Anemia severity among children aged 6-59 months in Gondar town, Ethiopia: A community-based cross-sectional study

Italian Journal of Pediatrics, Volume 44, No. 1, Year 2018

Interpretation

Background: Anemia is a public health problem affecting both developed and developing countries. Childhood anemia is associated with serious consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Hence, this study aimed at assessing the prevalence and factors associated with severity of anemia among children aged 6-59 months in Gondar town, northwest Ethiopia. Method: A community-based cross-sectional study was conducted. A multi-stage sampling technique was employed to select study participants. Socio demographic and socioeconomic data were collected using a pre-tested structured questionnaire. Anthropometric measurements were taken as per WHO recommendation. Hemoglobin (Hb) concentration was measured using a portable HemoCue301 instrument (A Quest Diagnostic Company, Sweden). Mild anemia corresponds to a level of adjusted Hb of 10.0-10.9 g/dl; moderate anemia corresponds to a level of 7.0-9.9 g/dl, while severe anemia corresponds to a level less than 7.0 g/dl. Descriptive statistics were used to describe the study participants. Both bivariable and multivariable ordinal logistic regression were done, and proportional odds ratio (POR) with a 95% confidence interval (CI) was reported to show the strength of association. A p-value < 0.05 was considered statistically significant. Result: Out of the total of 707 children included in this study, more than half (53.5%) of them were male. The median age of children was 30 months. Two hundred two (28.6%) of children were anemic: 124(17.5%) were mildly anemic, 73(10.3%) were moderately anemic, and 5 (0.7%) were severely anemic. The young age of the child, low frequency of child complementary feeding per day, primary maternal educational status, unmarried maternal marital status, and home delivery were factors associated with severity of childhood anemia. Conclusion: Anemia among children aged 6-59 months in Gondar Town was a moderate public health problem. Improving access to education, providing regular health education about childcare and child feeding practices, strengthening the socioeconomic support for single-parent families and conducting regular community-based screening are recommended to reduce childhood anemia. A community-based cross-sectional study was conducted in April 2015 among children aged 6–59 months in Gondar town, northwest Ethiopia. A sample size of 735 was calculated by single population proportion formula, considering estimated prevalence of anemia (35.1%) among children aged 6–59 month in Amhara region [4], 95%CI, 5% margin of error, design effect of 2, and 5% non- response rate. A multi-stage random sampling technique was employed to select study participants in two stages. At the first stage, four out of twelve kebeles (smallest administrative units) (i.e. 30% of the total area) were selected by simple random sampling technique. At the second stage, a total of 735 households were selected using a systematic random sampling method with proportional allocation to each selected kebeles. The total number of households with children aged between 6 and 59 months was obtained from the respective administrative areas and used to calculate the sampling fraction. In the case where more than one children were found eligible in the selected households, only one of them was chosen randomly using the lottery method. A pretested structured questionnaire was used to collect socio-demographic and economic data from mothers by face-to-face interview. Anthropometric measurements such as weight and height were measured for children according to the 2006 WHO recommendation [24]. Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated using WHO Anthro software. Nutritional status was defined as underweight if WAZ was less than − 2 standards deviation (SD), stunting if HAZ was less than -2SD, and wasting if WHZ was less than -2SD [25]. Body mass index (BMI) was also calculated for the mothers according to the WHO STEP-wise surveillance manual [26]. Hb was measured by a portable HemoCue301 instrument (A Quest Diagnostic Company, Sweden) from capillary blood. HemoCue method of Hb determination is recommended by WHO to determine population prevalence of anemia, and several studies have established the validity of this instrument [24, 27]. After adjusting Hb concentration for altitude, anemia was defined as mild if Hb was between 10 and 10.9 mg/dl, moderate if between 9.9 and 7 g/dl, and severe if < 7 g/dl [24]. The questionnaire was prepared in English, translated to Amharic and then translated back to English to check for consistency. Data were collected by trained data collectors (BSC nurses and senior medical laboratory technologists) after training was given about the objective of the study, confidentiality issues, study participants’ right, consenting, techniques of interview, and Hb and anthropometric measurements. The data collection process was closely supervised by investigators. All measurements were performed by following the manufacturers’ recommendation. Data were entered using Epi Info version 3.5.3 statistical software, and then exported to SPSS version 20 for analysis. Descriptive statistics including frequencies, percentages, median, and interquartile range were performed to describe the study participants. The bi-variable and multi-variable proportional odds model (POM), the most widely used family of ordinal logistic regression in epidemiological studies, was fitted to identify factors associated with severity of childhood anemia. The proportionality assumptions for POM were checked using Chi-square parallel line tests, (p-value = 0.791) indicating that the assumption was not violated. The Pearson chi-square goodness-of-fit test showed that the model fitted the data well (p = 0.152). All variables with a p-value ≤ 0.2 in the bivariable analysis were fitted into the multivariable analysis to control confounding effects. Adjusted proportional odds ratio (aPOR) with a 95% CI was used to evaluate the strength of statistical association between explanatory and outcome variables. All variables with p-values < 0.05 in the multi-variable analysis were considered to be statistically significant.

