[ad_1]
This study looked at the increase in anemia in children under 5 in Ethiopia between 2011 and 2016. A more in-depth analysis of this increase in anemia is required to understand which sociodemographic segments were most affected. More than half, 56.9%, of Ethiopian children under the age of 5 are anemic according to the 2016 EDHS. This is slightly lower than the average prevalence of anemia of 59.9% in children under 5 years of age of 27 countries in sub-Saharan Africa. [19]. Anemia in children is a serious public health problem in Ethiopia and needs urgent attention to address its underlying causes.
Anemia increased in all age categories, and children aged 36 to 47 months had the highest increase (42.5%) in anemia (Table 1). Age had the greatest strength of association with anemia (Cramer’s V = 0.25) than the rest of the predictor variables studied (Table 2). Similar to the findings from Armenia [20] and India [21], infants aged 9-11 months had the highest prevalence (72.7%) of anemia. At the same time, except in infants aged 9-11 months, all forms of anemia increased in all age categories (Figure 1). The most affected group was 48 to 59 months, this is a time interval in which the growth rate of the child decreases, there is a better variety of food available for the child and the child is physiologically more equipped to participate at the table of the family dining room, for example chewing meat [22]. The greatest increase in severe anemia occurred among children aged 6 to 8 months (Fig. 1). Increased anemia after 6 months could be due to depletion of fetal iron stores [6] and increased iron needs of the body around 6 months of exclusive breastfeeding after birth [1, 23].
Regardless of their educational level, anemia increased in children born to mothers of all educational levels. The highest prevalence of anemia occurs among children born to mothers without formal education (Table 1). The highest increase in anemia (65.8%) was observed in children born to mothers with higher education than secondary school (Table 1). Although the smaller sample size and lower baseline prevalence of anemia could be a possible reason, this finding is counterintuitive because mothers with higher levels of education are more likely to work and have better knowledge about diet childish. It is important to note that having an education beyond high school does not necessarily mean that mothers are employed. Also, educated mothers could be practicing poor eating habits for themselves and their children because they spend too many hours at work. Between 2011 and 2016, the gap in the prevalence of anemia between children born to mothers with no education and upper secondary education has decreased from 15% to 8% (Table 1). Figure 2 shows that mild and moderate anemia showed the highest increase among mothers who passed secondary education (Figure 2).
Anemia increased in all wealth quintile groups and the greatest increase (41.5%) was recorded among children born to the lowest wealth quintile (Table 1). Severe anemia decreased among children born in the second and a half wealth quintiles (Fig. 3). The household wealth index was significantly associated with the anemia status of the children (P <0.0001). This association is supported by some studies. [13, 24, 25]However, other studies in Ethiopia [14, 26, 27] have reported that there was no statistically significant relationship between household wealth and anemia. The strength of association between anemia and the wealth quintile increased from weak (χtwo = 61.6, V = 0.079) in 2011 to moderate (χtwo = 166.9, V = 0.134), furthermore, the gap between the highest and lowest quintiles increased from 12% in 2011 to 20% in 2016 (Table 1). The highest wealth quintile showed the second highest increase (33.4%) in anemia (Table 1). This increase in the highest wealth quintile is unexpected because families with the highest incomes are more likely to be food secure and provide better health care for their children. Food-secure households may lack proper dietary practices and be committed to eating less nutritious and undiversified foods. Also, the highest quintile does not necessarily mean that they are rich; it simply represents the highest quintile compared to the rest of the population. Furthermore, most of the increase in anemia in the highest wealth quintile is mainly mild anemia (Fig. 3).
Anemia in children shows significant differences between regions of Ethiopia. Except for the Benishangul Gumuz region, anemia increased in all regions of Ethiopia (Table 1). The largest increase was recorded in the Tigray (42.9%) and South Nations Nationalities People (SNNP) (35.5%) regions. The Somali region had the largest decrease in mild anemia and the largest increase in moderate anemia since its baseline in 2011. Moderate and mild anemia decreased in the Affar and Benishangul Gumuz regions, but Benishangul Gumuz is the only region where all the forms of anemia decreased (Fig. 4). Since Ethiopia’s regional administrations have an ethnic basis, anemia can be affected by the cultural and dietary practices of the populations living in a given region.
Benishangul Gumuz regional health and nutrition reports show indicators that are better than most regions and possibly explain why anemia might have decreased in this region. For example, Benishangul Gumuz has the second highest score for minimum dietary diversity (eating from at least four food groups) and the second highest minimum acceptable diet compared to the other regions. Additionally, Benishangul Gumuz has the second highest median duration of breastfeeding, the lowest prevalence of severe anemia, and the second lowest prevalence of anemia in children. It also has the lowest percentage of children who were described as “very young” after birth and the lowest percentage of children under 5 with a fever in the 2 weeks prior to the survey. Compared to usual practice, Benishangul Gumuz children receive the greatest increase in food during diarrhea [9]. A national nutrition survey in 2015 reported that Benishangul Gumuz had the second lowest vitamin A deficiency after the capital Addis Ababa and the highest percentage of children who drank fine porridge (semi-solid food) prior to the survey. [28]. Thus, the decrease in anemia in the children of Benishangul Gumuz could be due in part to the dietary and childcare practices of the people living in this region.
Ethiopia is off course in meeting its goal of reducing anemia in children under 5, as outlined in its NNPs. The rise in anemia testifies that the implementation of nutrition programs must be strengthened and coordinated more efficiently. The other regions of Ethiopia could benefit from Benishangul Gumuz’s successful experience in reducing anemia in children. More studies are required on infant feeding practices and dietary customs in the Benishangul Gumuz region to identify the reasons behind this exceptional decrease in anemia in this region. Because this study was a secondary analysis of a cross-sectional study, it is associated with the problem of cause and effect of such cross-sectional studies. Hemoglobin was the only indicator used to measure the anemia status of the children, so the specific type of anemia could not be determined.
