combinations of predictors of childhood anaemia that can be used in primary health care professionals.

Impact of a Nutrition Education Intervention on Knowledge, Healthy Eating Index, and Biochemical Profile in a Rural Community in Peru

Background

Non-communicable diseases in adults and anemia in children represent a major global public health problem, with multiple causes including poor dietary quality. However, nutrition education interventions can empower individuals to make appropriate dietary changes.

Objective

To evaluate the impact of a nutritional education intervention on nutrition knowledge (NK), healthy eating index (HEI), and biochemical profile in families in the community in Peru.

Methods

A pre-experimental study was conducted in the community of Sinchicuy, located on the banks of the Amazon River, Iquitos, Peru. Nutrition education was provided over a 16-week period to a total of 61 heads of household (23 children under 5 years of age and 23 older adults). Fasting glucose and hemoglobin (Hb) concentration analyses were also carried out before and after the intervention.

Results

After the intervention, a significant improvement in the NK score was observed, increasing by 90% (p < 0.001). Additionally, the average HEI scores experienced a significant increase, rising by approximately 11.4% (p < 0.001). In children under 5 years of age, the Hb level showed a significant increase of 5.1% (p = 0.017). However, no statistically significant difference in glucose concentration was observed in older adults after the intervention.

Conclusion

The findings of this study indicated a positive impact on NK, HEI, and Hb in heads of households, older adults, and children under five in a rural community where there is limited access to basic services.

Spatial variation and clustering of anaemia prevalence in school-aged children in Western Kenya

Anaemia surveillance has overlooked school-aged children (SAC), hence information on this age group is scarce. This study examined the spatial variation of anaemia prevalence among SAC (5-14 years) in western Kenya, a region associated with high malaria infection rates. A total of 8051 SAC were examined from 82 schools across eight counties in Western Kenya in February 2022. Haemoglobin (Hb) concentrations were assessed at the school and village level and anaemia defined as Hb<11.5g/dl for age 5-11yrs and Hb <12.0g/dl for 12-14yrs after adjusting for altitude. Moran's I analysis was used to measure spatial autocorrelation, and local clusters of anaemia were mapped using spatial scan statistics and local indices of spatial association (LISA). The prevalence of anaemia among SAC was 27.8%. The spatial variation of anaemia was non-random, with Global Moran's I 0.2 (p-value < 0.002). Two significant anaemia cluster windows were identified: Cluster 1 (LLR = 38.9, RR = 1.4, prevalence = 32.0%) and cluster 2 (LLR = 23.6, RR = 1.6, prevalence = 45.5%) at schools and cluster 1 (LLR = 41.3, RR = 1.4, prevalence = 33.3%) and cluster 2 (LLR = 24.5, RR = 1.6, prevalence = 36.8%) at villages. Additionally, LISA analysis identified ten school catchments as anaemia hotspots corresponding geographically to SatScan clusters. Anaemia in the SAC is a public health problem in the Western region of Kenya with some localised areas presenting greater risk relative to others. Increasing coverage of interventions, geographically targeting the prevention of anaemia in the SAC, including malaria, is required to alleviate the burden among children attending school in Western Kenya.

Nutritional status and dietary habits among Quranic school's (Khalwa) students in Khartoum State, Sudan: a cross-sectional study

Khalawi are non-governmental, traditional educational boarding institutions, widely scattered in Sudan. Many Khalawi are resource-limited with deficient feeding and poor housing conditions, which could seriously affect the students' health. A cross-sectional study was conducted, involving all students of a Khalwa in Sharg Al-Neel Locality, Khartoum State. Demographic data were collected using a structured questionnaire with anthropometric measurements, along with laboratory and clinical assessments for anaemia. The dietary behaviours of students were also assessed using Global School-based Health Survey. Statistical analysis was conducted using SPSS software. A total of 131 students were included in this study. Their mean age was 13.7 ± 2.7 years, nearly half of them were from Darfur State in western Sudan, and the majority of them are primary school students. Upon assessment, many displayed serious symptoms and signs of anaemia namely: conjunctival pallor, palmar pallor, fatigability, lightheadedness and palpitation. Based on their haemoglobin testing, 95% were anemic and 24% had severe anaemia. Although 63.6% of them had normal body mass index (4.5%), 11.4%, were found 'severely thin' and 'thin', respectively. Regarding their dietary habits, 46.8% of them consumed milk or milk products less than one time per day, while 20.6% did not consume milk products in the past 30 days. Moreover, 39.4%, 44.9% and 39.4% did not consume any vegetables, fruits or fruit juice, respectively, in the past month. Students of Khalwa displayed poor dietary habits, which resulted in nutritional deficiencies. Programmes must be directed towards improving the quality of diet provided at these schools.

Assessment of anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia: Hospital-based cross-sectional study

Background

Anemia adversely affects children’s mental, physical and social development, particularly in Africa. In the early stages of life, it leads to severe negative consequences on the cognitive, growth and development of children.

Objective

This study aimed to assess anemia and associated risk factors among children under-five years old in the West Guji Zone, southern Ethiopia, from October to November 2020.

Method

A hospital-based quantitative cross-sectional study was conducted at Bule Hora General Hospital, Southern Ethiopia. A convenience sampling technique was used to include 375 under-five children enrolled in the study. The pretested structure questionnaire was used to collect socioeconomic and demographic characteristics of study individuals after taking appropriate written informed consent. Then, a venous blood sample was collected from each child and analyzed for hemoglobin determination using a Midray BC 3000 Plus machine. Binary logistic regression models were used to identify associated factors of anemia. A p-value ≤ 0.05 was considered statistically significant.

