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Spatial distribution and determinant factors of anemia among adults aged 15–59 in Ethiopia; using mixed-effects ordinal logistic regression model
Authors: Biruk Shalmeno Tusa, Sewnet Adem Kebede, and Adisu Birhanu Weldesenbet
Source: BMC Nutrition, Volume 7, Article number: 18; DOI:
Topic(s): Adult health
Data models
Spatial analysis
Country: Africa
Published: MAY 2021
Abstract: Background Anemia is a global public health problem, particularly in developing countries. Assessing the geographic distributions and determinant factors is a key and crucial step in designing targeted prevention and intervention programmes to address anemia. Thus, the current study is aimed to assess the spatial distribution and determinant factors of anemia in Ethiopia among adults aged 15–59. Methods A secondary data analysis was done based on 2016 Ethiopian Demographic and Health Surveys (EDHS). Total weighted samples of 29,140 adults were included. Data processing and analysis were performed using STATA 14; ArcGIS 10.1 and SaTScan 9.6 software. Spatial autocorrelation was checked using Global Moran’s index (Moran’s I). Hotspot analysis was made using Gettis-OrdGi statistics. Additionally, spatial scan statistics were applied to identify significant primary and secondary cluster of anemia. Mixed effect ordinal logistics were fitted to determine factors associated with the level of anemia. Result The spatial distribution of anemia in Ethiopia among adults age 15–59 was found to be clustered (Global Moran’s I = 0.81, p value < 0.0001). In the multivariable mixed-effect ordinal regression analysis; Females [AOR = 1.53; 95% CI: 1.42, 1.66], Never married [AOR = 0.86; 95% CI: 0.77, 0.96], highly educated [AOR = 0.71; 95% CI: 0.60, 0.84], rural residents [AOR = 1.53; 95% CI: 1.23, 1.81], rich wealth status [AOR = 0.77; 95% CI: 0.69, 0.86] and underweight [AOR = 1.15; 1.06, 1.24] were significant predictors of anemia among adults. Conclusions A significant clustering of anemia among adults aged 15–59 were found in Ethiopia and the significant hotspot areas with high cluster anemia were identified in Somalia, Afar, Gambella, Dire Dewa and Harari regions. Besides, sex, marital status, educational level, place of residence, region, wealth index and BMI were significant predictors of anemia. Therefore, effective public health intervention and nutritional education should be designed for the identified hotspot areas and risk groups in order to decrease the incidence of anemia.