Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis

Tadesse, Sisay Eshete; Zerga, Aregash Abebayehu; Mekonnen, Tefera Chane; Tadesse, Abay Woday; Hussien, Fozia Mohammed; Feleke, Yitbarek Wasihun; Anagaw, Melaku Yalew; Ayele, Fanos Yeshanew

doi:https://doi.org/10.1155/2022/1382940

Anemia

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Abstract Background Methods and Materials Discussion Data Availability Conflicts of Interest Authors’ Contributions Acknowledgments References Copyright Related Articles

Review Article | Open Access

Volume 2022 | Article ID 1382940 | https://doi.org/10.1155/2022/1382940

Burden and Determinants of Anemia among Under-Five Children in Africa: Systematic Review and Meta-Analysis

Sisay Eshete Tadesse,¹Aregash Abebayehu Zerga,¹Tefera Chane Mekonnen,¹Abay Woday Tadesse,²Fozia Mohammed Hussien,¹Yitbarek Wasihun Feleke,¹Melaku Yalew Anagaw,³and Fanos Yeshanew Ayele¹

Academic Editor: Alemayehu Toma

Received15 Apr 2022

Revised14 Jul 2022

Accepted21 Jul 2022

Published11 Sept 2022

Abstract

Introduction. Globally, anemia among under-five children is a serious public health problem. Even if there are pocket studies here and there, there is limited evidence on the pooled prevalence of anemia among under-five children in Africa. Therefore, the aim of this study was to determine the pooled prevalence and determinants of anemia. Methods and Analysis. This systematic review and meta-analysis was done following the PRISMA guidelines. A comprehensive search was made in PubMed/MEDLINE, Cochrane Library, HINARI, and Ethiopian Journal of Health Development for studies published since 2009. It was supplemented with Google Scholar search. Study selection, data extraction, and quality of studies were assessed by eight reviewers. The Cochrane Q test and I² test statistic were used to test the heterogeneity of studies. A random-effects model of DerSimonian-Laird method was used. Result. A total of 37 articles were included in this systematic review and meta-analysis. The pooled prevalence of anemia among under-five children in Africa was 59% (95% CI: 55, 63). Being female (AOR = 0.71; 95% CI: 0.57, 0.87), maternal education (AOR = 1.47; 95% CI: 1.31, 1.66), residence (AOR = 0.80; 95% CI: 0.67, 0.95), and family size (AOR = 0.93; 95% CI: 0.89, 0.98) were the determinants of anemia among African under-five children. Conclusion and Recommendation. This pooled study revealed that anemia was a severe public health problem. Sex, maternal education, residence, and family size were the determinants of anemia. Therefore, anemia prevention strategy should include sex consideration, educating mothers through youth education, area specific intervention, and encouraging birth spacing.

1. Background

Anemia among under-five children is defined as a hemoglobin level <11 mg/dl or children with hematocrit less than 33% [1]. Worldwide, anemia among under-five children is a major public health problem [2]. Globally, 20 million infants were born with low birth weight (LBW) every year. Nearly, 3.6 million of them died before celebrating their 28 days, of whom almost two-thirds were located in Sub-Saharan Africa and Southern Asia [3]. The effect of anemia can extend up to postpartum period and even newly delivered baby may suffer from a reduced iron store problem up to one year [4]. In developing countries, 46–66% of children under the age of five were affected by anemia [3]. African and Asian regions were the major contributor for a high burden of anemia [5].

The rapid growth and cognitive development of children make them more vulnerable for the development of anemia [6]. The consequences of iron deficiency anemia (IDA) during childhood include growth retardation, reduced school achievement, impaired motor and cognitive development, and increased morbidity and mortality. Mental impairments at early age are thought to be irreversible and the consequences may continue even after treatment, reinforcing the importance of early detection and prevention [7, 8].

The causes for anemia among under-five children are complex. Among these, low birth weight, undernutrition, poor socioeconomic status, household food insecurity, duration of breast feeding, poor dietary iron intake, poor maternal educational status, diarrhea, fever, poverty, poor sanitation and hygiene, monotonous diet, parent’s level of education, and maternal anemia were the commonest contributors for under-five anemia [9–13].

