Household, maternal, and child related determinants of hemoglobin levels of Ethiopian children: hierarchical regression analysis

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Abstract
Anemia remains a major public health problem among children under five years old in Ethiopia, rising unexpectedly from 44% national prevalence in 2011 to 57% in 2016. In this study, we investigated the household, maternal and child-related dietary and non-dietary factors associated with hemoglobin (Hb) level of infants and young children. We analyzed data from a nationally representative sample of 2902 children aged 6–23 months, included in the 2016 Ethiopian demographic and health survey (EDHS). Hierarchical linear regression analysis was done to identify the factors associated with Hb level. We reported adjusted β (aβ) with 95% confidence interval (CI). Overall, 72% of children under 2 years of age were anemic in Ethiopia in 2016. Household factors: rich household wealth category (aβ = 0.48, 95%CI = 0.33–0.63, P < 0.001), and agrarian regions (aβ = 0.64, 95%CI = 0.40–0.88, P < 0.001) were significantly associated with a higher mean Hb level. Maternal factors: secondary and above education level (aβ = 0.69, 95%CI = 0.23–1.16, P = 0.004), and being not anemic (aβ = 0.40, 95%CI = 0.26–0.53, P < 0.001) were significantly associated with a higher mean Hb level. Child factors: age below 12 months (aβ = 0.72, 95%CI = 0.57–0.88, P < 0.001), female sex (aβ = 0.16, 95%CI = 0.03–0.30, P = 0.019), being not underweight (aβ = 0.22, 95%CI = 0.02–0.42, P = 0.031), average birth size (aβ = 0.25, 95%CI = 0.08–0.42, P = 0.003), no history of recent infection (aβ = 0.18, 95%CI = 0.02–0.33, P = 0.025), currently breastfeeding (aβ = 0.28, 95%CI = 0.12–0.44, P = 0.002), vitamin A supplementation (aβ = 0.17, 95%CI = 0.06–0.28, P = 0.021), and frequent meal feeding (aβ = 0.11, 95%CI = 0.05–0.16, P = 0.034) were significantly associated with a higher mean Hb level. Hb level was associated with various dietary and non-dietary influences originating from household, maternal, and child levels. A comprehensive approach, addressing the multi-factorial nature of Hb status, might stand an important consideration to reverse the recent rise in anemia prevalence in Ethiopia.

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