Department of Statistics, Federal University Lokoja, Nigeria.
Department of Statistics, University of Ilorin, Ilorin, Nigeria.
Spat Spatiotemporal Epidemiol. 2023 Jun;45:100578. doi: 10.1016/j.sste.2023.100578. Epub 2023 Feb 2.
Anaemia which is a condition that describes low haemoglobin (Hb) levels has been recognized as a major public health problem amongst pregnant women in many sub-Saharan African countries including Nigeria. The causes of maternal anaemia which are interconnected and complex vary between countries and can vary within a country. This study aimed to investigate the spatial pattern and identify demographic and socio-economic determinants associated with anaemia amongst Nigerian pregnant women aged 15-49 years using data from the 2018 Nigeria Demographic and Health Survey (NDHS). This study utilized chi-square tests of independence and semiparametric structured additive models to describe the relationship between the presumed factors and anaemia status or Hb level while also taking spatial effects at state level into account. The Gaussian and Binomial distributions were used for Hb level and anaemia status respectively. The overall observed prevalence of anaemia in pregnant women and average Hb level in Nigeria were 64% and 10.4 (SD = 1.6) g/dL respectively while the prevalence of mild, moderate and severe anaemia were 27.2%, 34.6% and 2.2% respectively. Higher education, older age, and currently breastfeeding were associated with higher Hb level. Low education, being unemployed and recently having a sexually transmitted infection were identified as risk factors for maternal anaemia. Body mass index (BMI) and household size had a nonlinear effect on Hb level while BMI and age were nonlinearly related to odds of anaemia. Bivariate analysis indicated that living in rural area, low wealth class, using unsafe water and non-usage of internet were significantly associated with increased risk of anaemia. Maternal anaemia prevalence was highest in the South Eastern part of Nigeria with Imo state producing the highest prevalence of maternal anaemia while Cross River state yielded the lowest prevalence of maternal anaemia. The spatial effects associated with states were significant but unstructured indicating that states in close proximity do not necessarily share similar spatial effects. Hence, unobserved characteristics shared by states in close proximity do not influence maternal anaemia and Hb level. The findings from this study can undoubtedly help in the planning and designing of anaemia interventions that match local conditions taking into consideration the aetiology of anaemia in Nigeria.
贫血是一种描述血红蛋白（Hb）水平低的病症，在包括尼日利亚在内的许多撒哈拉以南非洲国家的孕妇中已被视为一个主要的公共卫生问题。导致孕产妇贫血的原因相互关联且复杂，因国家而异，在一个国家内也可能有所不同。本研究旨在利用 2018 年尼日利亚人口与健康调查（NDHS）的数据，调查尼日利亚 15-49 岁孕妇贫血的空间模式，并确定与贫血相关的人口统计学和社会经济决定因素。本研究利用独立性卡方检验和半参数结构加法模型，描述了假定因素与贫血状况或 Hb 水平之间的关系，同时考虑了州一级的空间效应。正态分布和二项式分布分别用于 Hb 水平和贫血状况。尼日利亚孕妇贫血的总体观察患病率和平均 Hb 水平分别为 64%和 10.4（SD=1.6）g/dL，轻度、中度和重度贫血的患病率分别为 27.2%、34.6%和 2.2%。接受过高等教育、年龄较大和正在哺乳的孕妇与较高的 Hb 水平相关。接受过较低教育、失业和最近患有性传播感染的孕妇被确定为孕产妇贫血的风险因素。身体质量指数（BMI）和家庭规模对 Hb 水平有非线性影响，而 BMI 和年龄与贫血的几率呈非线性关系。双变量分析表明，生活在农村地区、低财富阶层、使用不安全的水和不使用互联网与贫血风险增加显著相关。尼日利亚东南部的孕产妇贫血患病率最高，伊莫州的孕产妇贫血患病率最高，而克罗斯河州的孕产妇贫血患病率最低。各州之间的空间效应显著但无结构，这表明相邻的州不一定具有相似的空间效应。因此，相邻州之间共同的未观察到的特征不会影响孕产妇贫血和 Hb 水平。本研究的结果无疑有助于规划和设计符合当地条件的贫血干预措施，同时考虑到尼日利亚贫血的病因。