AI Digest

Study Justification:

– Anemia is a significant public health problem in both developed and developing countries.
– Childhood anemia can have serious consequences on growth, motor and cognitive development, and overall health.
– Understanding the prevalence and factors associated with anemia among children aged 6-59 months in Gondar town, Ethiopia is crucial for developing effective interventions and policies to address this issue.

Study Highlights:

– A community-based cross-sectional study was conducted in Gondar town, northwest Ethiopia.
– A total of 707 children aged 6-59 months were included in the study.
– The prevalence of anemia among the children was 28.6%.
– Factors associated with the severity of childhood anemia included the young age of the child, low frequency of child complementary feeding per day, primary maternal educational status, unmarried maternal marital status, and home delivery.

Study Recommendations:

– Improve access to education to increase awareness about childcare and child feeding practices.
– Provide regular health education to parents and caregivers about proper child feeding practices.
– Strengthen socioeconomic support for single-parent families to improve their ability to provide adequate nutrition for their children.
– Conduct regular community-based screening to identify and address anemia among children.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies and programs to address childhood anemia.
– Local Health Authorities: Involved in coordinating and implementing community-based screening and health education initiatives.
– Non-Governmental Organizations (NGOs): Collaborate with government agencies to provide support and resources for addressing childhood anemia.
– Health Workers: Conduct screening, provide health education, and deliver interventions to prevent and treat childhood anemia.

Cost Items for Planning Recommendations:

– Education and Training: Budget for training programs to educate health workers and parents/caregivers on child feeding practices and anemia prevention.
– Health Education Materials: Allocate funds for the development and distribution of educational materials on child nutrition and anemia prevention.
– Screening Equipment: Budget for the purchase and maintenance of screening equipment, such as portable HemoCue301 instruments, to identify anemia cases.
– Socioeconomic Support: Allocate resources to provide financial assistance and support services to single-parent families.
– Monitoring and Evaluation: Set aside funds for monitoring and evaluating the effectiveness of interventions and programs aimed at reducing childhood anemia.