Result

The overall prevalence of anemia among under-five children was 13.2% (50) [95% CI = 5.2–21.2%]. Among anemic children under-five years of age, 12% (6) had mild anemia, 32% (16) had moderate anemia and 56% (28) had severe anemia. In this study, anemia was significantly associated with a history of intestinal protozoan infection [AOR = 2.55, 95% CI = 1.28–10.42], malaria infection [AOR = 5.01, 95% CI = 0.18–11.44] and soil-transmitted helminths infection [AOR = 6.39, 95% CI = 1.75–29.08].

Conclusion

The prevalence of anemia among under-five children was found to be low in the study area; however, the majority of anemic children were in a severe stage. It could be managed by preventing malaria infection, intestinal protozoa and soil-transmitted helminthic infection.

Anemia and Associated Factors Among Under Five Year Old Children Who Attended Bule Hora General Hospital in West Guji zone, Southern Ethiopia

Background

Anemia is a major global public health public health problem in the early stages of childhood, particularly in developing countries. In Africa, anemia causes higher morbidity and mortality among children less than five years old, especially in Ethiopia.

Objective

This study aimed to assess the prevalence of anemia and its associated factors among children under five years old attending Bule Hora General Hospital, West Guji Zone, southern Ethiopia.

Methods

A hospital-based quantitative cross-sectional study was conducted at Bule Hora General Hospital, Southern Ethiopia from October to November 2020. A convenience sampling technique was used to include 375 under five children enrolled in the study. The pretested structure questionnaire was used to collect socioeconomic and demographic characteristics of study individuals after taking appropriate written informed consent. Then, a venous blood sample was collected from each child and analyzed for hemoglobin determination using a Cell-DYN 1800 machine. Binary logistic regression models were used to identify associated factors of anemia. A P value ≤ 0.05 was considered statistically significant.

Results

The overall prevalence of anemia among under five children was 13.2% (50) [95% CI=5.2–21.2%] of them anemic children, 11.1% (1) had mild anemia, and 33.3% (3) had moderate anemia and 55.6% (5) had severe anemia. In this study, anemia was significantly associated with recent intestinal protozoan infection [AOR=2.13, 95% CI=1.35–9.270], malaria infection [AOR=5.42, 95% CI=0.307–11.034] and soil-transmitted helminths infection [AOR=6.09, 95% CI=2.047–27.54].

Conclusion

Anemia among under five children in this study was found to be a mild public health problem. It could be managed by preventing malaria infection, intestinal protozoa and soil-transmitted helminthic infection.

Hemoglobin Level and Risk of Anemia in Soil-Transmitted Helminths Infections among Children: A Systematic Review and Meta-analysis

Introduction. Soil Transmitted Helminthiasis (STH) is a Neglected Tropical Disease with almost 25% world population infected. Children were vulnerable to infection with morbidities affecting growth. STH infection alters children nutritional status which potentially causing anemia. Meta-analysis relating STH infections to hemoglobin (Hb) level and risk of anemia in children is limited. Aim. To compare hemoglobin levels and risk of anemia in children infected and uninfected with STH. Methods. Meta-analysis conducted from journals obtained from Pubmed, ScienceDirect, WileyLibrary, Cochrane, EBSCO, Proquest, DOAJ, and GoogleScholar from 2011-2021. Full text cross sectional studies on children with relevant topic is included, while unclear, inaccessible, or post interventional studies were excluded. Articles were analyzed in Review Manager 5.4 in mean difference (MD) and odds ratio (OR) with Confidence Interval (CI) of 95%. Result. Out of 25,683 articles in literature search, 29 were eligible for systematic review and meta-analysis. STH infection significantly decreases hemoglobin level (MD -0.2g/dL; p=0.02) and increases risk of anemia (OR 1.83; p<0.00001). Species analysis presented parallel result on Trichuris trichiura (MD -0.31g/dL; p=0.001 and OR 1.66; p=0.009), Hookworm (MD -0.56g/dL; p=0.02 and OR 3.3; p<0.00001), and multiple infection (MD -0.25g/dL; p=0.03 and OR 4.49; p=0.005). Ascaris lumbricoides didn’t show significance on hemoglobin level but comparable for risk of anemia (MD -0.16g/dL; p=0.17 and OR 1.57; p=0.001). Discussion. All STH infections exhibits lower hemoglobin level and higher risk of anemia caused by lower nutrition absorption and occult bleeding in gastrointestinal tract. Hookworm and multiple infections has the highest risk of anemia. Proportion of anemia may vary in studies and influenced by sociodemographic characteristics, but higher proportions occur in STH infected. Conclusion. Children infected with STH has lower hemoglobin level and in risk of anemia compared to uninfected children, hence further study is still needed to be conducted. Keywords: Anemia, Children, Hemoglobin, Infection, Soil Transmitted Helminths

Optimization of nutritional and functional qualities of local complementary foods of southern Ethiopia using a customized mixture design

Commercially produced complementary foods are inaccessible to rural households in Ethiopia. This study aimed to optimize the nutritional and functional properties of local complementary foods using flours of the following locally available crops: maize, red kidney bean, kocho, and pumpkin fruit. Ten formulations were generated using a customized mixture design. A five-point hedonic scale was used for the determination of organoleptic properties, and standard methods were used for the analyses of nutritional composition and functional properties. The flours were mixed in the range of 20%-30% for kocho, 10%-25% for pumpkin fruit, 10%-40% for red kidney bean, and 15%-30% for maize. Optimal nutritional and functional properties were obtained using 33.5% kocho, 22.5% maize, 17.5% pumpkin, and 26.5% red kidney bean. Optimal values for functional properties were 0.86 g/ml, 5.94 ml/g, 4.14 ml/g, 2.96 g/g, 5.0 ml/g, and 1225.3 cP for bulk density, water absorption capacity, oil absorption capacity, swelling capacity, swelling index, and viscosity, respectively. All formulations were within acceptable limits with scores ranging from 3.00 to 4.32 on a scale of 5. The inclusion of 25% pumpkin fruit flour and other ingredients between 20% and 30% increased the pro-vitamin A carotenoid and vitamin E contents of the composite flours. Aside from optimization, a higher concentration of limiting amino acids was achieved with 40% kidney beans and 15%-25% of the other ingredients. The mineral contents improved with increasing pumpkin, kidney bean, and kocho. To sum up, the nutrient quality, energy density, and functional quality of complementary foods can be optimized at a low cost using local ingredients.