Despite the numerous interventions done so far by the government of African countries and other concerning stakeholders, anemia among under-five children is still a severe public health concern [14–19]. Even though many independent pocket studies have been conducted in the region, the results were inconsistent and the prevalence varies significantly between studies [20–22]. In Africa, the pooled prevalence and determinants of anemia among under-five children have not been yet done. Assessing the pooled result will help to inspire the government’s commitment and increase the social and resource mobilization in order to enhance the implementation of evidence based interventions for culminating the effect of anemia among under-five children in particular and the nation in general. Therefore, the aim of this study was to determine the pooled prevalence and determinants of anemia among under-five children in Africa. The findings of this study will help policy makers, program planners, health care providers, and concerned stakeholders to work more on anemia in order to reduce the prevalence of anemia, its consequences, and complication among under-five children.

Prompt identification and treatment of anemia lead to overall improvement of population health outcomes, improved physical exercise performance, and well-being that results in enhanced economic productivity.

2. Methods and Materials

2.1. Patient and Public Involvement

All under-five children in Africa were involved in this study.

2.2. Eligibility Criteria

All studies that reported prevalence and determinants of anemia among under-five children in Africa using English language and gray literatures were included. For estimating the prevalence of anemia, studies with cross-sectional design were included, while, for pooling the determinants of anemia, cross-sectional and case-control studies were included in the study. While studies whose full texts cannot be accessed after trying to contact the primary investigator within 3 months, descriptive studies, systematic reviews of the effects of an intervention, review articles, conference abstract and editorials were excluded from the study.

2.3. Search Strategies

This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [23]. The study was conducted following the Joanna Briggs Institute (JBI) criteria. Data bases such as MEDLINE (via PubMed), EMBASE, and Cochrane Library, SCOPUS, HINARY, and Google Scholar were used to extensively search the relevant articles conducted since January 1, 2009. Gray literatures were also included by manual search.

2.4. Search Terms Used

The strategy applied to search articles from the electronic data bases was (anemia) OR (“iron deficiency anemia”) OR (“low hemoglobin level”) AND (determinants) OR (“associated factors”) (“Under Five Children”) AND (Ethiopia) OR (Eritrea) OR (Kenya) OR (Angola) OR (Benin) OR (Botswana) OR (“Burkina Faso”) OR (Burundi) OR (Cameroon) OR (“Cape Verde”) OR (“Central African Republic of Chad”) OR (Comoros) OR (Congo) OR (“Côte d’Ivoire”) OR (Djibouti) OR (“Equatorial Guinea”) OR (Gabon) OR (Gambia) OR (Ghana) OR (Guinea) OR (“Guinea-Bissau”) OR (Lesotho) OR (Liberia) OR (Madagascar) OR (Malawi) OR (MAli) OR (Mauritania) OR (Mauritius) OR (Mozambique) OR (Namibia) OR (Niger) OR (Nigeria) OR (Réunion) OR (Rwanda) OR (“Sao Tome and Principe”) OR (Senegal) OR (“Seychelles”) OR (Sierra Leone) OR (Somalia) OR (“South Africa”) OR (“Sudan”) OR (Swaziland) OR (Tanzania) OR (Togo) OR (Uganda) OR (“Western Sahara”) OR (Zambia) OR (Zimbabwe).

2.5. Data Extraction

After obtaining the full text of all articles, duplicates were screened and removed from the citation manger. Based on the eligibility criteria, eight reviewers (SE, AA, TC, AW, MY, FM, FY, and YW) independently reviewed the studies by title, abstract, and full article. Those included and undecided studies were further assessed by reading the full text. Studies that were not eligible based on the full text assessment were excluded and reasons were described for their exclusion in combination with the PRISMA flow diagram to summarize the selection procedure [23]. Studies that passed through this selection process were included in this study. Discrepancies between authors were resolved through discussion and consensus. The study characteristics (author, year of publication, region, target group, sample size, study design, response rate, and children with anemia), subject recruitment procedures, count data with (2 × 2 tables), crude odds ratio (where count data were not found), and population characteristics were extracted by using extraction sheet developed with Microsoft Excel 2013.

2.6. Quality Assessment and Risk of Bias

The Joanna Briggs Institute (JBI) critical appraisal check list was used to assess the quality of each paper. During data extraction, eight investigators independently performed the quality assessment. The quality scores of six data extractors were averaged. Any disagreement between investigators was solved by discussion and consensus. Finally, studies with higher scores (>50%) were included in the systematic review and meta-analysis.

