Anemia prevalence and its predictors among children under‐five years in Ghana. A multilevel analysis of the cross‐sectional 2019 Ghana Malaria Indicator Survey

Abstract

Background and AimsDespite the implementation of anemia control interventions in Ghana, anemia prevalence is still high in children under‐fives. Reducing the prevalence of anemia requires identifying and targeting associated critical risk factors. This study seeks to identify predictors of anemia among children under‐fives in Ghana.MethodsNationally representative data from the 2019 Ghana Malaria Indicator Survey was used in this study. Both fixed and random effects (multilevel) logistic regression models were applied to 2434 children to identify critical factors associated with anemia.ResultsIn this study, 54% (95% confidence interval [CI] 52.0–57.0) of children under‐5 years were anemic. Infants were more likely to be anemic (66.7%) compared with other children below 5 years. In the multivariable multilevel model, the risk of anemia was found to be higher in younger children especially 6–11 months old (adjusted odds ratio [aOR] = 3.59, CI: 2.54–5.08) and 12–23 months old (aOR = 2.97, CI: 2.08–4.23), children who had malaria (aOR = 1.53, CI: 1.13–2.06), children whose mothers were not registered but not covered with health insurance (aOR = 1.45, CI: 1.21–1.74) or were not even registered for insurance (aOR = 1.49, CI: 1.15–1.93), children born to adolescent mothers (aOR = 2.21, CI: 1.36–3.57), children born to non‐Christian mothers (Islam [aOR = 1.53, CI: 1.17–2.00]), children born to families of poorer households (poorest [aOR = 3.01, CI: 1.64–5.51]; poorer [aOR = 2.56, CI: 1.65–3.98]); middle (aOR = 2.03, CI: 1.32–3.11) and richer (aOR = 1.78, CI: 1.19–2.64), and children who lived in either Upper East (aOR = 2.03, CI: 1.26–3.26) or Central (aOR = 2.52, CI: 1.42–4.47) regions. Significant unobserved community‐level differences in anemia prevalence were observed.ConclusionThe probability of anemia in children under‐fives differs substantially from one community to another, and the prevalence remains high. The identified critical risk factors should be addressed. Multifaceted and targeted approaches are needed to help reduce the anemia prevalence in this setting to achieve the multiple United Nation's Sustainable Development Goals, which are related to risk and prevalence of anemia by 2030.

Maternal Anemia Emerges as a Potential Risk Factor for Anemia in Children Aged 6-59 Months in Tanzania: Evidence from the 2022 TDHS-MIS Cross-Sectional Household Survey

“…Male children in this study had a higher probability of developing anemia compared to female children (AOR = 1.27; 95% CI: 1.06; 1.51). This trend is consistent with several other ndings in previous studies [10,23,26]. This might be explained by the fact that male children tend to have a higher growth rate, which results in an increased demand for iron in the body [32].…”

“…Additionally, children aged between 6 and 23 months (AOR = 1.72; 95% CI: 1.43; 2.07) had a higher chance of developing anemia compared to children over 23 months of age. This nding is in line with several previous studies [21,23,24,26]. After six months of age, children begin to introduce complementary foods into their diet.…”

“…Compared to other African countries, such as Nigeria (68.1%) [14], Togo (70.9%) [8], and Mozambique (80.3%) [22], Tanzania showed converging rates, although lower than those of Ghana [16,23], Ethiopia [15,24], Zimbabwe [25], and Namibia [26]. Among these affected children, 40.8% had mild anemia, 56.4% moderate anemia, and 2.8% severe anemia.…”

“…While the WHO considers a prevalence of anemia above 40% as a serious public health problem [1,2], most African countries, including the context of this study, face rates well above this threshold. It is crucial to improve existing policies and implement speci c interventions, such as geographic, behavioral, community, and individual strategies, to drastically reduce these rates [23].…”