Prevalence of Helicobacter pylori Infection among Anemic School-Age Children in Egypt: A Cross-Sectional Population-Based Study

Anemia and Helicobacter pylori infection in school-age children are important public health problems. The association between H. pylori infection and the development of anemia, especially iron deficiency anemia, has been previously studied and until now it is still a matter of argument. This study aimed to determine the prevalence of anemia and H. pylori infection among school-age children and to find the association between H. pylori infection and anemia in school-age children. We conducted this population-based cross-sectional study in six Egyptian primary schools over a 12-month-period, including 1,200 students from all grades who fulfilled the inclusion criteria. The study participants were subjected to the following: medical history, clinical examination, and laboratory investigations included complete blood count and H. pylori antigen in stool, and according to the level of hemoglobin (Hb), we divided the students into two groups; the anemic group with Hb level <11.5 g/dL and nonanemic group with Hb level ≥11.5 g/dL, and the serum ferritin levels were measured only for the anemic group as the best indicator for iron status. The overall prevalence of H. pylori infection was 25%. The overall prevalence of anemia was 13.25%, of which hypochromic microcytic anemia represented 87.4% of the anemic group, and the mean ferritin level in the anemic group was 18.56 ± 9.96 ng/mL. The prevalence of anemia among H. pylori-infected patients (62.3%) was significantly (p < 0.001) higher than in noninfected children (37.7%). In the anemic group, the mean ferritin level in H. pylori-infected children was significantly lower than the mean level in the noninfected children (p <0.001). Furthermore, the anemic group had a significantly higher incidence of H. pylori infection and a lower age (p <0.001) in comparison with the nonanemic group. The dominant type of anemia in H. pylori-infected children was the microcytic hypochromic anemia, with a significantly higher incidence in comparison to other types of anemia (p <0.001). The findings of this study demonstrate a significant association between H. pylori infection and anemia in school-aged children, especially iron deficiency anemia, as the incidence of H. pylori infection was greater in anemic children than in non-anemic children.

Prevalence and associated risk factors of asymptomatic malaria and anaemia among school-aged children in Dara Mallo and Uba Debretsehay districts: results from baseline cluster randomized trial

Background

Despite the growing evidence that malaria and anaemia are two interlinked health problems of school-aged children (SAC) in developing countries, there is scarce information about malaria among SAC in Ethiopia. Moreover, anaemia-related studies were more concentrated in easily accessible areas. This study aimed to assess the prevalence of malaria and anaemia and corresponding risk factors among SAC in Dara Mallo and Uba Debretshay districts, in hard to reach areas, so as to inform appropriate integrated interventions for both diseases.

Methods

This study was part of baseline data collected for a cluster-randomized trial registered in Pan African Clinical Trials Registry (PACTR202001837195738). Data were collected from 2167 SAC and their households through face-to-face interview; malaria was diagnosed by using rapid diagnostic test (RDT); haemoglobin concentration was determined using hemoCue hb 301 and adjusted for altitude to determine anaemic status; helminth infections were determined by using kato-katz, and anthropometric measurements were made to determine nutritional status of children. Generalized mixed effects logistic regression model was used to assess the association between predictor variables and malaria and anaemia using school as a random variable.

Results

The overall prevalence of malaria was 1.62% (95% CI 1.15–2.27%) (35/2167). Of the 35 children positive for malaria, 20 (57.14%), 3 (8.57%) and 12 (34.29%) were due to Plasmodium falciparum, Plasmodium vivax and mixed infections of P. falciparum and P. vivax, respectively. Malaria was significantly lower among children from literate household head (Adjusted OR  =  0.38; 95% CI 0.15–0.95) and residence house located at an altitude range above 1100 masl (AOR  =  0.40; 95% CI 0.17–0.94). The prevalence of anaemia was 22.00% (95% CI 20.3–23.8%) (477/2167) and was significantly reduced by eating legumes, nuts or seed group of food in their 24-h dietary diversity recall (AOR  =  0.64; 95% CI 0.41–0.99).

Conclusions

The prevalence of malaria was low and unevenly distributed per school while the overall prevalence of anaemia was moderate. It is important to implement integrated interventions targeting both malaria and anaemia, with special emphasis given to children from illiterate households and living at an altitude below 1100 masl. The micronutrient content of locally grown legumes should be further investigated to recommend specific interventions to overcome anaemia.

The prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Thrombocytopenia and leucopenia are frequently encountered hematological disorders among people living with HIV/AIDS. This systematic review and meta-analysis were aimed to indicate the national prevalence of thrombocytopenia and leucopenia among HIV/AIDS patients.

METHODS

This systematic review and meta-analysis was conducted following the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. A systematic search was conducted from February 01, 2021 to April 02, 2021 using electronic databases Google Scholar, PubMed, Web of Sciences, Google, EMBASE, SCOPUS and ResearchGate. The quality of the included studies was assessed using Newcastle-Ottawa Quality Assessment Scale (NOS) adapted for cross-sectional studies. Data analysis was done using STATA version 14 using metan commands. Random effect meta-analysis was used to estimate the pooled prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS in Ethiopia.