2.7. Data Synthesis and Analysis

Data were analyzed using STATA version 14.0. The pooled proportion was calculated to estimate the prevalence of anemia. The pooled odds ratio (OR) with 95% CI was determined to estimate the determinants of anemia among under-five children. The degree of heterogeneity was checked by Cochran Q and I² statistics. The Cochrane Q statistic was considered significant, if the value is <0.10, while the I² statistics at least 50% was considered to be significant [24, 25]. Since the variation between the study findings is significant, a random-effects model with 95% confidence interval was used. Heterogeneity was checked by running metaregression, subgroup analysis, and sensitivity analysis. Subgroup analysis was performed based on sex and study setting (region). Funnel plots analysis, Egger weighted regression, and Begg rank correlation tests were done to detect publication bias ( was considered as a suggestive of statistically significant publication bias) [25, 26].

2.8. Registration and Reporting

This systematic review and meta-analysis was registered in the PROSPERO with a CRD number of 42020150881.

2.9. Ethical Clearance

This study was reviewed and approved by institutional review board of College of Medicine and Health Sciences, Wollo University.

3. Result

A total of 331,236 articles were retrieved by literature search (Figure 1). Of these, 129,180 were excluded because of duplication, 201,898 did not have any relation with the aim of this study, and 121 did not meet the eligibility criteria. Finally, only 37 articles were included in this systematic review and meta-analysis. All included articles were full text and done using cross-sectional study design with one cohort [27] and three case controls [28–30]. The sample population varied from 210 [28] to 8,260 [31] children aging between 0 and 59 months. In this study, a total of 67,647 under-five children were included. The overall information regarding the prevalence of anemia was obtained from twenty African countries. These countries were Benin [32], Cameroon [33], Cape Verde [34], Congo [22], Ethiopia [14, 15, 31, 35–42], Gambia [43], Ghana [18, 28, 44], Guinea [20, 45], Kenya [19, 46], Lesotho [47], Malawi [48], Mozambique [29], Nigeria [49, 50], Rwanda [21], Senegal [17], Sierra Leone [51], South Africa [27], Tanzania [16, 30, 52–55], Togo [56], and Uganda [57–59] (Table 1).

3.1. Prevalence of Anemia among Under-Five Children in Africa

The overall pooled prevalence of anemia among under-five children in Africa was 59% (95% CI: 55, 63). The true variability among studies other than chance was 100% (I² = 100%, value = 0.000). The lowest prevalence was observed in Rwanda 7% (95% CI: 7%, 7%), while the highest prevalence was observed in Senegal 87% (95% CI: 86%, 87%) (Figure 1). A study done in Rwanda did not include the milder form of anemia. This may be the reason for the lowest report of anemia prevalence in Rwanda (Figure 2).

To deal with the possible sources of heterogeneity, subgroup analysis was done by sex and region (study setting). The analysis result showed that heterogeneity still exists in both parameters mentioned above. In terms of region, the sources of heterogeneity were Ethiopia, Tanzania, Lesotho, Ghana, and Uganda.

The following funnel plot appears asymmetric; even if it indicates the presence of publication bias, it was not statistically significant (Figure 3).

3.2. Sensitivity Analysis

3.2.1. Determinants of Anemia among Under-Five Children in Africa

The result of this systematic review and meta-analysis indicated that sex of a child, maternal educational status, residence, and family size were the pooled determinants of anemia among under-five children in Africa. Being female is a protective against anemia among under-five children (AOR = 0.71; 95% CI: 0.57, 0.87), Mothers who were unable to read and write were 53% times more likely to have anemic child (AOR = 1.47; 95% CI: 1.31, 1.65). Those children from rural setting were 20% less likely to be affected by anemia as compared to children from urban setting (AOR = 0.80; 95% CI: 0.67, 0.95). Under-five children from a family size of less than five were 7% less likely to be affected by anemia (AOR = 0.93; 95% CI: 0.89, 0.98) (Table 2).

4. Discussion

This study was aimed at estimating the pooled prevalence and determinants of anemia among under-five children in Africa by reviewing the existing pocket studies. Based on the finding of this study, the pooled prevalence of anemia among under-five children in Africa was 59%. This finding is in line with a global prevalence of anemia [60]. According to the classification of World Health Organization (WHO), it was categorized under severe public health problem [61]. This finding suggests that, based on the current pace, it is difficult to achieve the global 50% reduction of anemia by 2025 in Africa [62].

