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Updated: Jun 27, 2025
Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Published on: January 19, 2024
Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance
Beminate Lemma Seifu1, Getayeneh Antehunegn Tesema2, Tsion Tebeje3
1Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia beminetlemma1915@gmail.com.
Insights
Only 34.9% of children under five in Sub-Saharan Africa have normal hemoglobin levels, highlighting anemia as a major public health issue. Factors like maternal education and child health influence hemoglobin concentration.
Area of Science:
- Pediatrics
- Public Health
- Hematology
Background:
- Low hemoglobin levels in children are associated with developmental delays and other adverse outcomes.
- Globally, over half of children under five have low hemoglobin concentrations.
- Limited research exists on normal hemoglobin concentration determinants in Sub-Saharan African (SSA) children.
Purpose of the Study:
- To assess the determinants of normal hemoglobin concentration in children under five in Sub-Saharan Africa.
Main Methods:
- Cross-sectional study utilizing a positive deviance approach across 33 SSA countries.
- A multilevel Poisson regression model with robust variance was applied to 129,408 children aged 6-59 months.
- Statistical significance was determined using adjusted prevalence ratios and 95% confidence intervals.
Main Results:
- The pooled prevalence of normal hemoglobin concentration was 34.9% in SSA children under five.
- Factors associated with increased odds of normal hemoglobin included high maternal education, wealthier households, female sex, frequent antenatal care, non-anemic mothers, anthelmintic drug use, and good nutritional status.
- Factors associated with lower odds of normal hemoglobin included higher birth order, fever, diarrhea, and rural residence.
Conclusions:
- Normal hemoglobin levels are present in only 34.9% of SSA children under five, indicating anemia is a significant public health concern.
- Interventions should focus on improving maternal education, deworming, and managing maternal anemia, febrile illnesses, and diarrheal diseases in children.
- Addressing these determinants is crucial for improving child hemoglobin levels and overall health in SSA.
Background:
Low haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin concentration. However, there is limited research on the prevalence and determinants of normal haemoglobin concentration among under-five children in sub-Saharan Africa.
Objective:
To assess determinants of normal haemoglobin concentration among under-five children in SSA.
Design:
Cross-sectional study design using a positive deviance approach SETTING: 33 SSA countries.
Participants:
129 408 children aged 6-59 months PRIMARY AND SECONDARY OUTCOME MEASURES: A multilevel Poisson regression model with robust variance was fitted to identify determinants of normal haemoglobin concentration. An adjusted prevalence ratio with a 95% CI was reported to declare the statistical significance.
Result:
The pooled prevalence of normal haemoglobin concentration among under-five children in SSA was 34.9% (95% CI: 34.6% to 35.1%). High maternal education, middle and rich household wealth, female child, frequent antenatal care visits, non-anaemic mothers, taking anthelmintic drugs and normal nutritional status were associated with increased odds of normal haemoglobin concentration. On the other hand, higher birth order, having fever and diarrhoea, rural residence were associated with lower odds of normal haemoglobin levels.
Conclusion:
According to our finding, only four out of 10 under-five children in SSA had a normal haemoglobin level. This finding proved that anaemia among children in SSA remains a serious public health concern. Therefore, improving maternal education, provision of drugs for an intestinal parasite and early detection and treatment of maternal anaemia, febrile illness and diarrhoeal disease is important.
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