RESULT

Of the 349 initially searched articles, 90 were assessed for eligibility and only 13 articles published from 2014 to 2020 were included in the final meta-analysis. A total of 3854 participants were involved in the included studies. The pooled prevalence of thrombocytopenia was 9.69% (95%CI; 7.40-11.97%). Significant heterogeneity was observed with I2 value of 84.7%. Thrombocytopenia was 11.91% and 5.95% prevalent among HAART naive and HAART exposed HIV/AIDS patients, respectively. The pooled prevalence of leucopenia among HIV/AIDS patients was 17.31% (95%CI: 12.37-22.25%).

CONCLUSION

This study showed a high prevalence of thrombocytopenia and leucopenia among people living with HIV/AIDS, indicating the necessity of regular screening of HIV seropositive patients for different hematological parameters and providing treatment.

Magnitude of anemia and associated factors among children aged 6-59 months at Debre Markos referral hospital, Northwest Ethiopia: a hospital-based cross-sectional study

Background

Anemia, the most common micro-nutrient deficiency disorder, is the world’s second leading cause of morbidity and morbidity, affecting 24.8% of the population, of which 47.4% are under-five children. The prevalence of anemia ranges from 44 to 56% in Ethiopia. Although its magnitude has shown decreases across regions; it continues to be a significant public health problem, particularly in developing countries including Ethiopia. Despite this evidence, the magnitude and associated factors of anemia was not systematically explored and there is a limited information or limited evidences in the study area. Hence, the aim of this study was to assess the magnitude and associated factors of anemia among children aged 6–59 months attending at Debre Markos Referral Hospital, Northwest Ethiopia.

Methods

A hospital-based cross-sectional study was conducted at Debre Markos referral hospital Northwest Ethiopia from September 30 to December 30, 2019. Data on socio-demographic and socio-economic factors, health and nutritional features of children and their mothers were obtained using pre-tested structured questionnaires in a face-to-face interview with child care providers. Blood samples and stool examination for intestinal parasites were performed. Hemoglobin level was analyzed using the HemoCue device (HemoCueHb 301). The collected data were coded, cleared and entered into Epi-Data version 3.1, and analyzed using Stata version 14 software. To identify candidates and predictor variables, bivariate and multivariate logistic regressions were applied respectively. The significance level was determined at a confidence interval of 95% at p-value < 0.05.

Results

Of the total of 341 participants planned to be participated, about 310 mother-child pairs participated in the study, giving a response rate of 91%; and data were collected from children as well as their parents or guardians.

In this study, the magnitude of anemia was 11.9% (95% CI, 8.5, 16.2%). Poor dietary diversity (AOR = 2.3; 95% CI: 1.12, 5.14), food-insecure households (AOR = 3.24; 95% CI: 1.85, 4.52), complementary feeding initiation time (AOR = 3.20; 95% CI:1.23, 6.61), intestinal parasites infection (AOR = 3.20; 95% CI:1.23, 6.61) and family income (AOR = 2.87; 95% CI:1.57, 5.0) were found to be factors significantly associated with anemia.

Conclusion

Overall, anemia is considered a public health problem among children aged 6–59 months attending at Debre Markos referral hospital, based on the cut-off point of the World Health Organization. Poor dietary diversity, complementary feeding initiation time, household food insecurity, intestinal parasite infection and family income were significantly associated with childhood anemia. Thus, it needs for proven interventions in public health such as food diversification, anti-helmintic drug provision and household food security. In addition, educating women about nutrition and diet diversification, as well as involving them in alternative sources of income-generating activity, can be vital in the study area.

Concurrent anemia and stunting among schoolchildren in Wonago district in southern Ethiopia: a cross-sectional multilevel analysis

BACKGROUND

Even if many schoolchildren in Ethiopia are anemic and stunted, few have studied the co-existence of anemia and stunting among schoolchildren in Ethiopia. In addition, multilevel analysis to explore the variation in prevalence of concurrent anemia and stunting (CAS) across schools and classes is rarely applied. Thus, we aimed to assess the prevalence and risk factors of CAS at the individual, household, and school level among schoolchildren in southern Ethiopia.

METHODS

We recruited 864 students aged 7-14 years from the Wonago district in southern Ethiopia using a three-stage random sampling, assigning four schools to level one, 24 classes to level two. We then randomly selected 36 children from each class, and recorded their weight, height, haemoglobin, intestinal helminthic infections, hygienic practices, dietary practices, household food insecurity, and socio-demographic information. A multivariate, multilevel logistic regression model was applied to detect potential risk factors for CAS.

RESULTS

The prevalence of CAS was 10.5% (85/810) among schoolchildren, which increased with age in years (adjusted odds ratio [aOR] 1.39 [95% confidence interval 1.13, 1.71, P = 0.002]) and among children who always did not wash their hands with soap after use of latrine (aOR 4.30 [1.21, 15.3, P = 0.02]). Children who walked barefoot (aOR 10.4 [2.77, 39.1, P = 0.001]), were infected with Trichuris trichiura (aOR 1.74 [1.05, 2.88, P = 0.03]), or had head lice infestation (aOR 1.71 [1.01, 2.92, P = 0.04]) had higher CAS prevalence. Prevalence rates of CAS were low in those using treated drinking water (aOR 0.32 [95% CI 0.11, 0.97, P = 0.04]). Most of the risk factors for CAS were identified at the individual level. The clustering effect measured by the intra-cluster correlation coefficient was 6.8% at school level and 19% at class.

CONCLUSION

CAS prevalence is a moderate public health problem among schoolchildren in southern Ethiopia and varies across classes and schools. After controlling for clustering effects at the school and class levels, we found an association between CAS and increasing age, not always washing hands with soap after using latrine, walking barefoot, and T. trichiura infection. Using treated water for drinking was found to have a protective effect against CAS. Thus, educating children on personal hygiene and provision of safe drinking water could reduce the CAS burden in schoolchildren in rural areas of southern Ethiopia.

