Date Published: June 3, 2018
Author(s): Kemal N. Kawo, Zeytu G. Asfaw, Negusse Yohannes.
Anemia is a widely spread public health problem and affects individuals at all levels. However, there is a considerable regional variation in its distribution.
Thus, this study aimed to assess and model the determinants of prevalence of anemia among children aged 6–59 months in Ethiopia.
Cross-sectional data from Ethiopian Demographic and Health Survey was used for the analysis. It was implemented by the Central Statistical Agency from 27 December 2010 through June 2011 and the sampling technique employed was multistage.
The statistical models that suit the hierarchical data such as variance components model, random intercept model, and random coefficients model were used to analyze the data. Likelihood and Bayesian approaches were used to estimate both fixed effects and random effects in multilevel analysis.
This study revealed that the prevalence of anemia among children aged between 6 and 59 months in the country was around 42.8%. The multilevel binary logistic regression analysis was performed to investigate the variation of predictor variables of the prevalence of anemia among children aged between 6 and 59 months. Accordingly, it has been identified that the number of children under five in the household, wealth index, age of children, mothers’ current working status, education level, given iron pills, size of child at birth, and source of drinking water have a significant effect on prevalence of anemia. It is found that variances related to the random term were statistically significant implying that there is variation in prevalence of anemia across regions. From the methodological aspect, it was found that random intercept model is better compared to the other two models in fitting the data well. Bayesian analysis gave consistent estimates with the respective multilevel models and additional solutions as posterior distribution of the parameters.
The current study confirmed that prevalence of anemia among children aged 6–59 months in Ethiopia was severe public health problem, where 42.8% of them are anemic. Thus, stakeholders should pay attention to all significant factors mentioned in the analysis of this study but wealth index/improving household income and availability of pure drinking water are the most influential factors that should be improved anyway.
Anemia is a condition characterized by a low level of hemoglobin in the blood . Anemia is a widespread public health problem, and severe anemia is a significant cause of childhood mortality . The World Health Organization (WHO) considers anemia prevalence over 40% as a major public health problem, between 20 and 40% as a medium-level public health problem, and between 5% and 20% as a mild public health problem . High prevalence of anemia and its consequences on children’s health, especially for their growth and development, have made anemia an important public health problem, given the difficulty in implementing effective measures for controlling it . Therefore, it is important to understand the scope and strength of individual risk factors for anemia in populations where anemia is common to design more effective interventions .
Multilevel models allow the relationship between the explanatory variables at different level and dependent variables at lower level to be estimated, enabling the extent of variation in the outcome of interest to be measured at each level assumed in the model both before and after the inclusion of the explanatory variables in the model.
The results of the analysis are divided into descriptive analysis and multilevel binary logistic models from categorical data. Results and their discussions are presented in the following sections.
The current study confirmed that prevalence of anemia among children aged 6–59 months in Ethiopia was severe public health problem, where 42.8% of them anemic and based on WHO criteria greater than 40% are categorized under severe public health problem. Thus, stakeholders should pay attention to all significant factors mentioned in the analysis of this study but wealth index/improving household income and availability of pure drinking water are the most influential factors that should be improved anyway. Regional variation is the sole finding of this paper and hence potential stakeholders have to give special consideration for children who are living in the highest anemic prevalence regions. Moreover, those households who are living in nomadic region like Afar and Somalia should be trained on the cause of anemia and its consequences.