This study showed that sex was a significant predictor of anemia among under-five children. Being female is protective against anemia among under-five children. The possible explanation for anemia discrepancy by sex could be due to the state of rapid growth of male children compared to females in the first months of life which increases their micronutrient requirement including iron, which cannot be met by diet alone [63]. If this physiological state is not compensated with iron rich complementary foods, risk of iron deficiency anemia will be higher in male children as compared to females.

This finding revealed that maternal education was a significant predictor of anemia among under-five children. Mothers with informal education were 53% more likely to have child with anemia. This finding is in line with a systematic review and meta-analysis study conducted in Ethiopia [64]. This might be because mothers with no formal education may not understand the introduction of scientifically sound feeding practices and are less likely to follow the recommended child feeding practices [65]. In addition, mothers with no education were negatively affecting the socioeconomic status of households which in turn limits food purchasing power and is a strong predictor for nutritional outcomes of children. Hence, their access to hem iron source food is limited [66]. In order to tackle the effect of anemia in children, nutrition education is suggested for mothers [67].

This study indicated that residence was a significant predictor of anemia among under-five children. Those children from rural setting were 20% less likely to be affected by anemia as compared to children from urban setting. This may be because mothers in the rural setting will breastfed their children exclusively till six months of age and continue breastfeeding till 24 months and more. Since iron in breast milk is more likely to be absorbed and utilized by the child’s body, it will contribute for the normal stores of iron, which will help in reducing anemia among under-five children. In order to turn on the health loss due to anemia in children, UNICEF and WHO jointly recommended adequate breastfeeding practices [67]. But the finding of this study is inconsistent with a systematic review and meta-analysis study conducted in Ethiopia [64].

This study showed that family size was a significant predictor of anemia among under-five children in Africa. Those children from a household size of <5 were 7% less likely to be anemic as compared to their counterparts. This could be because large family size is associated with food insecurity. The lesser the families are, the more likely adequate and diversified diet can be afforded, which is rich in iron [68].

Some of the limitations of this study were articles published only in English language that were included. This may affect the prevalence estimation of anemia. Another limitation of this study was articles which were conducted among pediatrics that were not included. The data were obtained from twenty African countries. However, the analyzed pooled prevalence may not fully represent the prevalence of anemia in Africa because there is lack of evidences in some parts of the region.

To conclude, based on this systematic review and meta-analysis, anemia was a severe public health problem among under-five children in Africa. Sex, maternal education, residence, and family size were the determinants of anemia among under-five children. Therefore, adequate intervention should be designed by considering sex and residence difference, addressing maternal illiteracy through youth education and nutrition education, and promoting birth spacing.

Data Availability

All the required data is included within the article.

Conflicts of Interest

The authors declare that there are no conflicts of interest.

Authors’ Contributions

SE and AA participated in the conceptualization, searching, and selection, data extraction and analysis, writing, and approving the manuscript. TC participated in data extraction and analysis, report writing-up, writing, and approving the manuscript. AW and FY participated in the conceptualization, searching, and selection, writing, and approving the manuscript. FM participated in the conceptualization, editing, and approving the manuscript. MY took part in searching and selection, data analysis, revising, and approving the manuscript. YW contributed to searching and selection, data extraction and analysis, writing the manuscript, and approving the manuscript.

Acknowledgments

The authors would like to acknowledge PROSPERO for registering this protocol.