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

Background

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

Methods

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

Results

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

Conclusions

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

Magnitude and associated factors of peripheral cytopenia among HIV-infected children attending at University of Gondar Specialized Referral Hospital, Northwest Ethiopia

BACKGROUND

Isolated or multi lineage cytopenia are the most common clinicopathological features and independently associated with increased risk of disease progression and death among human immunodeficiency virus infected children. In the study area, there is scarcity of data about the magnitude of various cytopenia.

OBJECTIVES

Aimed to determine the magnitude and associated factors of peripheral cytopenia among HIV infected children at the University of Gondar Specialized Referral Hospital ART clinic, Northwest Ethiopia.

METHODS

Institutional based cross-sectional study was conducted on 255 HIV infected children from January- April 2020. None probable convenient sampling technique was used to select the study participant. Socio demographic data were collected by pre tested structured questionnaire via face-to-face interview and their medical data were obtained from their follow-up medical records. Moreover, blood specimens were collected and examined for complete blood count, viral load and blood film, whereas stool specimens were collected and examined for intestinal parasites. Bi-variable and multi-variable logistic regression models were fitted to identify associated factors of cytopenia. P-Value <0.05 was considered as statistically significant.

RESULT

The overall magnitude of peripheral cytopenia was 38.9%. Anemia, leukopenia, lymphopenia, thrombocytopenia and bi-cytopenia were 21.2%, 12.2%, 11%, 1.6% and 3.9% respectively. Being in the age group of 2-10 years (AOR = 5.38, 95%CI 2.33-12.46), AZT based regimen (AOR = 5.44, 95%CI: 2.24-13.21), no eating green vegetables (AOR = 2.49, 95% CI: 1.26-4.92) and having plasma viral load >1000 copies /ml (AOR = 5.38, 95%CI: 2.22-13.03) showed significant association with anemia.

CONCLUSION

Anemia was the predominant peripheral cytopenia among HIV infected children in this study. It was strongly associated with AZT based drug type, age below 10 years and high viral load. Critical stress should be given for early investigation and management of cytopenia in addition to the use of alternative drug which leads to higher viral suppression and lower risk of toxicity issue.

Patterns of Dietary Iron Intake, Iron Status, and Predictors of Haemoglobin Levels among Early Adolescents in a Rural Ghanaian District

Introduction

Early adolescents are vulnerable to anaemia due to lean body mass and menarche. The study assessed patterns of dietary iron intake, iron status, and predictors of anaemia among early adolescents.

Method

One hundred and thirty-seven early adolescents were randomly selected in a rural district in Ghana. Multiple-pass 24-hour recall, iron food frequency questionnaire consisting of 27 food items, and semistructured questionnaire were administered. Variables include sociodemographics, dietary factors, and laboratory investigation including haemoglobin, ferritin, and C-reactive protein examination. Statistical Package for the Social Sciences (SPSS) software was used to calculate odds ratio and perform Mann–Whitney U test, chi-square (X²) test, exploratory factor analysis, and partial correlation (r) tests.

Results

Participants had mean age of 11.5 years. Three iron dietary patterns explaining 28.7% of the total variance were identified: iron dietary pattern 1 (11%) composed of iron-rich, iron-enhancing, and iron-inhibiting foods; iron dietary pattern 2 (9.9%) comprised of iron-rich, iron-enhancing, and non-iron-inhibiting foods; and iron dietary pattern 3 (7.1%) consisting of stinging nettle, iron-inhibiting foods, non-iron-enhancing foods, non-cocoyam leaves, and non-turkey berries. Meal skipping (X² = 5.7, p < 0.05), times of eating a day (X² = 12.6, p < 0.05), and guardian educational status (X² = 6.7, p < 0.05) significantly affected dietary iron intake. Anaemia was associated with meal skipping (β = 0.367, p > 0.05), snacking (β = 0.484, p > 0.05), and junior high school (JHS) education (β = 0.544, p > 0.05). Partial correlation showed statistically significant relationship between iron dietary pattern 1 and dietary iron (r = −0.234, p < 0.01), iron dietary pattern 2 and dietary iron (r = -0.198, p < 0.05), iron dietary pattern 2 and vitamin C (r = -0.201, p < 0.05), and haemoglobin and ferritin (r = −0.178, p < 0.05).

Conclusion

Meal skipping, guardian educational status, and number of times of eating a day were significantly associated with dietary iron intake. Meal skipping, snacking, and adolescents with JHS education were positively associated with anaemia.

A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia

Background

Anemia is a wide-spread public health problem characterized by a decrease in hemoglobin concentration and/ or red blood cell volume below an established cut-off value. In developing countries including Ethiopia, about half of children are estimated to be anemic. Therefore, the purpose of this study was to determine the pooled prevalence of anemia and its predictor factors among children in Ethiopia.

Method

The studies were identified through explicit and exhaustive search of reputable databases (PubMed, Google scholar, Science Direct, EMBASE, Cochrane library, and the hand search of reference lists of previous prevalence studies to retrieve more related articles. Thirty-nine studies were selected based on a comprehensive list of inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA 14 statistical software. To assess heterogeneity, the Cochrane Q test statistic and I2 tests were used. In our analysis, considerable heterogeneity was observed. Therefore, a random effect meta-analysis model was used to estimate the pooled prevalence of anemia. Moreover, the predictor factors of anemia were examined.

