Anaemia and its determinants among young children aged 6–23 months in Ethiopia (2005–2016)

Abstract Anaemia in children remains a significant public health threat. Recent numbers from Ethiopia showed that more than two‐thirds of children under the age of 2 years were anaemic. This study aimed to investigate the determinants of anaemia throughout Ethiopia over 11 years, making use of the Ethiopian Demographic and Health Survey (EDHS) rounds 2005, 2011 and 2016. The EDHS made it possible to use data on blood tests and detailed questionnaires among infants and young children. Multivariable logistic regression was applied to assess the association of anaemia and different immediate and underlying determinants. A total of 7,324 children aged 6–23 months were included in the analysis, with prevalences of anaemia being 71% in 2005, 61% in 2011 and 72% in 2016. The following determinants were significantly associated with childhood anaemia throughout the entire period: children younger than 1 year, anaemic mothers and those growing up in pastoralist regions. Risk factors such as diet and infections were consistently not significantly associated with anaemia. Given the tremendous adverse health effects of anaemia in young children, urgent action is needed. Hence, this study recommends nationwide multisectoral interventions targeting pastoralist regions, maternal and child health, screening and treatment of risk groups that could reduce the prevalence of anaemia.

[1]  J. V. Amaral Infant and young child feeding , 2020 .

[2]  C. Henry,et al.  Why are animal source foods rarely consumed by 6-23 months old children in rural communities of Northern Ethiopia? A qualitative study , 2020, PloS one.

[3]  Olivia Nankinga,et al.  Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys , 2019, BMC Public Health.

[4]  M. Melku,et al.  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 , 2019, BMC Public Health.

[5]  Weilan Liang,et al.  Prevalence of Anemia and Its Associated Risk Factors Among 6-Months-Old Infants in Beijing , 2019, Front. Pediatr..

[6]  Tadele Girum,et al.  Burden of malaria in Ethiopia, 2000-2016: findings from the Global Health Estimates 2016 , 2019, Tropical Diseases, Travel Medicine and Vaccines.

[7]  A. Belachew,et al.  Factors affecting feeding 6–23 months age children according to minimum acceptable diet in Ethiopia: A multilevel analysis of the Ethiopian Demographic Health Survey , 2019, PloS one.

[8]  M. Demeke,et al.  Analysis of incentives and disincentives for teff in Ethiopia , 2019 .

[9]  J. Kazura,et al.  Malaria epidemiology and interventions in Ethiopia from 2001 to 2016 , 2018, Infectious Diseases of Poverty.

[10]  N. White Anaemia and malaria , 2018, Malaria Journal.

[11]  Bereket Yakob,et al.  Prevalence and correlates of anemia among children aged 6-23 months in Wolaita Zone, Southern Ethiopia , 2018, bioRxiv.

[12]  P. Nguyen,et al.  Trends and drivers of change in the prevalence of anaemia among 1 million women and children in India, 2006 to 2016 , 2018, BMJ Global Health.

[13]  Hadgu Gerensea,et al.  The magnitude of anemia and associated factors among pregnant women attending public institutions of Shire Town, Shire, Tigray, Northern Ethiopia, 2018 , 2018, BMC Research Notes.

[14]  Hadgu Gerensea,et al.  Consistency of Integrated Management of Newborn and Childhood Illness (IMNCI) in Shire Governmental Health Institution in 2017 , 2018, BMC research notes.

[15]  T. Belachew,et al.  Anemia and associated factors among children aged 6–23 months in Damot Sore District, Wolaita Zone, South Ethiopia , 2018, BMC Hematology.

[16]  A. Dangour,et al.  Sustainable Undernutrition Reduction in Ethiopia (SURE) evaluation study: a protocol to evaluate impact, process and context of a large-scale integrated health and agriculture programme to improve complementary feeding in Ethiopia , 2018, BMJ Open.

[17]  K. Berhane,et al.  Spatial pattern and determinants of anaemia in Ethiopia , 2018, PloS one.

[18]  Degefaye Zelalem Anlay,et al.  Prevalence of anemia and its associated factors among children in Ethiopia: a protocol for systematic review and meta-analysis , 2018, EJIFCC.

[19]  B. Minten,et al.  Diet transformation in Africa: the case of Ethiopia , 2017 .

[20]  Colin Andrews,et al.  Examining changes in maternal and child health inequalities in Ethiopia , 2017, International Journal for Equity in Health.

[21]  K. Lewis Understanding climate as a driver of food insecurity in Ethiopia , 2017, Climatic Change.

[22]  P. Coyte,et al.  Decomposing the causes of socioeconomic-related health inequality among urban and rural populations in China: a new decomposition approach , 2017, International Journal for Equity in Health.

[23]  J. Ramos,et al.  Malaria and severe anemia over eight years at Gambo Rural Hospital, southern Ethiopia , 2017, Pathogens and global health.

[24]  A. Hailu,et al.  Anaemia among children in a drought affected community in south-central Ethiopia , 2017, PloS one.

[25]  Patrick Kolsteren,et al.  Household dietary diversity and Animal Source Food consumption in Ethiopia: evidence from the 2011 Welfare Monitoring Survey , 2016, BMC Public Health.

[26]  Kindie Fentahun Muchie Determinants of severity levels of anemia among children aged 6–59 months in Ethiopia: further analysis of the 2011 Ethiopian demographic and health survey , 2016, BMC Nutrition.