References

S. Geneva and W. H. Organization, “Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity,” Vitamin and Mineral Nutrition Information System, World Health Organization, Geneva, Switzerland, 2011.
View at: Google Scholar
F. Habibzadeh, “The control of non-communicable diseases in rural Iran,” Lancet, vol. 379, no. 9810, pp. 6-7, 2012.
View at: Publisher Site | Google Scholar
T. M. Wardlaw, Low Birthweight: Country, Regional and Global Estimates, Unicef, New York, NY, USA, 2004.
F. Mardones, A. Rioseco, M. Ocqueteau et al., “Anemia in pregnant women from the community of puente alto, chile,” Revista Medica de Chile, vol. 131, no. 5, pp. 520–525, 2003.
View at: Google Scholar
C. Who, “Worldwide prevalence of anaemia 1993–2005,” WHO Global Database on Anaemia, World Health Organization, Geneva, Switzerland, 2008, https://apps.who.int/iris/handle/10665/43894.
View at: Google Scholar
R. J. Stoltzfus, “Iron deficiency: global prevalence and consequences,” Food and Nutrition Bulletin, vol. 24, pp. S99–S103, 2003.
View at: Publisher Site | Google Scholar
T. Walter, “Effect of iron-deficiency anemia on cognitive skills and neuromaturation in infancy and childhood,” Food and Nutrition Bulletin, vol. 24, pp. S104–S110, 2003.
View at: Publisher Site | Google Scholar
D. R. Brunt, C. C. Grant, C. R. Wall, and P. W. Reed, “Interaction between risk factors for iron deficiency in young children,” Nutrition and Dietetics, vol. 69, no. 4, pp. 285–292, 2012.
View at: Publisher Site | Google Scholar
R. D. Semba, S. de Pee, M. O. Ricks, M. Sari, and M. W. Bloem, “Diarrhea and fever as risk factors for anemia among children under age five living in urban slum areas of Indonesia,” International Journal of Infectious Diseases, vol. 12, no. 1, pp. 62–70, 2008.
View at: Publisher Site | Google Scholar
S.-R. Pasricha, J. Black, S. Muthayya et al., “Determinants of anemia among young children in rural India,” Pediatrics, vol. 126, no. 1, pp. e140–e149, 2010.
View at: Publisher Site | Google Scholar
G. Egbi, M. Steiner-Asiedu, F. S. Kwesi et al., “Anaemia among school children older than five years in the Volta Region of Ghana,” The Pan African Medical Journal, vol. 17, no. 1, p. 10, 2014.
View at: Publisher Site | Google Scholar
O. Ngesa and H. Mwambi, “Prevalence and risk factors of anaemia among children aged between 6 months and 14 years in Kenya,” PLoS One, vol. 9, no. 11, Article ID e113756, 2014.
View at: Publisher Site | Google Scholar
A. Desalegn, A. Mossie, and L. Gedefaw, “Nutritional iron deficiency anemia: magnitude and its predictors among school age children, southwest Ethiopia: a community based cross-sectional study,” PLoS One, vol. 9, no. 12, Article ID e114059, 2014.
View at: Publisher Site | Google Scholar
R. A. Guled and N. M. Mamat, “Anaemia prevalence and its predictors among children aged 6 to 59 months in a pastoralist and agro pastoralist community of Somali region, eastern Ethiopia,” International Journal of Allied Health Sciences, vol. 1, no. 1, 2017.
View at: Google Scholar
G. Gebreegziabiher, B. Etana, and D. Niggusie, “Determinants of anemia among children aged 6–59 months living in Kilte Awulaelo Woreda, northern Ethiopia,” Anemia, vol. 2014, Article ID 245870, 9 pages, 2014.
View at: Publisher Site | Google Scholar
R. H. Simbauranga, E. Kamugisha, A. Hokororo, B. R. Kidenya, and J. Makani, “Prevalence and factors associated with severe anaemia amongst under-five children hospitalized at Bugando medical centre, Mwanza, Tanzania,” BMC Hematology, vol. 15, no. 1, pp. 13–19, 2015.
View at: Publisher Site | Google Scholar
S. Diouf, A. Sylla, F. Diop, A. Diallo, and M. Sarr, “Anemia among apparently healthy Senegalese children aged 9–15 months,” International Journal of Child Health and Nutrition, vol. 2, no. 1, pp. 9–14, 2013.
View at: Publisher Site | Google Scholar
K. M. VanBuskirk, A. Ofosu, A. Kennedy, and D. M. Denno, “Pediatric anemia in rural Ghana: a cross-sectional study of prevalence and risk factors,” Journal of Tropical Pediatrics, vol. 60, no. 4, pp. 308–317, 2014.
View at: Publisher Site | Google Scholar