Results

The forest plot of 39 included studies revealed that the overall pooled prevalence of anemia among children in Ethiopia was 34.4% (95% CI: 29.1, 39.7%). Sub-group analysis showed that the highest anemia prevalence was observed in Somali Region with a prevalence of 49.4 % (95% CI: 20.9, 77.8). Also, anemia in children was found to be highest in the age group of less than five years (45.2, 95% CI: 39.6,50.8). Low literacy of families: 1.3 (95% CI: 1.1, 1.7), low family socioeconomic status: 1.9 (95% CI: 1.1,3.01.3), having housewife mothers or with no job: 1.5 (95% CI: 1.4, 1.9) and rural residence: 3.3 (95% CI: 1.7,6.1) were found to be predictors of anemia among children.

Conclusion

In this study, one in three children were anemic in Ethiopia. It is a moderate public health problem in children in this study. Low literacy, low socioeconomic status as well as rural residence of the families and helminthic infection of the children were found to be predictors of anemia in the children. Community and school-based interventions should be strengthened to improve the problem.

Assessment of Prevalence and Risk Factors for Intestinal Parasitosis, Malnutrition, and Anemia among School Children in Ghindae Area, Eritrea

Background

Research studies on determination of risk factors for intestinal parasitic infections and related malnutrition and anemia in various tropical areas are necessary for appropriate preventive resource allocation and cost effective control. This study is aimed at evaluating the prevalence and risk factors of intestinal parasitosis, malnutrition, and anemia amongst elementary and junior school students in Ghindae area, Eritrea.

Method

A cross-sectional study was conducted in 6 schools around Ghindae from February to April 2018. 460 children were selected randomly for analysis and consent was taken from guardians. The pertinent sociodemographic data was collected using a pretested questionnaire, and anthropometric measurements were carried out to determine the proportion of students with malnutrition, stunting, and thinness. Fecal samples were examined by formal-ether concentration technique, and blood specimen was collected and analyzed for the assessment of hemoglobin using Hemocue analyzers. The association between predictors and outcome variables were measured with a stepwise logistic regression model.

Result

The overall prevalence of intestinal parasitosis was 45.3%. Protozoan infections (38.2%) were more prevalent than soil-transmitted helminthic infections (10.4%). The presence of different intestinal parasitic infections had statistically significant association with the residence area, hand washing habits, source of drinking water, and type of latrine used. The prevalence of malnutrition was 36.9% with 18.5% stunting and 21.2% thinness. Students of rural areas had 2.03 times more odds of having malnutrition. The current prevalence of anemia was 12.4%, out of which 7.6% had mild anemia while 4.4% of them had moderate anemia and 0.4% were severely anemic.

Conclusion

The prevalence of parasitic infection among school-age children in Ghindae area was high. Unsafe drinking water sources from streams and springs were among the core problems for increased prevalence along with decreased awareness on personal hygienic and sanitation practices. Undernutrition was widely prevalent among students in Ghindae area. Height for age and BMI for age scores of all participants were found to be below the WHO growth standards. Malnutrition was in higher prevalence in rural areas outside Ghindae, which is attributed to two times higher odds than their counterparts. The magnitude of anemia found in this study is considered a mild public health problem.

Social Determinants of Health and the Role of Routine Pediatric Care in a Medically Complex Toddler

CASE

Late on a Friday afternoon, a new family presents to your practice for urgent care. They come with their youngest child Mai, a 2-year-old girl, who, although born in the United States at 36 weeks gestation, has resided in Laos with her grandparents for the past 16 months. Your triage nurse tells you that she has a fever and was found to have profound anemia while at the WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) office earlier today.On walking into the room, you describe Mai as "listless" and "sickly." Her vitals were notable for fever (102°F), tachycardia (140 beats per minute), and tachypnea (35 breaths per minute). On physical examination, she was grunting with a systolic ejection murmur and without hepatosplenomegaly. Laboratory test results revealed hemoglobin of 2.2 g/dL, hematocrit of 12%, mean corpuscular volume of 50 fL, red cell distribution width of 27%, reticulocyte count of 3%, ferritin of <2 ng/mL, iron of 15 μg/dL, total iron binding count of 420 μg/dL, white blood cell count of 13.5 K/μL, and platelets of 605 K/μL. Her evaluation was consistent with severe iron deficiency anemia (IDA), which was further supported by reported restrictive diet and excessive cow milk intake of 35 ounces daily. She was admitted to the Pediatric Intensive Care Unit in high-output cardiac failure and was slowly transfused with 15 mL/kg of packed red blood cells over 2 days with careful monitoring. Once stabilized, she was transferred to the inpatient floor for further nutritional evaluation and supplementation. Additional workup, including hemoglobin electrophoresis, fecal occult blood test, celiac studies, and stool parasite testing were normal. The clinical picture was consistent with a viral infection in the setting of profound IDA and malnutrition.Although her clinical status had improved, she remained inpatient for nutritional optimization. Her height was at the 54th percentile (z-score: 0.11), weight was at the first percentile (z-score: -2.25), and body mass index was below the first percentile (z-score: -3.18), diagnostic of severe protein-calorie malnutrition. She was evaluated by an interdisciplinary growth and nutrition team, received multivitamin and mineral supplements, and was monitored for refeeding syndrome. She was noted to be "difficult to engage," "resistant to new faces," and made little progress on expanding her dietary choices. Concerns about a possible diagnosis of autism spectrum disorder were raised by her treating team. What would you do next?

REFERENCE

1. Bouma S. Diagnosing pediatric malnutrition: paradigm shifts of etiology-related definitions and appraisal of the indicators. Nutr Clin Pract. 2017;32:52-67.

High burden of undernutrition among primary school-aged children and its determinant factors in Ethiopia; a systematic review and meta-analysis

BACKGROUND

Undernutrition remains a major public health concern affecting both children and adolescents in Ethiopia. However, little attention has been given to the undernutrition of primary school-aged children, with their exclusion within national surveys. Therefore, this systematic review and meta-analysis was conducted to determine pooled estimate and determinant factors of undernutrition among primary school-aged children (6 to 15 years of age) in Ethiopia.

