Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Ethiopia.
Department of Nutrition, School of Public Health, College of Health Sciences, Mekelle University, Tigray, Ethiopia.
PLoS One. 2020 Nov 13;15(11):e0241720. doi: 10.1371/journal.pone.0241720. eCollection 2020.
Anemia is a global public health problem; but its burden is disproportionately borne among children in the African Regions. The 2016 Ethiopia Demographic and Health Survey report showed that the prevalence of anemia among children 6-59 months of age was 57%; far exceeding the national target of 25% set for 2015. Although studies have been conducted in Ethiopia, multilevel analysis has rarely been used to identify factors associated with anemia among children. Therefore, this study aimed to identify individual and community-level factors associated with anemia among children 6-59 months of age by fitting a multilevel logistic regression model.
The data was obtained from the 2016 Ethiopia Demographic and Health Survey, conducted from January to June 2016, and downloaded from the website http://www.DHSprogram.com. The sample was taken using two-stage stratified sampling. In stage one, 645 Enumeration Areas and in stage two 28 households per Enumeration Area were selected. A sample of 7790 children 6-59 months of age was included. Data were analyzed using STATA version 14. A multilevel logistic regression model was fitted and an adjusted odds ratio with a 95% confidence interval was obtained.
From the individual-level factors, anemia was associated most strongly with child age, wealth index, maternal anemia and child stunting followed by child underweight, child fever and birth order whereas from the community-level, the strongest odds of anemia occurred among children from Somali, Harari, Dire Dawa and Afar region followed by Oromia and Addis Ababa. Low community-poverty is a protective factor for anemia. The odds of anemia were 0.81 (95% CI: 0.66, 0.99) times lower for children who were living in communities of lower poverty status than children who were living in communities of higher poverty status. Children from Somali and Dire Dawa had 3.38 (95% CI: 3.25, 5.07) and 2.22 (95% CI: 1.42, 3.48) times higher odds of anemia, respectively than children from the Tigray region.
This study shows that anemia among children 6-59 months of age is affected both by the individual and community level factors. It is better to strengthen the strategies of early detection and management of stunted and underweight children. At the same time, interventions should be strengthened to address maternal anemia, child fever and poverty, specifically targeting regions identified to have a high risk of anemia.
贫血是一个全球性的公共卫生问题；但在非洲区域，儿童所受的影响尤为严重。2016 年埃塞俄比亚人口与健康调查显示，6-59 月龄儿童贫血患病率为 57%；远高于 2015 年设定的 25%的国家目标。尽管埃塞俄比亚已经开展了相关研究，但很少有研究使用多水平分析来确定与儿童贫血相关的因素。因此，本研究旨在通过拟合多水平逻辑回归模型，确定与 6-59 月龄儿童贫血相关的个体和社区层面因素。
数据来自于 2016 年 1 月至 6 月进行的埃塞俄比亚人口与健康调查，并从网站 http://www.DHSprogram.com 下载。样本采用两阶段分层抽样法采集。第一阶段选择了 645 个普查区，第二阶段每个普查区选择了 28 户家庭。共纳入了 7790 名 6-59 月龄儿童。使用 STATA 版本 14 进行数据分析。拟合多水平逻辑回归模型，并获得 95%置信区间的调整比值比。
从个体层面因素来看，贫血与儿童年龄、财富指数、母亲贫血和儿童发育迟缓关系最为密切，其次是儿童消瘦、发热和出生顺序；从社区层面来看，来自索马里、哈拉里、德雷达瓦和阿法尔地区的儿童贫血发生率最高，其次是奥罗米亚和亚的斯亚贝巴。社区贫困程度低是贫血的保护因素。与生活在贫困程度较高社区的儿童相比，生活在贫困程度较低社区的儿童贫血的几率低 0.81（95%CI：0.66，0.99）倍。来自索马里和德雷达瓦的儿童贫血的几率分别比来自提格雷地区的儿童高 3.38（95%CI：3.25，5.07）和 2.22（95%CI：1.42，3.48）倍。
本研究表明，6-59 月龄儿童贫血受到个体和社区层面因素的共同影响。最好加强对发育迟缓儿童和消瘦儿童的早期发现和管理策略。同时，应加强干预措施，解决儿童发热、母亲贫血和贫困问题，特别是针对贫血风险较高的地区。