E. M. Foote, P. S. Suchdev, T. N. Williams et al., “Determinants of anemia among preschool children in rural, western Kenya,” The American Journal of Tropical Medicine and Hygiene, vol. 88, no. 4, pp. 757–764, 2013.
View at: Publisher Site | Google Scholar
B. A. Woodruff, J. P. Wirth, I. Ngnie-Teta et al., “Determinants of stunting, wasting, and anemia in Guinean preschool-age children: an analysis of DHS data from 1999, 2005, and 2012,” Food and Nutrition Bulletin, vol. 39, no. 1, pp. 39–53, 2018.
View at: Publisher Site | Google Scholar
F. Kateera, C. M. Ingabire, E. Hakizimana et al., “Malaria, anaemia and under-nutrition: three frequently co-existing conditions among preschool children in rural Rwanda,” Malaria Journal, vol. 14, no. 1, pp. 440–511, 2015.
View at: Publisher Site | Google Scholar
E. Bahizire, K. Mubagwa, P. Donnen et al., “High prevalence of anemia but low level of iron deficiency in preschool children during a low transmission period of malaria in rural Kivu, democratic republic of the Congo,” The American Journal of Tropical Medicine and Hygiene, vol. 97, no. 2, pp. 489–496, 2017.
View at: Publisher Site | Google Scholar
D. Moher, L. Shamseer, M. Clarke et al., “Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement,” Systematic Reviews, vol. 4, no. 1, Article ID 1, 2015.
View at: Publisher Site | Google Scholar
R. Tezera, Z. Sahile, D. Yilma, E. Misganaw, and E. Mulu, “Prevalence of anemia among school-age children in Ethiopia: a systematic review and meta-analysis,” Systematic Reviews, vol. 7, no. 1, p. 80, 2018.
View at: Publisher Site | Google Scholar
J. Higgins, Cochrane Handbook for Systematic Reviews of Interventions, The Cochrane Collaboration, London, UK, 2011.
M. Egger, G. D. Smith, M. Schneider, and C. Minder, “Bias in meta-analysis detected by a simple, graphical test,” BMJ, vol. 315, no. 7109, pp. 629–634, 1997.
View at: Publisher Site | Google Scholar
R. L. Mamabolo and M. Alberts, “Prevalence of anaemia and its associated factors in African children at one and three years residing in the Capricorn District of Limpopo province, South Africa,” Curationis, vol. 37, no. 1, pp. 1160–1169, 2014.
View at: Publisher Site | Google Scholar
P. A. Parbey, E. Tarkang, E. Manu et al., “Risk Factors of anaemia among children under five years in the Hohoe municipality, Ghana: A case control study,” Anemia, vol. 2019, Article ID 2139717, 9 pages, 2019.
View at: Publisher Site | Google Scholar
C. Moraleda, R. Aguilar, L. Quintó et al., “Anaemia in hospitalised preschool children from a rural area in Mozambique: a case control study in search for aetiological agents,” BMC Pediatrics, vol. 17, no. 1, p. 63, 2017.
View at: Publisher Site | Google Scholar
E. Kahigwa, D. Schellenberg, S. Sanz et al., “Risk factors for presentation to hospital with severe anaemia in Tanzanian children: a case-control study,” Tropical Medicine and International Health, vol. 7, no. 10, pp. 823–830, 2002.
View at: Publisher Site | Google Scholar
D. Habte, K. Asrat, M. Magafu et al., “Maternal risk factors for childhood anaemia in Ethiopia,” African Journal of Reproductive Health, vol. 17, no. 3, pp. 110–118, 2013.
View at: Google Scholar
H. Alaofè, J. Burney, R. Naylor, and D. Taren, “Prevalence of anaemia, deficiencies of iron and vitamin A and their determinants in rural women and young children: a cross-sectional study in Kalalé district of northern Benin,” Public Health Nutrition, vol. 20, no. 7, pp. 1203–1213, 2017.
View at: Publisher Site | Google Scholar
R. Engle-Stone, M. Nankap, A. O. Ndjebayi, J. G. Erhardt, and K. H. Brown, “Plasma ferritin and soluble transferrin receptor concentrations and body iron stores identify similar risk factors for iron deficiency but result in different estimates of the national prevalence of iron deficiency and iron-deficiency anemia among women and children in Cameroon,” Journal of Nutrition, vol. 143, no. 3, pp. 369–377, 2013.
View at: Publisher Site | Google Scholar
R. M. L. Semedo, M. M. A. S. Santos, M. R. Baião, R. R. Luiz, and G. V. da Veiga, “Prevalence of anaemia and associated factors among children below five years of age in Cape Verde, West Africa,” Journal of Health, Population and Nutrition, vol. 32, no. 4, pp. 646–657, 2014.
View at: Google Scholar