Strength of Evidence

N/A

Abstract

A community-based cross-sectional study was conducted in April 2015 among children aged 6–59 months in Gondar town, northwest Ethiopia. A sample size of 735 was calculated by single population proportion formula, considering estimated prevalence of anemia (35.1%) among children aged 6–59 month in Amhara region [4], 95%CI, 5% margin of error, design effect of 2, and 5% non- response rate. A multi-stage random sampling technique was employed to select study participants in two stages. At the first stage, four out of twelve kebeles (smallest administrative units) (i.e. 30% of the total area) were selected by simple random sampling technique. At the second stage, a total of 735 households were selected using a systematic random sampling method with proportional allocation to each selected kebeles. The total number of households with children aged between 6 and 59 months was obtained from the respective administrative areas and used to calculate the sampling fraction. In the case where more than one children were found eligible in the selected households, only one of them was chosen randomly using the lottery method. A pretested structured questionnaire was used to collect socio-demographic and economic data from mothers by face-to-face interview. Anthropometric measurements such as weight and height were measured for children according to the 2006 WHO recommendation [24]. Z-scores for weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ) were calculated using WHO Anthro software. Nutritional status was defined as underweight if WAZ was less than − 2 standards deviation (SD), stunting if HAZ was less than -2SD, and wasting if WHZ was less than -2SD [25]. Body mass index (BMI) was also calculated for the mothers according to the WHO STEP-wise surveillance manual [26]. Hb was measured by a portable HemoCue301 instrument (A Quest Diagnostic Company, Sweden) from capillary blood. HemoCue method of Hb determination is recommended by WHO to determine population prevalence of anemia, and several studies have established the validity of this instrument [24, 27]. After adjusting Hb concentration for altitude, anemia was defined as mild if Hb was between 10 and 10.9 mg/dl, moderate if between 9.9 and 7 g/dl, and severe if < 7 g/dl [24]. The questionnaire was prepared in English, translated to Amharic and then translated back to English to check for consistency. Data were collected by trained data collectors (BSC nurses and senior medical laboratory technologists) after training was given about the objective of the study, confidentiality issues, study participants’ right, consenting, techniques of interview, and Hb and anthropometric measurements. The data collection process was closely supervised by investigators. All measurements were performed by following the manufacturers’ recommendation. Data were entered using Epi Info version 3.5.3 statistical software, and then exported to SPSS version 20 for analysis. Descriptive statistics including frequencies, percentages, median, and interquartile range were performed to describe the study participants. The bi-variable and multi-variable proportional odds model (POM), the most widely used family of ordinal logistic regression in epidemiological studies, was fitted to identify factors associated with severity of childhood anemia. The proportionality assumptions for POM were checked using Chi-square parallel line tests, (p-value = 0.791) indicating that the assumption was not violated. The Pearson chi-square goodness-of-fit test showed that the model fitted the data well (p = 0.152). All variables with a p-value ≤ 0.2 in the bivariable analysis were fitted into the multivariable analysis to control confounding effects. Adjusted proportional odds ratio (aPOR) with a 95% CI was used to evaluate the strength of statistical association between explanatory and outcome variables. All variables with p-values < 0.05 in the multi-variable analysis were considered to be statistically significant.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and resources related to maternal health, including prenatal care, nutrition, and breastfeeding. These apps can be easily accessed by pregnant women and new mothers, providing them with valuable information and support.

2. Telemedicine: Implement telemedicine programs that allow pregnant women in remote or underserved areas to have virtual consultations with healthcare providers. This can help overcome geographical barriers and ensure that women receive necessary prenatal care and guidance.

3. Community Health Workers: Train and deploy community health workers who can provide education and support to pregnant women and new mothers in their own communities. These workers can help improve access to maternal health services by bridging the gap between healthcare facilities and the community.

4. Maternal Health Vouchers: Introduce voucher programs that provide pregnant women with financial assistance to access maternal health services. These vouchers can cover the cost of prenatal care, delivery, and postnatal care, making it more affordable for women to seek necessary healthcare.

5. Maternal Health Clinics: Establish dedicated maternal health clinics that provide comprehensive care for pregnant women and new mothers. These clinics can offer a range of services, including prenatal check-ups, vaccinations, and postnatal care, all in one location, making it easier for women to access the care they need.

6. Health Education Campaigns: Launch targeted health education campaigns that raise awareness about the importance of maternal health and promote healthy behaviors during pregnancy. These campaigns can be conducted through various channels, such as radio, television, and community outreach programs.

7. Transportation Support: Provide transportation support for pregnant women who face challenges in accessing healthcare facilities. This can include arranging transportation services or providing financial assistance for transportation costs.

8. Maternal Health Hotline: Establish a dedicated hotline where pregnant women and new mothers can seek advice, ask questions, and receive support from healthcare professionals. This can help address concerns and provide guidance, especially for women who may not have easy access to healthcare facilities.

