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Spatio-temporal distribution and associated factors of anaemia among children aged 6–59 months in Ethiopia: a spatial and multilevel analysis based on the EDHS 2005–2016
Authors: Samuel Hailegebreal, Araya Mesfin Nigatu, Zeleke Abebaw Mekonnen, and Berhanu Fikadie Endehabtu
Source: BMJ Open, Vol 11, Issue 8; DOI:
Topic(s): Anemia
Child health
Children under five
Spatial analysis
Country: Africa
Published: AUG 2021
Abstract: Anaemia is a global public health problem with major health and socioeconomic consequences. Though childhood anaemia is a major public health problem in Ethiopia, there is limited evidence on the spatio-temporal variability of childhood anaemia over time in the country. Therefore, this study aimed to assess the spatio-temporal distribution and associated factors of childhood anaemia using the Ethiopian Demographic and Health Survey (EDHS) data from 2005 to 2016. Survey-based cross-sectional study design was employed for the EDHS. Data were collected in all nine regions and two city administrations of Ethiopia in 2005, 2011 and 2016. The source population for this study was all children in Ethiopia aged 6–59 months. A total of 21 302 children aged 6–59 months were included in this study. The outcome variable was child anaemia status. The prevalence of anaemia declined from 53.9% in 2005 to 44.6% in 2011, but it showed an increase in 2016 to 57.6%. The spatial analysis revealed that the spatial distribution of anaemia varied across the regions. The spatial scan statistics analysis indicated a total of 22 clusters (relative risk (RR)=1.5, p<0.01) in 2005, 180 clusters (RR=1.4, p<0.01) in 2011 and 219 clusters (RR=1.4, p<0. 0.01) in 2016, significant primary clusters were identified. The child’s age, mother’s age, maternal anaemia status, wealth index, birth order, fever, stunting, wasting status and region were significant predictors of childhood anaemia. In this study, childhood anaemia remains a public health problem. The spatial distribution of childhood anaemia varied significantly across the country. Individual-level and community-level factors were associated with childhood anaemia. Therefore, in regions with a high risk of childhood anaemia, individual-level and community-level factors should be intensified by allocating additional resources and providing appropriate and tailored strategies.