A. Gebreweld, N. Ali, R. Ali, and T. Fisha, “Prevalence of anemia and its associated factors among children under five years of age attending at Guguftu health center, South Wollo, Northeast Ethiopia,” PLoS One, vol. 14, no. 7, Article ID e0218961, 2019.
View at: Publisher Site | Google Scholar
A. G. Wasihun, M. Teferi, L. Negash et al., “Intestinal parasitosis, anaemia and risk factors among pre-school children in Tigray region, northern Ethiopia,” BMC Infectious Diseases, vol. 20, pp. 379–411, 2020.
View at: Publisher Site | Google Scholar
Y. Jemal, J. Haidar, and W. Kogi Makau, “The magnitude and determinants of anaemia among refugee preschool children from the Kebribeyah refugee camp, Somali region, Ethiopia,” South African Journal of Clinical Nutrition, vol. 30, no. 1, pp. 1–6, 2017.
View at: Publisher Site | Google Scholar
H. Woldie, Y. Kebede, and A. Tariku, “Factors associated with anemia among children aged 6–23 months attending growth monitoring at Tsitsika health center, Wag-Himra zone, northeast Ethiopia,” Journal of Nutrition and Metabolism, vol. 2015, pp. 1–9, 2015.
View at: Publisher Site | Google Scholar
K. T. Roba, T. P. O’Connor, T. Belachew, and N. M. O’Brien, “Anemia and undernutrition among children aged 6–23 months in two agroecological zones of rural Ethiopia,” Pediatric Health, Medicine and Therapeutics, vol. 7, pp. 131–140, 2016.
View at: Publisher Site | Google Scholar
K. F. Muchie, “Determinants of severity levels of anemia among children aged 6–59 months in Ethiopia: further analysis of the 2011 Ethiopian demographic and health survey,” BMC Nutrition, vol. 2, no. 1, p. 51, 2016.
View at: Publisher Site | Google Scholar
B. G. Malako, B. O. Asamoah, M. Tadesse, R. Hussen, and M. T. Gebre, “Stunting and anemia among children 6–23 months old in Damot Sore district, Southern Ethiopia,” BMC nutrition, vol. 5, no. 1, p. 3, 2019.
View at: Publisher Site | Google Scholar
M. Melku, K. A. Alene, B. Terefe et al., “Anemia severity among children aged 6–59 months in Gondar town, Ethiopia: a community-based cross-sectional study,” The Italian Journal of Pediatrics, vol. 44, no. 1, p. 107, 2018.
View at: Publisher Site | Google Scholar
N. Petry, B. Jallow, Y. Sawo et al., “Micronutrient deficiencies, nutritional status and the determinants of anemia in children 0–59 months of age and non-pregnant women of reproductive age in the Gambia,” Nutrients, vol. 11, no. 10, p. 2275, 2019.
View at: Publisher Site | Google Scholar
D. A. Amugsi, “Determinants of normal haemoglobin concentration among children in Ghana: a positive deviance analysis of nationally representative cross-sectional survey data,” Scientific Reports, vol. 10, no. 1, pp. 7175–7179, 2020.
View at: Publisher Site | Google Scholar
C. J. Thorne, L. M. Roberts, D. R. Edwards, M. S. Haque, A. Cumbassa, and A. R. Last, “Anaemia and malnutrition in children aged 0–59 months on the Bijagos Archipelago, Guinea-Bissau, West Africa: a cross-sectional, population-based study,” Paediatrics and International Child Health, vol. 33, no. 3, pp. 151–160, 2013.
View at: Publisher Site | Google Scholar
N. L. Wangusi, J. N. Waudo, and B. J. Mugendi, “Prevalence and determinants of iron-deficiency anaemia among children 6–23 months attending Thika level-5 hospital,” International Journal of Food Science and Nutrition, vol. 1, 2016.
View at: Google Scholar
R. T. Gaston, S. Ramroop, and F. Habyarimana, “Determinants of factors associated with anemia among children under five years in Lesotho,” African Population Studies, vol. 32, no. 1, 2018.
View at: Google Scholar
P. A. M. Ntenda, O. Nkoka, P. Bass, and T. Senghore, “Maternal anemia is a potential risk factor for anemia in children aged 6–59 months in Southern Africa: a multilevel analysis,” BMC Public Health, vol. 18, no. 1, p. 650, 2018.
View at: Publisher Site | Google Scholar
F. O. Akinbo, R. Omoregie, R. Mordi, and C. E. Okaka, “Prevalence of malaria and anemia among young children in a tertiary hospital in Benin city, Edo state, Nigeria,” Fooyin Journal of Health Sciences, vol. 1, no. 2, pp. 81–84, 2009.
View at: Publisher Site | Google Scholar
G. Onyemaobi and I. Onimawo, “Anaemia prevalence among under-five children in Imo state, Nigeria,” Australian Journal of Basic and Applied Sciences, vol. 5, no. 2, pp. 122–126, 2011.
View at: Google Scholar
J. P. Wirth, F. Rohner, B. A. Woodruff et al., “Anemia, micronutrient deficiencies, and malaria in children and women in Sierra Leone prior to the Ebola outbreak-findings of a cross-sectional study,” PLoS One, vol. 11, no. 5, Article ID e0155031, 2016.
View at: Publisher Site | Google Scholar
F. P. Mghanga, C. M. Genge, L. Yeyeye et al., “Magnitude, severity, and morphological types of anemia in hospitalized children under the age of five in southern Tanzania,” Cureus, vol. 9, no. 7, Article ID e1499, 2017.
View at: Publisher Site | Google Scholar
O. O. Ojoniyi, C. O. Odimegwu, E. O. Olamijuwon, and J. O. Akinyemi, “Does education offset the effect of maternal disadvantage on childhood anaemia in Tanzania? evidence from a nationally representative cross-sectional study,” BMC Pediatrics, vol. 19, no. 1, p. 89, 2019.
View at: Publisher Site | Google Scholar
D. Kejo, P. M. Petrucka, H. Martin, M. E. Kimanya, and T. C. Mosha, “Prevalence and predictors of anemia among children under 5 years of age in Arusha district, Tanzania,” Pediatric Health, Medicine and Therapeutics, vol. 9, pp. 9–15, 2018.
View at: Publisher Site | Google Scholar
O. Ojoniyi, “Prevalence and risk factors of anemia among under-five children in Tanzania,” 2017, https://scholar.google.com/citations?user=-LZCGLIAAAAJ&hl=en.
View at: Google Scholar
A. Nambiema, A. Robert, and I. Yaya, “Prevalence and risk factors of anemia in children aged from 6 to 59 months in Togo: analysis from Togo demographic and health survey data, 2013–2014,” BMC Public Health, vol. 19, no. 1, p. 215, 2019.
View at: Publisher Site | Google Scholar
F. Kuziga, Y. Adoke, and R. K. Wanyenze, “Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: a cross-sectional study,” BMC Pediatrics, vol. 17, no. 1, Article ID 25, 2017.
View at: Publisher Site | Google Scholar
M. M. Ali, “Risk factors associated with anaemia among children under five years of age in Uganda 2018,” 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614984/.
View at: Google Scholar
M. P. Menon and S. S. Yoon, “Prevalence and factors associated with anemia among children under 5 years of age—Uganda, 2009,” The American Journal of Tropical Medicine and Hygiene, vol. 93, no. 3, pp. 521–526, 2015.
View at: Publisher Site | Google Scholar
G. A. Stevens, M. M. Finucane, L. M. De-Regil 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,” Lancet Global Health, vol. 1, no. 1, pp. e16–e25, 2013.
View at: Publisher Site | Google Scholar
WHO, The Global Prevalence of Anaemia in 2011, World Health Organization, Geneva, Switzerland, 2015.
W. H. Organization, Global Nutrition Targets 2025: Anaemia Policy Brief, World Health Organization, Geneva, Switzerland, 2014.
C. M. Chaparro, “Setting the stage for child health and development: prevention of iron deficiency in early infancy,” Journal of Nutrition, vol. 138, no. 12, pp. 2529–2533, 2008.
View at: Publisher Site | Google Scholar
A. Gebrie and A. Alebel, “A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia,” African Health Sciences, vol. 20, no. 4, pp. 2007–2021, 2020.
View at: Publisher Site | Google Scholar
H.-J. Choi, H.-J. Lee, H. B. Jang et al., “Effects of maternal education on diet, anemia, and iron deficiency in Korean school-aged children,” BMC Public Health, vol. 11, no. 1, p. 870, 2011.
View at: Publisher Site | Google Scholar
D. Makoka, The Impact of Maternal Education on Child Nutrition: Evidence from Malawi, Tanzania, and Zimbabwe, ICF International, Fairfax, VA, USA, 2013.
W. H. Organization, Iron Deficiency Anemia. Assessment, Prevention, and Control, World Health Organization, Geneva, Switzerland, 2001.
O. Dary and R. Hurrell, “Guidelines on food fortification with micronutrients,” Food and Agricultural Organization of the United Nations, World Health Organization, Geneva, Switzerland, 2006.
View at: Google Scholar

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Copyright © 2022 Sisay Eshete Tadesse et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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