Anaemia prevalence and determinants in under 5 years children: findings of a cross-sectional population-based study in Sudan

Abstract

Background Early childhood is an age at risk of anaemia and its deleterious consequences. In Sudan, there is limited evidence on the prevalence and determinant of anaemia in under-five children. This study was conducted in Sudan to assess the prevalence of anaemia in children and to identify its determinants. Methods We conducted a household survey involving children aged 6 months to 5 years in November 2016. A representative population was sampled across rural, urban and camps settlements across 18 states in Sudan. We used a pre-designed questionnaire data collection. Haemoglobin (Hb) level and malaria infection were checked. In this cross-sectional study, we dichotomized the outcome variable and performed logistic regression analyses. Results A total of 3094 children under 5 years enrolled in the study, 1566 (50.6%) of them were female and 690 (22.3%) of them were under 2 years old. Anaemia prevalence in the whole cohort (6 months - < 5 years) was 49.4% and the mean haemoglobin concentration was 108.1 (standard deviation (SD): 15.4) g/L. The prevalence in younger (6 months - < 2 years) children (61.9%) was higher than in older (2 - < 5 years) children (45.6%) (p < 0.001). Severe anaemia (Hb < 70 g/L) prevalence in the whole population was 1.6%. Age (Odds ratio (OR) 2.25, 95% confidence interval (95%CI) 1.75–2.90, p < 0.001), type of place of residence (OR 0.37, 95%CI 0.18–0.74, p = 0.005), maternal anaemia (OR 1.74, 95%CI 1.39–2.17, p < 0.001), and malaria infection (OR 2.82, 95%CI 1.56–5.11, p < 0.001) were the identified predictors of anaemia in the whole cohort. In younger children, only the economic class was an anaemia predictor, with a lower anaemia risk among the rich wealth class (OR 2.70, 95%CI 1.29–5.62, p = 0.008). However, in older children, three anaemia predictors were identified. These are maternal anaemia (OR 1.79, 95%CI 1.40–2.28, < 0.001), malaria infection (OR 2.77, 95%CI 1.48–5.21, p = 0.002), and type of residency (where camps’ residents were less likely affected with anaemia than rural children (OR 0.38, 95%CI 0.17–0.87, p = 0.022)). Conclusions About half of the under-5 children in Sudan are anaemic, with worse prevalence in younger children. Efforts targeted at improving socio-economic status, decreasing maternal anaemia and childhood malaria infection may mitigate this alarming trend.

Impact of malaria control interventions on malaria infection and anaemia in areas with irrigated schemes: a cross-sectional population-based study in Sudan

“…In such a low level of malaria transmission chronic malaria and repeated malaria infections are less common and therefore, may not be a major cause of anaemia. Studies from low to moderate transmission settings, including from Sudan [ 34 ], showed that anaemia was associated with malaria infection but not with the level of malaria transmission [ 27 , 58 – 60 ]. Moderate-to-severe anaemia (haemoglobin < 80 g/L) is a more sensitive measure to the association between anaemia and malaria compared to anaemia (haemoglobin < 110 g/L), which was used in this study [ 20 , 26 ].…”

“…Within each household, all household members were included in the study. Individual and household-related data were collected using a coded pre-tested questionnaire [ 34 ] and capillary blood samples were obtained from all eligible individuals. Written informed consent was obtained from participants.…”

Anaemia and malaria in low malaria transmission settings

“…Within each household, all household members were included in the study. Individual and household-related data were collected using a coded pre-tested questionnaire [122] and capillary blood samples were obtained from all eligible individuals. Written informed consent was obtained from participants.…”

“…In such a low level of malaria transmission chronic malaria and repeated malaria infections are less common and therefore, may not be a major cause of anaemia. Studies from low to moderate transmission settings, including from Sudan [122], showed that anaemia was associated with malaria infection but not with the level of malaria transmission [119,[144][145][146]. Moderate-to-severe anaemia (haemoglobin < 80g/L) is a more sensitive measure to the association between anaemia and malaria compared to anaemia (haemoglobin < 110g/L), which was used in this study [59,61].…”

“…The survey sample size was calculated to give precise estimates at national and subnational (state) levels and for rural, urban and camps (IDPs and refugees) strata. Background household, demographic, and socio-economic information, and interventions coverage and utilization data were collected using standard, pre-designed, pre-tested questionnaire that was designed to measure malaria related indicators [122]. From the survey database, relevant data was extracted and used in the analysis of this study.…”