Anemia and its associated factors among women of reproductive age in eastern Africa: A multilevel mixed-effects generalized linear model

Achamyeleh Birhanu Teshale, Getayeneh Antehunegn Tesema, Misganaw Gebrie Worku, Yigizie Yeshaw, Zemenu Tadesse Tessema, Achamyeleh Birhanu Teshale, Getayeneh Antehunegn Tesema, Misganaw Gebrie Worku, Yigizie Yeshaw, Zemenu Tadesse Tessema

Abstract

Background: Anemia in women of reproductive age is a major public health challenge for low- and middle-income countries with a long-term negative impact on the health of women, their children, and the economic growth of the society. Even though the world health organization targeted a 50% global reduction of anemia among women of reproductive age by 2025, with the current trend it is unlikely to achieve this goal.

Objective: This study aimed to assess the prevalence and associated factors of anemia among women of reproductive age in eastern Africa.

Methods: A secondary data analysis, using demographic and health survey (DHS) data of 10 eastern African countries, was conducted. For our study, a total weighted sample of 101524 women of reproductive age was used. We employed a multilevel mixed-effects generalized linear model (using Poisson regression with robust error variance). Both unadjusted and adjusted prevalence ratios with their 95% confidence interval were reported.

Results: The prevalence of anemia in eastern Africa was 34.85 (95%CI: 34.56-35.14) ranging from 19.23% in Rwanda to 53.98% in Mozambique. In the multivariable multilevel analysis, being older age, having primary and above education, being from households with second to highest wealth quantiles, being currently working, not perceiving distance as a big problem, use of modern contraceptive methods, and rural residence was associated with a lower prevalence of anemia. While, being married and divorced/separated/widowed, women from female-headed households, women from households with unimproved toilet facility and unimproved water source, ever had of a terminated pregnancy, having high parity, and being from large household size was associated with a higher prevalence of anemia.

Conclusion: The prevalence of anemia in eastern Africa was relatively high. Both individual level and community level factors were associated with the prevalence of anemia in women of reproductive age. Therefore, giving special attention to those women who are at a higher prevalence of anemia such as younger women, those who are from households with low socioeconomic status, unimproved toilet facility, and source of drinking water, as well as pregnant women could decrease anemia in women of reproductive age.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Prevalence of anemia in eastern…
Fig 1. Prevalence of anemia in eastern Africa showing great variation between countries.
Fig 2. Spatial distribution of anemia among…
Fig 2. Spatial distribution of anemia among women of reproductive age in eastern Africa.