These innovations can help improve access to maternal health services, provide necessary support and education, and ultimately contribute to better maternal and child health outcomes.

AI Innovations Description

The study conducted in Gondar town, Ethiopia aimed to assess the prevalence and factors associated with the severity of anemia among children aged 6-59 months. The study found that anemia was a moderate public health problem in the area, with 28.6% of children being anemic. Factors associated with the severity of childhood anemia included the young age of the child, low frequency of child complementary feeding per day, primary maternal educational status, unmarried maternal marital status, and home delivery.

Based on the study findings, the following recommendations can be made to improve access to maternal health and reduce childhood anemia:

1. Improve access to education: Providing education to mothers about childcare and child feeding practices can help increase their knowledge and understanding of the importance of proper nutrition for their children. This can be done through community-based health education programs and workshops.

2. Regular health education: Conducting regular health education sessions for mothers and caregivers can help raise awareness about the causes and consequences of childhood anemia. These sessions can provide information on proper nutrition, including the importance of iron-rich foods, and the need for regular health check-ups for children.

3. Strengthen socioeconomic support for single-parent families: Single-parent families may face additional challenges in providing adequate nutrition for their children. Strengthening socioeconomic support systems, such as providing financial assistance or job training, can help alleviate some of these challenges and improve access to nutritious food for children.

4. Conduct regular community-based screening: Implementing regular screening programs in the community can help identify children at risk of anemia at an early stage. This can be done through partnerships with local health centers or community health workers who can conduct screenings and refer children for further evaluation and treatment.

By implementing these recommendations, it is possible to improve access to maternal health and reduce the prevalence and severity of childhood anemia in Gondar town, Ethiopia.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Mobile Clinics: Implementing mobile clinics that can travel to remote areas and provide essential maternal health services, including prenatal care, vaccinations, and postnatal care.

2. Telemedicine: Utilizing telemedicine technology to connect pregnant women in rural areas with healthcare professionals, allowing them to receive virtual consultations and guidance throughout their pregnancy.

3. Community Health Workers: Training and deploying community health workers who can provide basic maternal health services, education, and support in underserved areas.

4. Transportation Support: Establishing transportation systems or subsidies to help pregnant women in remote areas reach healthcare facilities for prenatal visits, delivery, and emergency care.

5. Maternal Health Vouchers: Introducing voucher programs that provide financial assistance to pregnant women, enabling them to access quality maternal health services at accredited healthcare facilities.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Determine the key indicators that will be used to measure the impact, such as the number of pregnant women receiving prenatal care, the number of deliveries attended by skilled birth attendants, or the reduction in maternal mortality rates.

2. Baseline data collection: Collect data on the current state of maternal health access in the target area, including the number of healthcare facilities, the availability of skilled healthcare providers, and the utilization rates of maternal health services.

3. Model development: Develop a simulation model that incorporates the potential recommendations and their expected impact on the identified indicators. This model should consider factors such as population demographics, geographic distribution, and existing healthcare infrastructure.

4. Data input: Input relevant data into the simulation model, including the number of mobile clinics or community health workers to be deployed, the coverage area, the expected utilization rates, and the estimated impact on the indicators.

5. Simulation runs: Run the simulation model multiple times, adjusting the input parameters to explore different scenarios and assess the potential impact of the recommendations on improving access to maternal health.

6. Analysis and interpretation: Analyze the simulation results to identify the most effective recommendations and their potential impact on the indicators. Compare the different scenarios to determine the optimal combination of interventions.

7. Recommendations and implementation: Based on the simulation results, make recommendations for the implementation of specific interventions to improve access to maternal health. Consider factors such as feasibility, cost-effectiveness, and sustainability.

8. Monitoring and evaluation: Once the recommendations are implemented, establish a monitoring and evaluation system to track the actual impact and make adjustments as needed. Continuously collect data on the indicators to assess the progress and identify areas for further improvement.

Author

Dima Health

Statistics:

Citations: 12

Identifiers:

DOI: 10.1186/s13052-018-0547-0

ISSN: 17208424

Research Areas:

Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Male