Publications Summary

Document Type
Working Papers
Publication Topic(s)
Anemia, Child Health and Development
Benin, Burundi, Rwanda, Senegal, Uganda, Jordan, Cambodia, Maldives, Myanmar, Haiti
Recommended Citation
Benedict, Rukundo K., Sara Riese, Thomas W. Pullum, and Erin Milner. 2022. Examining the Association between Anemia and Early Childhood Development in 9 Low- and Middle-income Countries. DHS Working Papers No. 188. Rockville, Maryland, USA: ICF.
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Publication Date
September 2022
Publication ID

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Anemia is a significant public health problem in many low- and middle-income countries (LMICs), with young children being especially vulnerable. Iron deficiency is a leading cause of anemia and prior studies have shown associations between low iron status/iron deficiency anemia and poor child development outcomes. In LMICs, 43% of children under the age of 5 years are at risk of not meeting their developmental potential. However, few studies have examined associations between anemia status and early childhood development (ECD) in large population-based surveys. We examined the associations between severe or moderate anemia and ECD domains (literacy- numeracy, physical, social-emotional, and learning) and an overall ECD index among children age 36–59 months. Demographic and Health Survey (DHS) data from the last phase of The DHS Program (DHS-7) that included the ECD module and hemoglobin testing in children under age 5 were used. Bivariate and multivariate logistic regressions were run for each of the five outcomes. Multivariate models controlled for early learning/interaction variables, child, maternal, and paternal characteristics, and socio-economic and household characteristics. Results showed almost no significant associations between anemia and ECD domains or the overall ECD index except for social- emotional development in Benin (AOR = 1.00 p < .05) and physical development in Maldives (AORs = 0.97 p < .05). Attendance at an early childhood education program was also significantly associated with the outcomes in many of the countries. Our findings reinforce the importance of the Nurturing Care Framework which describes a multi-sectoral approach to promote ECD in LMICs.


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