References

    1. Organization WH. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization; 2011.
    1. WHO C. Assessing the iron status of populations: report of a joint World Health Organization/Centers for Disease Control and Prevention technical consultation on the assessment of iron status at the population level. World Health Organization, Geneva, Switzerland: 2007.
    1. Organization WH. Comprehensive implementation plan on maternal, infant and young child nutrition. World Health Organization; 2014.
    1. Organization WH. Global nutrition targets 2025: Policy brief series. World Health Organization; 2014.
    1. Organization WH. The global prevalence of anaemia in 2011. Geneva: World Health Organization; 2015. 2017.
    1. Haas JD, Brownlie T IV. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. The Journal of nutrition. 2001;131(2):676S–90S.
    1. Horton S, Ross J. The economics of iron deficiency. Food policy. 2003;28(1):51–75.
    1. Brabin BJ, Hakimi M, Pelletier D. An analysis of anemia and pregnancy-related maternal mortality. The Journal of nutrition. 2001;131(2):604S–15S.
    1. Mawani M, Ali SA, Bano G, Ali SA. Iron deficiency anemia among women of reproductive age, an important public health problem: Situation analysis. Reproductive System & Sexual Disorders: Current Research. 2016;5(3):1.
    1. World Health Organization. Global Nutrition Targets 2025: Anemia Policy Brief Geneva: WHO; 2014. [10 March 2019]. .
    1. Terefe B, Birhanu A, Nigussie P, Tsegaye A. Effect of maternal iron deficiency anemia on the iron store of newborns in Ethiopia. Anemia. 2015;2015.
    1. Kumar KJ, Asha N, Murthy DS, Sujatha M, Manjunath V. Maternal anemia in various trimesters and its effect on newborn weight and maturity: an observational study. International journal of preventive medicine. 2013;4(2):193.
    1. Dane B, Arslan N, Batmaz G, Dane C. Does maternal anemia affect the newborn. Özgün Araştırma. 2013:195–9.
    1. De Benoist B, Cogswell M, Egli I, McLean E. Worldwide prevalence of anaemia 1993–2005; WHO Global Database of anaemia. 2008.
    1. Nojilana B, Norman R, Bradshaw D, Van Stuijvenberg ME, Dhansay MA, Labadarios D, et al. Estimating the burden of disease attributable to vitamin A deficiency in South Africa in 2000. South African Medical Journal. 2007;97(8):748–53.
    1. Unicef U, WHO U. WHO: Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. 2001.
    1. McLean E, Cogswell M, Egli I, Wojdyla D, De Benoist B. Worldwide prevalence of anaemia, WHO vitamin and mineral nutrition information system, 1993–2005. Public health nutrition. 2009;12(4):444–54.
    1. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health. 2013;1(1):e16–e25.
    1. Kassebaum NJ. The global burden of anemia. Hematology/Oncology Clinics. 2016;30(2):247–308.
    1. Hakizimana D, Nisingizwe MP, Logan J, Wong R. Identifying risk factors of anemia among women of reproductive age in Rwanda–a cross-sectional study using secondary data from the Rwanda demographic and health survey 2014/2015. BMC Public Health. 2019;19(1):1662.
    1. Nankinga O, Aguta D. Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys. BMC Public Health. 2019;19(1):1–9.
    1. Massawe SN, Urassa EN, Nyström L, Lindmark G. Anaemia in women of reproductive age in Dar-es-Salaam, Tanzania. East African medical journal. 2002;79(9):461–6.
    1. World Bank. Zambia—Prevalence Of Anemia Among Women Of Reproductive Age (% Of Women Ages 15–49). 2016.
    1. World Bank. Burundi—Prevalence Of Anemia Among Women Of Reproductive Age (% Of Women Ages 15–49). 2016.
    1. Debelo O, Shiferaw Y. Correlates of Anemia Status Among Women of Reproductive Age in Ethiopia. SSRN 3463707. 2019.
    1. World Bank. Malawi—Prevalence Of Anemia Among Women Of Reproductive Age (% Of Women Ages 15–49). 2016.
    1. Bezerra AGN, Leal VS, Lira PICd, Oliveira JS, Costa EC, Menezes RCEd, et al. Anemia and associated factors in women at reproductive age in a Brazilian Northeastern municipality. Revista Brasileira de Epidemiologia. 2018;21:e180001.
    1. Kandala NI, Pallikadavath S, Channon AA, Knight G, Madise NJ. A multilevel approach to correlates of anaemia in women in the Democratic Republic of Congo: findings from a nationally representative survey. European Journal of Clinical Nutrition. 2020;74(5):720–31.
    1. Habyarimana F, Zewotir T, Ramroop S. Spatial Distribution and Analysis of Risk Factors Associated with Anemia Among Women of Reproductive Age: Case of 2014 Rwanda Demographic and Health Survey Data. The Open Public Health Journal. 2018;11(1).
    1. Kibret KT, Chojenta C, D’Arcy E, Loxton D. Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis. BMJ open. 2019;9(4):e027276.
    1. Lover AA, Hartman M, Chia KS, Heymann DL. Demographic and spatial predictors of anemia in women of reproductive age in Timor-Leste: implications for health program prioritization. PloS one. 2014;9(3).
    1. Liyew AM, Teshale AB. Individual and community level factors associated with anemia among lactating mothers in Ethiopia using data from Ethiopian demographic and health survey, 2016; a multilevel analysis. BMC Public Health. 2020;20(1):1–11.
    1. Lakew Y, Biadgilign S, Haile D. Anaemia prevalence and associated factors among lactating mothers in Ethiopia: evidence from the 2005 and 2011 demographic and health surveys. BMJ open. 2015;5(4):e006001.
    1. Gautam S, Min H, Kim H, Jeong H-S. Determining factors for the prevalence of anemia in women of reproductive age in Nepal: Evidence from recent national survey data. PloS one. 2019;14(6).
    1. Win HH, Ko MK. Geographical disparities and determinants of anaemia among women of reproductive age in Myanmar: analysis of the 2015–2016 Myanmar Demographic and Health Survey. WHO South-East Asia journal of public health. 2018;7(2):107–13.
