Department of Public Health, Madda Walabu University Goba Referral Hospital, Bale-Goba P.O. Box 302, Ethiopia.
Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide Campus, Adelaide 5000, Australia.
Int J Environ Res Public Health. 2023 Jun 29;20(13):6251. doi: 10.3390/ijerph20136251.
Stunting and anaemia, two severe public health problems, affect a significant number of children under the age of five. To date, the burden of and predictive factors for coexisting forms of stunting and anaemia in childhood have not been well documented in Ethiopia, where both the conditions are endemic. The primary aims of the present study were to: (i) determine the prevalence of co-morbid anaemia and stunting (CAS); (ii) and identify factors associated with these co-morbid conditions among children aged 6-59 months in Ethiopia.
The study was based on data from the Ethiopian Demographic and Health Survey (EDHS 2005-2016). The EDHS was a cross-sectional study that used a two-stage stratified cluster sampling technique to select households. A total weighted sample of 21,172 children aged 6-59 months was included in the current study (EDHS-2005 (n = 3898), EDHS-2011 (n = 8943), and EDHS-2016 (n = 8332)). Children with height-for-age z-scores (HAZ) less than -2 SD were classified as stunted. Anaemia status was measured by haemoglobin level with readings below 11.0 g/deciliter (g/dL) categorized as anaemic. A multilevel mixed-effects logistic regression model was used to identify the factors associated with CAS. The findings from the models were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CIs).
Almost half of the children were males (51.1%) and the majority were from rural areas (89.2%). The prevalence of CAS was 24.4% [95% CI: (23.8-24.9)]. Multivariate analyses revealed that children aged 12-23 months, 24-35 months, and 36-59 months, and children perceived by their mothers to be smaller than normal at birth had higher odds of CAS. The odds of CAS were significantly higher among children born to anaemic mothers [AOR: 1.25, 95% CI: (1.11-1.41)], mothers with very short stature [AOR: 2.04, 95% CI: (1.44-2.91)], children from households which practiced open defecation [AOR: 1.57, 95% CI: (1.27-1.92)], children born to mothers without education [AOR: 3.66, 95% CI: (1.85-7.22)], and those who reside in rural areas [AOR: 1.41, 95% CI: (1.10, 1.82)]. Male children had 19% lower odds of having CAS compared to female children [AOR: 0.81, 95% CI: (0.73-0.91)]. Children born to mothers who had normal body mass index (BMI) [AOR: 0.82, 95%CI: (0.73-0.92)] reported lower odds of CAS.
One in four preschool-age children in Ethiopia had co-morbid anaemia and stunting, which is a significant public health problem. Future interventions to reduce CAS in Ethiopia should target those children perceived to be small at birth, anaemic mothers, and mothers with short stature.
引言：发育迟缓与贫血是两种严重的公共卫生问题，严重影响了五岁以下儿童的健康。迄今为止，埃塞俄比亚一直存在这两种疾病，但尚未充分记录儿童期同时存在这两种疾病的负担和预测因素，这两种疾病在该国都很普遍。本研究的主要目的是：(i) 确定 6-59 月龄儿童合并贫血和发育迟缓的患病率 (CAS)；(ii) 确定与这些合并疾病相关的因素。
方法：本研究基于埃塞俄比亚人口与健康调查 (EDHS 2005-2016) 数据。EDHS 是一项横断面研究，采用两阶段分层聚类抽样技术选择家庭。当前研究共纳入 21172 名 6-59 月龄儿童(EDHS-2005(n = 3898)、EDHS-2011(n = 8943)和 EDHS-2016(n = 8332))。身高别年龄 z 评分 (HAZ) 低于-2 SD 的儿童被归类为发育迟缓。贫血状况通过血红蛋白水平测量，读数低于 11.0 g/dL(克/分升)被归类为贫血。使用多水平混合效应逻辑回归模型确定与 CAS 相关的因素。模型的结果以调整后的优势比 (AOR) 及其 95%置信区间 (CI) 表示。
结果：近一半的儿童为男性 (51.1%)，大部分来自农村地区 (89.2%)。CAS 的患病率为 24.4%[95%CI：(23.8-24.9)]。多变量分析显示，12-23 个月、24-35 个月和 36-59 个月的儿童，以及母亲认为出生时体型较小的儿童，患 CAS 的几率更高。出生时母亲贫血(AOR：1.25，95%CI：(1.11-1.41))、母亲身材矮小(AOR：2.04，95%CI：(1.44-2.91))、在有排便习惯的家庭中(AOR：1.57，95%CI：(1.27-1.92))、母亲未接受教育(AOR：3.66，95%CI：(1.85-7.22))和居住在农村地区(AOR：1.41，95%CI：(1.10-1.82))的儿童患 CAS 的几率显著增加。与女性儿童相比，男性儿童患 CAS 的几率低 19%(AOR：0.81，95%CI：(0.73-0.91))。出生时母亲体重指数 (BMI) 正常(AOR：0.82，95%CI：(0.73-0.92))的儿童患 CAS 的几率较低。
结论：埃塞俄比亚四分之一的学龄前儿童同时患有贫血和发育迟缓，这是一个严重的公共卫生问题。未来在埃塞俄比亚减少 CAS 的干预措施应针对那些出生时体型较小、贫血母亲和身材矮小的母亲的儿童。
