What factors are associated with the increase of anemia in Ethiopian children aged 6 to 59\u2009months between 2011 and 2016?

Nebyu Daniel Amaha

doi:10.1186/s40795-020-00371-6

Abstract

BackgroundIn Ethiopia more than half of the children under 5 years are anemic and between 2011 and 2016 anemia in children under-5 increased by 28.7%. This study aimed to analyze this increase in anemia by socio-demographic characteristics.MethodThis study was a secondary analysis of the data from the Ethiopian Demographic Health Surveys (EDHS) for 2011 and 2016. The increase of anemia was calculated using percentage change. The chi-square test was used to determine the association between anemia and six predictor variables of age, sex, mother’s educational level, residence, wealth quintile and region. The strength of association was measured using Cramer’s V.ResultsAnemia increased in all age groups, both sexes, urban and rural residencies, across all wealth quintiles, all maternal education levels and all regions of Ethiopia except Benishangul Gumuz. The highest increase of anemia was seen among children born to mothers with above secondary education (65.8%), living in urban areas (40.1%), in the lowest wealth quintile (41.5%), and children from Tigray region (42.9%). Severe anemia increased in all age categories except in infants aged 9–11 months. Children of mothers with above secondary educational level had the highest increase of mild and moderate anemia. Severe anemia decreased in the second and middle wealth quintiles whereas it increased in the rest quintiles. Benishangul Gumuz is the only region where mild, moderate, and severe anemia decreased. Pearson’s chi-square (χ2) test showed that all the predictor variables except sex were significantly associated with anemia. Although highly significant (p < 0.001) using the chi-square test, Cramer’s V showed that residence (V = 0.052–0.066) and maternal education (V = 0.041–0.044) were only weakly associated with anemia.ConclusionAnemia in children under-5 continues to be a severe public health problem in Ethiopia. Benishangul Gumuz region is the only region that was able to reduce the prevalence of all forms of anemia under-5 between 2011 and 2016, consequently other regions of Ethiopia could learn from this experience. The high increase of anemia in children born to mothers with above secondary education and highest wealth quintiles points to poor dietary practices, therefore, community based nutrition education for mothers needs to be strengthened.

Highlights

Benishangul Gumuz region is the only region that was able to reduce the prevalence of all forms of anemia under-5 between 2011 and 2016, other regions of Ethiopia could learn from this experience
The high increase of anemia in children born to mothers with above secondary education and highest wealth quintiles points to poor dietary practices, community based nutrition education for mothers needs to be strengthened
This study aims to disaggregate this increase of anemia by age, sex, residence, educational level, regions, and wealth quintile; identify worse hit age groups and regions; and bring attention to the problem of anemia in children under-5 in Ethiopia

Summary

Introduction

In Ethiopia more than half of the children under 5 years are anemic and between 2011 and 2016 anemia in children under-5 increased by 28.7%. Dietary iron is available as either heme or non-heme form in our diets. The heme form is present in animal meat, poultry and fish and is absorbed 15–35% whereas the non-heme iron present in plant foods and dairy products is absorbed less than 10% and populations whose diets mainly consist of plants are at risk of iron deficiency [4,5,6,7]. Preschool children and women have the highest risk of developing anemia than other members of society [1, 8]. Adverse effects of iron deficiency in children include a decrease in cognitive, behavioral and physical growth, reduced school performance, lowered immunity and increased morbidity [6]

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