METHOD

We systematically retrieved available articles on the prevalence of undernutrition in primary school-aged children in Ethiopia by using a number of computerized databases, including PubMed, Scopus, Cochrane Library, Google Scholar, and Science Direct between September 1 and November 25, 2019. Two authors independently extracted relevant data using a standardized data extraction form. Heterogeneity among included studies was assessed with the Cochrane Q test statistics and Higgins I2 tests. The pooled estimates and determinant factors of school-aged undernutrition were assessed with random-effects model using Stata/se Version 14.

RESULT

We have retrieved 30 eligible articles with pooled sample size of 16,642 primary school- aged children to determine the prevalence of undernutrition in Ethiopia. Hence, the pooled prevalence of stunting, underweight, and wasting were found to be 21.3% (95% CI: 17.0, 25.5), 18.2% (95% CI: 14.4, 22.0) and 17.7% (95% CI, 13.5, 21.8) respectively. Heterogeneity was assessed by doing subgroup analysis for study province/region. Thus, the highest prevalence of stunting was 27.6% (95% CI, 20.7, 34.5) and underweight 22.7% (95% CI, 19.2, 26.3) in Amhara Region while, in the instance of wasting, it was 19.3%(95% CI: 5.1, 33.4) in Southern Nations, Nationalities and People's Region. Maternal educational status (OR = 1.91, 95% CI: 1.33, 2.73), age of school-aged child (OR = 0.56, 95% CI: 0.44, 0.72) and sex of school-aged child (OR = 0.73, 95% CI: 0.62, 0.85) were found to be significantly associated with stunting. Maternal educational status (OR = 0.6, 95% CI: 0.36, 0.9) and age of school-aged child (OR = 2.74, 95% CI: 1.81, 4.14) were associated with thinness/wasting. Parasitic infection (OR = 2.02, 95% CI: 1.10, 3.73) were associated with underweight of school age children.

CONCLUSION

The prevalence of stunting and underweight among primary school-aged children are moderately high while acute undernutrition (wasting) is more critical than under-five national average as reported in the 2016 Ethiopian Demography and Health Survey. Therefore, this finding warrants the need to design a school-aged children nutrition survey and expand school feeding programs to improve the nutritional status of primary school-aged children in the country. In addition, emphasis should be given to female school-aged children in the early school years, creating awareness for those mothers who lack formal education, and preventing and treating/deworming parasitic infection. Moreover, researchers must conduct research in province/regions which have not yet studied school aged children's nutritional status to date.

Low educational level of head of household, as a proxy for poverty, is associated with severe anaemia among children with sickle cell disease living in a low-resource setting: evidence from the SPRING trial

Severe anaemia, defined as haemoglobin level < 6·0 g/dl, is an independent risk factor for death in individuals with sickle cell disease living in resource-limited settings. We conducted a cross-sectional study of 941 children with sickle cell anaemia, who had been defined as phenotype HbSS or HbSβ⁰ thalassaemia, aged five to 12 years, and were screened for enrollment into a large primary stroke prevention trial in Nigeria (SPRING; NCT02560935). The main aim of the study was to determine the prevalence and risk factors for severe anaemia. We found severe anaemia to be present in 3·9% (37 of 941) of the SPRING study participants. Severe anaemia was significantly associated with the lower educational level of the head of the household (P = 0·003), as a proxy for poverty, and a greater number of children per room in the household (P = 0·004). Body mass index was not associated with severe anaemia. The etiology of severe anaemia in children living with sickle cell anaemia in Nigeria is likely to be multifactorial with an interplay between an individual's disease severity and other socio-economic factors related to poverty.

Under nutrition, maternal anemia and household food insecurity are risk factors of anemia among preschool aged children in Menz Gera Midir district, Eastern Amhara, Ethiopia: a community based cross-sectional study

BACKGROUND

In Ethiopian, the prevalence of anemia among preschool aged children widely varied across regions. Since anemia adversely affects the cognitive and physical development of the children, it is important to determine its burden for implementing appropriate measurements. Therefore, this study was aimed at determining the anemia prevalence and associated factors among preschool aged children.

METHOD

A community based cross-sectional study was conducted on a total of 432 preschool children in Menz Gera Midir district from January to May, 2017. A multi stage sampling procedure was applied to select the target groups. Hemocue analyzer for Haemoglobin determination; anthropometric measurements for assessment nutritional status, structured questionnaires for socio-demographic and economic variables were used for data collection. The morphological appearance of red blood cell was assessed microscopically to determine type of anemia. Descriptive statistics were employed to summarize the data and binary logistic regression was used for inferential statistics. A p value less than 0.05 was considered as statistically significant.

RESULT

The overall prevalence of anemia was 123 (28.5%); of which 38 (30.9%) and 85 (69.1%) were moderate and mild, respectively. Morphologically about 50.4, 37.4 and 12.2% were microcytic hypochromic, normocytic normochromic and macrocytic anemias, respectively. Child age 6-11 months (COR: 5.67, 95% CI: 2.2, 14.86), child age 12-23 months (COR: 5.8, 95% CI: 2.3, 14.7), wasting (COR: 3.5, 95% CI: 1.2, 9.8), stunting (COR: 3.8, 95% CI: 1.92, 7.77), underweight (COR: 2.12, 95% CI: 1.07, 4.38), MUAC measurement below 13 cm (COR: 5.6, 95% CI: 2.83, 11.15), household headed by female (COR: 3.24, 95% CI: 1.1, 9.63), maternal anemia (COR: 4, 95% CI: 2.2, 7.23) and household food insecurity (COR: 2.12, 95% CI: 1.09, 4.12) were significantly associated with anemia.

CONCLUSION

The prevalence of anemia among the children was found to be high and associated with child age group, child nutritional status, house hold headed by female, maternal anemia and household food insecurity. Further studies on nutritional anemia, community based nutritional education, iron supplementation to children at risk should be promoted.

Prevalence of Anemia and Associated Factors Among Hospitalized Children Attending the University of Gondar Hospital, Northwest Ethiopia

BACKGROUND

Anemia in children continues to be a major public health challenge in most developing countries, particularly in Africa.In the early stages of life, it leads to severe negative consequences on the cognitive functions as well as growth and development of the children, which may persist even after treatment.

OBJECTIVE

The main aim of this study was to assess the prevalence and associated factors of anemia among hospitalized children attending at university of Gondar comprehensive and specialized referral hospital, Northwest Ethiopia.

METHOD

A cross sectional study was conducted on 384 hospitalized children, between February and June, 2018. Data of socio demographic characteristics and clinical conditions of the study individuals were collected using questionnaire after taking appropriate written informed consent and assent. Then 3 mL of blood was collected for complete blood count analysis and also stool examination was done for intestinal parasites. Data were coded, cleared and entered into SPSS version 20 for analysis.Bivariate and multivariate logistic regression models were used to identify associated factors of anemia. P-value ≤ 0.05 was considered as statistically significant.

RESULT

The overall magnitude of anemia among hospitalized children was 58.6%; of them 56.4% were males. Of anemic children, 28% had mild, 51.1% moderate and 20.9% severe anemia. The magnitude of anemia among children aged 6-59 months, 5-11 years and 12-14 years were 54.1%, 58.9% and 67.5%, respectively.In this study, anemia was positively associated with parasitic infection (AOR= 2.541; 95% CI: 1.363, 4.737), not eating meat and animal products (AOR = 1.615; 95% CI: 1.014, 2.574).

CONCLUSION

Anemia among hospitalized children in this study was found to be a severe public health problem. It was strongly associated with intestinal parasitic infection and not eating meat and animal products.Focused polices and strategies should be designed to reduce anemia among hospitalized children in Ethiopia.

Male and undernourished children were at high risk of anemia in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Anemia is one of the global public health problems affecting more than one-third of the world population. It has been strongly associated with limited psychomotor development; and poor growth and performance in cognitive, social, and emotional function in children. Despite published data revealed that anemia is a public health problem among children in Ethiopia, there is no a pooled national estimate on the prevalence and associated risk factors of anemia.

METHODS

Published articles until December 31, 2017, were searched using comprehensive search strings through PubMed/Medline, EMBASE, SCOPUS, HINARI, Web of Science, Google Scholar and Google. Reference probing of published articles and hand searching were employed for grey literature. Two groups of review authors independently appraised the studies for eligibility and extracted the data. The quality of articles was assessed using Joana Brigg's institute critical appraisal checklist for prevalence and analytical studies. The pooled estimates were determined using random effect model. Heterogeneity between the included studies was assessed using the I2 statistics. Subgroup analysis was employed in the evidence of heterogeneity. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression test statistic.

RESULTS

Of the total 871 articles retrieved, 34 articles which involved 61,748 children were eligible for meta-analysis. The overall pooled prevalence of anemia using random effect model was 31.14% (95% CI: 24.62, 37.66%). In subgroup analysis, the pooled prevalence of anemia was higher among preschool-aged children (44.17%; 95% CI: 37.19, 51.15%) than school-aged children (22.19%; 95% CI: 17.54, 26.83%). Furthermore, the odds of anemia was higher among children who were male (OR = 1.11; 95% CI: 1.03, 1.19), stunted (OR = 1.95; 95% CI: 1.52, 2.51), and wasted (OR = 2.05; 95% CI: 1.36, 3.10).

CONCLUSION

The pooled prevalence of anemia among children was high, indicating that it had been continuing to be a public health problem. Therefore, there is a need to design a comprehensive prevention and control strategies to reduce its burden.

Prevalence of anemia and its associated factors among children in Ethiopia: a protocol for systematic review and meta-analysis

BACKGROUND

Anemia is one of the global public health problems that affect more than one third of the world population. It has been strongly associated with poor growth and development, limited psychomotor development, and poor long-term performance in cognitive, social, and emotional functioning in children. There is not a single national figure about childhood anemia in Ethiopia. There is also inconclusive evidence about factors associated with anemia. Moreover, the present meta-analysis will generate concrete evidence in which the result may urge policy makers and program managers to design appropriate intervention to control childhood anemia. Thus, the aim of this review is to estimate the pooled prevalence and to identify associated factors of anemia among children in Ethiopia.

METHOD

Published relevant cross-sectional studies will be searched using comprehensive search strings through PubMed/Medline, SCOPUS, HINARI, EMBASE, Web of Science databases. In addition, Google Scholar and Google will be searched for grey literature.Reference lists and communication with content experts will be used to get additional relevant studies. Two groups of review authors will independently appraise the studies for scientific quality and extract the data using the Joanna Briggs Institute (JBI) tools. The pooled estimate will be determined using random effect model. Heterogeneity between the studies will be assessed using the I2 statistics. Sensitivity and subgroup analysis will be employed in the case of heterogeneity. Publication bias will be assessed by visual inspection of the funnel plot, and using Egger's and Begg's statistical tests.

DISCUSSION

Childhood anemia is known to have negative consequences on mental, physical and social development of children. The burden and its associated factors are greatly varied as to the social, economic, and geographical differences of the target population.Therefore, the proposed systematic review will generate evidence about the pooled prevalence of anemia and its associated factors among children in Ethiopia.

PROTOCOL REGISTRATION

The protocol was registered at PROSPERO International Prospective Register of Systematic Reviews.(Registration number: CRD42018088223).