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Determinants of anemia severity levels among children aged 6-59 months in Ethiopia: Multilevel Bayesian statistical

Tesfa Sewunet Alamneh¹, Alemakef Wagnew Melesse², Kassahun Alemu Gelaye²

¹Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. tesfasewunet23@gmail.com.

Scientific Reports

|March 14, 2023

Insights

Anemia is a severe public health issue in Ethiopian children. Factors like child age, sex, maternal education, stunting, and maternal anemia influence anemia severity, requiring targeted interventions.

Area of Science:

Public Health
Pediatrics
Nutritional Epidemiology

Background:

Anemia is a critical global health concern, disproportionately affecting children and pregnant women.
Childhood anemia negatively impacts growth, cognitive development, school performance, and increases mortality risk.
Existing anemia control strategies often overlook the ordered nature of anemia severity.

Purpose of the Study:

To identify key factors contributing to anemia severity levels in Ethiopian children aged 6-59 months.
To apply an ordinal analysis using a Bayesian hierarchical statistical approach for a nuanced understanding of anemia determinants.

Main Methods:

Secondary data analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS).
Inclusion of 8483 weighted children.
Utilized an ordinal logistic regression model within a hierarchical Bayesian framework to account for data structure and ordered outcomes.

Main Results:

Moderate anemia was the most prevalent type (29.4%).
Factors associated with lower risk of higher anemia severity included female sex, higher wealth quintiles, primary maternal education, and antenatal care visits.
Factors associated with higher risk of higher anemia severity included moderate maternal anemia and child stunting.
Child age, multiple births, deworming status, birth weight, and history of fever-like illness also significantly influenced specific anemia severity levels.

Conclusions:

Childhood anemia remains a severe public health problem in Ethiopia.
Key determinants of anemia severity include child age, sex, maternal education, child stunting, fever history, multiple births, birth weight, deworming, and maternal anemia.
Interventions must address these identified factors to effectively control and prevent childhood anemia.

Read full analysis

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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