[27]  E. Finkelstein,et al.  Measuring Socioeconomic Inequality in Obesity: Looking Beyond the Obesity Threshold , 2016, Health economics.

[28]  N. Kassebaum The Global Burden of Anemia. , 2016, Hematology/oncology clinics of North America.

[29]  E. Kennedy,et al.  Multisector Nutrition Program Governance and Implementation in Ethiopia , 2015, Food and nutrition bulletin.

[30]  T. Sunil,et al.  Decomposition of childhood malnutrition in Cambodia. , 2015, Maternal & child nutrition.

[31]  A. J. van der Ven,et al.  Positive Effect of Large Birth Intervals on Early Childhood Hemoglobin Levels in Africa Is Limited to Girls: Cross-Sectional DHS Study , 2015, PloS one.

[32]  Y. Kebede,et al.  Factors Associated with Anemia among Children Aged 6–23 Months Attending Growth Monitoring at Tsitsika Health Center, Wag-Himra Zone, Northeast Ethiopia , 2015, Journal of nutrition and metabolism.

[33]  Douglas L. Miller,et al.  A Practitioner’s Guide to Cluster-Robust Inference , 2015, The Journal of Human Resources.

[34]  Lealem Gedefaw,et al.  Nutritional Iron Deficiency Anemia: Magnitude and Its Predictors among School Age Children, Southwest Ethiopia: A Community Based Cross-Sectional Study , 2014, PloS one.

[35]  P. Kolsteren,et al.  Effectiveness of a nutrition education package in improving feeding practices, dietary adequacy and growth of infants and young children in rural Tanzania: rationale, design and methods of a cluster randomised trial , 2014, BMC Public Health.

[36]  S. Shiferaw,et al.  Urban food insecurity in the context of high food prices: a community based cross sectional study in Addis Ababa, Ethiopia , 2014, BMC Public Health.

[37]  R. Stoltzfus,et al.  Water, sanitation, and hygiene (WASH), environmental enteropathy, nutrition, and early child development: making the links , 2014, Annals of the New York Academy of Sciences.

[38]  P. Graves,et al.  Risk factors for anemia in children under 6 years of age in Ethiopia: analysis of the data from the cross-sectional Malaria IndicatorSurvey, 2007. , 2013, Transactions of the Royal Society of Tropical Medicine and Hygiene.

[39]  S. Vollmer,et al.  Economic Growth and Child Undernutrition in sub-Saharan Africa , 2013 .

[40]  K. Deribe,et al.  Factors associated with exclusive breastfeeding practices among mothers in Goba district, south east Ethiopia: a cross-sectional study , 2012, International Breastfeeding Journal.

[41]  A. Conde-Agudelo,et al.  Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. , 2012, Studies in family planning.

[42]  S. Villalpando,et al.  Nutritional causes of anemia in Mexican children under 5 years. Results from the 2006 National Health and Nutrition Survey. , 2012, Salud publica de Mexico.

[43]  SV Subramanian,et al.  Anaemia in low-income and middle-income countries , 2011, The Lancet.

[44]  Mz Hossain,et al.  Prevalence of Anaemia in Children of 6 Months to 59 Months in Narayanganj, Bangladesh , 2011 .

[45]  S. Muthayya,et al.  Determinants of Anemia Among Young Children in Rural India , 2010, Pediatrics.

[46]  D. Habte,et al.  Determinants of exclusive breastfeeding practices in Ethiopia , 2009 .

[47]  Q. Nguyen,et al.  Achieving Unity of Effort: Leveraging Interagency Cooperation Between the Department of Defense (DOD) and the United States Agency for International Development (USAID) , 2009 .

[48]  Richard F Hurrell,et al.  Nutritional iron deficiency , 2007, The Lancet.

[49]  J. Connor,et al.  Long-lasting neural and behavioral effects of iron deficiency in infancy. , 2006, Nutrition reviews.

[50]  J. Meinzen-Derr,et al.  Risk of infant anemia is associated with exclusive breast-feeding and maternal anemia in a Mexican cohort. , 2006, The Journal of nutrition.

[51]  S. Esrey,et al.  Risk factors for iron deficiency anaemia in preschool children in northern Ethiopia , 1999, Public Health Nutrition.

[52]  I. Booth,et al.  Iron deficiency anaemia in infancy and early childhood , 1997, Archives of disease in childhood.

[53]  Health Organization,et al.  WHO infant and young child feeding. , 1980, Health visitor.

[54]  MEDIBAi opRNmH Prevalence of Anaemia , 1961, British medical journal.

[55]  J. McDermott,et al.  Food systems for healthier diets in Ethiopia : toward a research agenda , 2018 .

[56]  B. Minten,et al.  Consumption of animal-source foods in Ethiopia: Patterns, changes, and determinants , 2018 .

[57]  P. Lanzkowsky Iron-Deficiency Anemia , 2016 .

[58]  J. Fish,et al.  Lanzkowsky's Manual of Pediatric Hematology and Oncology , 2016 .

[59]  K. Baye Teff: nutrient composition and health benefits , 2014 .

[60]  G. Ramana,et al.  The Health Extension Program in Ethiopia , 2013 .

[61]  C. Gray,et al.  DROUGHT AND POPULATION MOBILITY IN RURAL ETHIOPIA. , 2012, World development.

[62]  E. McLean,et al.  Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. , 2008 .