    1. Sadeghian M, Fatourechi A, Lesanpezeshki M, Ahmadnezhad E. Prevalence of anemia and correlated factors in the reproductive age women in rural areas of tabas. Journal of family & reproductive health. 2013;7(3):139.
    1. Ali JH. Gender differences in household headship and level of awareness on anaemia among Ethiopian women: Evidences from a nationwide cross-sectional survey. Ethiopian Journal of Health Development. 2018;32(2).
    1. Nisar R, Anwar S, Nisar S. Food security as determinant of anemia at household level in Nepal. Journal of Food Security. 2013;1(2):27–9.
    1. Alemu T, Umeta M. Reproductive and Obstetric Factors Are Key Predictors of Maternal Anemia during Pregnancy in Ethiopia: Evidence from Demographic and Health Survey (2011). Anemia. 2015;2015:649815.
    1. Klemm R, Sommerfelt AE, Boyo A, Barba C, Kotecha P, Steffen M, et al. Are we making progress on reducing anemia in women. Cross-country Comparison of Anemia Prevalence, Reach, and Use of Antenatal Care and Anemia Reduction Interventions. Washington DC, USA: A2Z: The USAID Micronutriend and Child Blindness Project. 2011 Jun.
    1. Mbule M, Byaruhanga Y, Kabahenda M, Lubowa A. Determinants of anemia among pregnant women in rural Uganda. Rural and remote health. 2012;13:2259.
    1. Kordas K, Centeno ZYF, Pachón H, Soto AZJ. Being overweight or obese is associated with lower prevalence of anemia among Colombian women of reproductive age. The Journal of nutrition. 2013;143(2):175–81.
    1. Wiebe ER, Trouton KJ, Eftekhari A. Anemia in early pregnancy among Canadian women presenting for abortion. International Journal of Gynecology & Obstetrics. 2006. July;94(1):60–1.
    1. Uche-Nwachi EO, Odekunle A, Jacinto S, Burnett M, Clapperton M, David Y, et al. Anaemia in pregnancy: associations with parity, abortions and child spacing in primary healthcare clinic attendees in Trinidad and Tobago. African health sciences. 2010. March;10(1):66.
    1. Arabyat RM, Arabyat G, Al-Taani G. Prevalence and risk factors of anaemia among ever-married women in Jordan. East Mediterr Health J. 2018;24(8).
    1. Obse N, Mossie A, Gobena T. Magnitude of anemia and associated risk factors among pregnant women attending antenatal care in Shalla Woreda, West Arsi Zone, Oromia Region, Ethiopia. Ethiopian journal of health sciences. 2013;23(2):165–73.
    1. Bekele A, Tilahun M, Mekuria A. Prevalence of anemia and its associated factors among pregnant women attending antenatal care in health institutions of Arba Minch Town, Gamo Gofa Zone, Ethiopia: a cross-sectional study. Anemia. 2016;2016.
    1. Gebremedhin S, Asefa A. Association between type of contraceptive use and haemoglobin status among women of reproductive age in 24 sub-Saharan Africa countries. BMJ sexual & reproductive health. 2019;45(1):54–60.
    1. Adamu AL, Crampin A, Kayuni N, Amberbir A, Koole O, Phiri A, et al. Prevalence and risk factors for anemia severity and type in Malawian men and women: urban and rural differences. Population health metrics. 2017;15(1):12.
    1. Organization WH. Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. 2008.
    1. WHO. Global Nutrition Targets 2025. AnaemiaPolicy Brief, Geneva. World Health Organization. 2014.
    1. DHS Methodology. Obtained from . Accessed on 19 June 2017: DHS Program; [cited 2017 19 June 2017].
    1. Raghuram V, Anil M, Jayaram S. Prevalence of anaemia amongst women in the reproductive age group in a rural area in south india. Int J Biol Med Res. 2012;3(2):1482–4.
    1. Harding KL, Aguayo VM, Namirembe G, Webb P. Determinants of anemia among women and children in Nepal and Pakistan: An analysis of recent national survey data. Maternal & child nutrition. 2018;14:e12478.
    1. Jamnok J, Sanchaisuriya K, Sanchaisuriya P, Fucharoen G, Fucharoen S, Ahmed F. Factors associated with anaemia and iron deficiency among women of reproductive age in Northeast Thailand: a cross-sectional study. BMC Public Health. 2020;20(1):102.
    1. Saydam BK, Genc RE, Sarac F, Turfan EC. Prevalence of anemia and related factors among women in Turkey. Pakistan journal of medical sciences. 2017;33(2):433.
    1. Little M, Zivot C, Humphries S, Dodd W, Patel K, Dewey C. Burden and determinants of anemia in a rural population in south India: A Cross-Sectional Study. Anemia. 2018;2018.
    1. Trinh LTT, Dibley M. Anaemia in pregnant, postpartum and non pregnant women in Lak district, Daklak province of Vietnam. Asia Pacific journal of clinical nutrition. 2007;16(2).
    1. Soofi S, Khan GN, Sadiq K, Ariff S, Habib A, Kureishy S, et al. Prevalence and possible factors associated with anaemia, and vitamin B 12 and folate deficiencies in women of reproductive age in Pakistan: analysis of national-level secondary survey data. BMJ Open. 2017;7(12):e018007.
    1. Nankinga, Olivia, Danstan Aguta, and Catherine Kabahuma. 2019. Trends and Determinants of Anemia in Uganda: Further Analysis of the Demographic and Health Surveys. DHS Working Paper No. 149. Rockville, Maryland, USA: ICF.
    1. Arpey NC, Gaglioti AH, Rosenbaum ME. How socioeconomic status affects patient perceptions of health care: a qualitative study. Journal of primary care & community health. 2017;8(3):169–75.
    1. Apouey BH. Health policies and the relationships between socioeconomic status, access to health care, and health. Israel journal of health policy research. 2013;2(1):50.
    1. Breymann C. Iron deficiency anemia in pregnancy. InSeminars in hematology 2015 Oct 1 (Vol. 52, No. 4, pp. 339–347). WB Saunders.
    1. Miller L, Hughes JP. Continuous combination oral contraceptive pills to eliminate withdrawal bleeding: a randomized trial. Obstetrics & Gynecology. 2003. April 1;101(4):653–61.
    1. Glasier AF, Smith KB, Van der Spuy ZM, Ho PC, Cheng L, Dada K, et al. Amenorrhea associated with contraception—an international study on acceptability. Contraception. 2003. January 1;67(1):1–8.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel