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      Trends in regional inequalities in childhood anemia in Ethiopia: evidence from the 2005–2016 Ethiopian Demographic and Health Surveys

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          Abstract

          Introduction

          Globally, 269 million children aged 6–59 months were anemic in 2019. Of these, 103 million anemic children were from Africa. Childhood anemia is still a serious public health concern in SSA countries, including Ethiopia. In Ethiopia, the prevalence of childhood anemia largely varies by geographic administration regions. This study is aimed to examine trends in regional inequalities in childhood anemia in Ethiopia over the period 2005–2016.

          Method

          This cross-sectional study was based on a pooled total sample of 17,766 children aged 6–59 months drawn from three rounds of the Ethiopian Demography and Health Surveys (2005–2016). We employed multilevel binary logistic regression analysis to identify the determinants of childhood anemia among children aged 6–59 months. We also used Theil and multivariate decomposition analyses to examine the levels and trends in relative regional inequalities in childhood anemia.

          Result

          A combination of individual-, household- and community-level factors were significantly (p < 001) associated with childhood anemia. From the pooled data, the highest childhood anemia was observed in Somali (78.68%) followed by Afar region (72.76%) while the lowest childhood anemia was in Amhara (41.01%), Addis Ababa (42.64%) and SNNPR (44%) between 2005 and 2016. The total relative inequality declined from 0.620 in 2005 to 0.548 in 2016. Overall, one-third of change in regional inequalities in childhood anemia was due to the differential resulted from the difference in observable characteristics of the subjects.

          Conclusion

          Overall progress made in Ethiopia was very slow with only a 13.14% reduction in the relative regional inequalities in childhood anemia over 11 years. The present study underscores addressing the existing disparities in socioeconomic status, maternal anemia and maternal employment status between emerging and non-emerging regions to reduce regional inequality in childhood anemia.

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          Most cited references26

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          Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour

          Many ecological- and individual-level analyses of voting behaviour use multiple regressions with a considerable number of independent variables but few discussions of their results pay any attention to the potential impact of inter-relationships among those independent variables—do they confound the regression parameters and hence their interpretation? Three empirical examples are deployed to address that question, with results which suggest considerable problems. Inter-relationships between variables, even if not approaching high collinearity, can have a substantial impact on regression model results and how they are interpreted in the light of prior expectations. Confounded relationships could be the norm and interpretations open to doubt, unless considerable care is applied in the analyses and an extended principal components method for doing that is introduced and exemplified.
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            Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019

            Background Anemia is a common disease which affects around 40% of children and 30% of reproductive age women and can have major health consequences. The present study reports the global, regional and national burden of anemia and its underlying causes between 1990 and 2019, by age, sex and socio-demographic index (SDI). Methods Publicly available data on the point prevalence and years lived with disability (YLDs) were retrieved from the global burden of disease (GBD) 2019 study for 204 countries and territories between 1990 and 2019. The point prevalence, YLD counts and rates per 100,000 population were presented, along with their corresponding 95% uncertainty intervals. Results In 2019, the global age-standardized point prevalence and YLD rates for anemia were 23,176.2 (22,943.5–23,418.6) and 672.4 (447.2–981.5) per 100,000 population, respectively. Moreover, the global age-standardized point prevalence and YLD rate decreased by 13.4% (12.1–14.5%) and 18.8% (16.9–20.8%), respectively, over the period 1990–2019. The highest national point prevalences of anemia were found in Zambia [49327.1 (95% UI: 46,838.5–51,700.1)], Mali [46890.1 (95% UI: 44,301.1–49,389.8)], and Burkina Faso [46117.2 (95% UI: 43,640.7–48,319.2)]. In 2019, the global point prevalence of anemia was highest in the 15–19 and 95+ age groups in females and males, respectively. Also, the burden of anemia was lower in regions with higher socio-economic development. Globally, most of the prevalent cases were attributable to dietary iron deficiency, as well as hemoglobinopathies and hemolytic anemias. Conclusions Anemia remains a major health problem, especially among females in less developed countries. The implementation of preventive programs with a focus on improving access to iron supplements, early diagnosis and the treatment of hemoglobinopathies should be taken into consideration. Supplementary Information The online version contains supplementary material available at 10.1186/s13045-021-01202-2.
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              National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data

              Summary Background Anaemia causes health and economic harms. The prevalence of anaemia in women aged 15–49 years, by pregnancy status, is indicator 2.2.3 of the UN Sustainable Development Goals, and the aim of halving the anaemia prevalence in women of reproductive age by 2030 is an extension of the 2025 global nutrition targets endorsed by the World Health Assembly (WHA). We aimed to estimate the prevalence of anaemia by severity for children aged 6–59 months, non-pregnant women aged 15–49 years, and pregnant women aged 15–49 years in 197 countries and territories and globally for the period 2000–19. Methods For this pooled analysis of population-representative data, we collated 489 data sources on haemoglobin distribution in children and women from 133 countries, including 4·5 million haemoglobin measurements. Our data sources comprised health examination, nutrition, and household surveys, accessed as anonymised individual records or as summary statistics such as mean haemoglobin and anaemia prevalence. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions in each population and country-year. This model allowed for coherent estimation of mean haemoglobin and prevalence of anaemia by severity. Findings Globally, in 2019, 40% (95% uncertainty interval [UI] 36–44) of children aged 6–59 months were anaemic, compared to 48% (45–51) in 2000. Globally, the prevalence of anaemia in non-pregnant women aged 15–49 years changed little between 2000 and 2019, from 31% (95% UI 28–34) to 30% (27–33), while in pregnant women aged 15–49 years it decreased from 41% (39–43) to 36% (34–39). In 2019, the prevalence of anaemia in children aged 6–59 months exceeded 70% in 11 countries and exceeded 50% in all women aged 15–49 years in ten countries. Globally in all populations and in most countries and regions, the prevalence of mild anaemia changed little, while moderate and severe anaemia declined in most populations and geographical locations, indicating a shift towards mild anaemia. Interpretation Globally, regionally, and in nearly all countries, progress on anaemia in women aged 15–49 years is insufficient to meet the WHA global nutrition target to halve anaemia prevalence by 2030, and the prevalence of anaemia in children also remains high. A better understanding of the context-specific causes of anaemia and quality implementation of effective multisectoral actions to address these causes are needed. Funding USAID, US Centers for Disease Control and Prevention, and Bill & Melinda Gates Foundation.
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                Author and article information

                Journal
                Discover Social Science and Health
                Discov Soc Sci Health
                Springer Science and Business Media LLC
                2731-0469
                December 2023
                March 30 2023
                : 3
                : 1
                Article
                10.1007/s44155-023-00038-0
                99fd5e1b-b545-41d9-b5ef-b5455417858c
                © 2023

                https://creativecommons.org/licenses/by/4.0

                https://creativecommons.org/licenses/by/4.0

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