Abstract
Anaemia has prevailed as a mild to severe public health problem in Ethiopian women of reproductive age. Many studies carried out on anaemia have been limited to subnational assessments and subgroups of women. The effects of potential factors thought to affect anaemia and severity levels of anaemia have not been well considered. Therefore, this study identifies individual, household and community level factors associated with anaemia among women of reproductive age in Ethiopia applying multilevel ordinal logistic regression models. Proportional odds assumption was tested by likelihood ratio test. About 35.6% of the variation on anaemia was due to between household and community level differences. Pregnancy (adjusted odds ratio [AOR] = 2.30, 95% confidence interval [CI]: 1.82, 2.91), HIV (AOR = 2.40, 95% CI: 1.76, 3.25), giving birth once (AOR = 1.2, 95% CI: 1.05, 1.40), giving birth more than once (AOR = 1.4, 95% CI: 1.19, 1.71), living with five or more family members (AOR = 1.24, 95% CI: 1.05, 1.47), living in poorest households (AOR = 1.34, 95% CI: 1.2, 1.61) and rural area (AOR = 1.57, 95% CI: 1.28, 1.92) were associated with greater odds of more severe anaemia compared with their respective counter parts. Secondary and above education (AOR = 0.83, 95% CI: 0.70, 0.97) and use of pills, implants or injectable (AOR = 0.67, 95% CI: 0.59, 0.77) were associated with lower odds of more severe anaemia. Anaemia prevention and control programmes need to be strengthened for women living with HIV/AIDS and during pregnancy. Household poverty reduction and social protection services need to be strengthened and integrated in anaemia prevention and management activities in women.
Highlights
Anaemia is a global public health problem affecting about one-third (32.8%) of all women of reproductive age (WRA), 40% of pregnant and 32.5% of nonpregnant women in 2016 (The World Bank, 2018)
Anaemia was found to be influenced by factors evolving at individual, household and community levels
There was a sizable heterogeneity in likelihood of anaemia across households and clusters
Summary
Anaemia is a global public health problem affecting about one-third (32.8%) of all women of reproductive age (WRA), 40% of pregnant and 32.5% of nonpregnant women in 2016 (The World Bank, 2018). It is a severe public health problem in many countries of the world. Defined as a condition characterized by a lower than normal concentration of haemoglobin (Hb) (World Health Organization, 2015), anaemia contributes to maternal and perinatal mortality It doubles the risk of maternal death and accounts for 20% of all maternal deaths (Balarajan, Ramakrishnan, Özaltin, Shankar, & Subramanian, 2011; Black et al, 2008; Daru et al, 2018). The aggregated effects of such consequences pose a substantial economic burden to individuals and country (Horton & Ross, 2007; Vanishri et al, 2017; World Bank, 2009)
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