Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia.
Department of Epidemiology & Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2023 Nov 29;18(11):e0294992. doi: 10.1371/journal.pone.0294992. eCollection 2023.
Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries.
We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software.
The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception.
Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.
尽管实施了不同的营养和非营养干预措施，非洲仍有 43%的育龄妇女患有贫血。最近的证据还表明，撒哈拉以南非洲（SSA）国家中没有一个国家能够实现到 2030 年将贫血减少 50%的营养目标。迄今为止，关于 SSA 国家育龄妇女贫血程度及其决定因素的信息有限。因此，本研究旨在估计 SSA 国家育龄妇女贫血程度的总体流行率及其决定因素。
我们使用了 29 个 SSA 国家最近的人口和健康调查中的 205627 名育龄妇女的汇总数据，这些调查是在 2010-2021 年期间进行的。使用多水平混合效应分析和有序逻辑回归模型来确定贫血程度的决定因素，并使用偏差值来选择最佳拟合模型。首先，进行了两变量有序逻辑回归分析，并使用 Brant 检验检查了每个解释变量的比例优势假设。最后，在多变量多水平有序逻辑回归模型中，使用 p 值<0.05 和具有相应 95%CI 的比值比（AOR）来确定贫血程度的决定因素。所有分析均使用 Stata 版本 17 软件进行。
SSA 国家育龄妇女贫血的总体患病率为 40.5%[95%CI=40.2%-40.7%]，其中 24.8%[95%CI：24.6%-25.0%]、11.1%[95%CI=10.9%-11.2%]和 0.8%[95%CI=0.7%-0.8%]分别患有轻度、中度和重度贫血。患病率差异显著，从最低的卢旺达 13%到马里的最高 62%不等，并且贫血被认为是一个严重的公共卫生问题（患病率≥40%）在 18 个国家。回归结果表明，多配偶婚姻、妇女和丈夫文盲、家庭贫困、出生间隔较短、不参加产前保健、体重不足、未改善的厕所和供水设施以及社区层面妇女识字率低与高贫血水平呈正相关。此外，超重和使用现代避孕措施的妇女发生贫血的可能性较低。
总体结果表明，SSA 国家育龄妇女贫血是一个严重的公共卫生问题，影响了十分之四以上的妇女。因此，增加获得孕产妇保健服务（产前保健和避孕）和改善卫生设施将补充现有的减少贫血的干预措施。此外，加强妇女教育和规范禁止多配偶婚姻的政策对于解决运营限制很重要。
