Geospatial Inequality of Anemia Among Children in Ethiopia

Abstract Background: Anemia remains a severe public health problem among children in Ethiopia. The lack of progress in the trend of anemia infers the failure of national anemia prevention and control programs. If there are considerable geospatial differences in the prevalence of anemia in Ethiopia, targeted approaches, based on the distribution and specific risk factors for that setting are needed to efficiently target health interventions. This study aimed to identify and locate anemia hotspots among children in Ethiopia. Methods : Data analysis was performed using Ethiopia Demographic and Health Survey (EDHS) 2016 Data. Blood specimens for anemia testing were collected from children age 6-59 months. Hemoglobin analyses were placed in a HemoCue photometer and the results were recorded onsite for 9,268 children. The outcome variable anemia was categorized into a dichotomous variable (anemic and not anemic); a child was considered as anemic if the blood-hemoglobin count was less than 11.0 g/dl. We applied Kulldorf’s spatial scan statistics and used SaTScanTM to identify locations and estimate cluster sizes. In addition, we ran LISA (local indicator of spatial association) and the Getis-Ord Gi(d) local statistics to detect and locate hotspots of anemia. We ran multilevel multivariable analysis to identify risk factors for anemia clustering. Result: More than half (57%) of children aged 6-59 months were anemic in Ethiopia. Higher prevalence of anemia was found among children who live in Somali region (83%), in rural area (58%), in the lowest wealth quintile (68%), and among children of mothers’ with no education (59%). We found significant geospatial inequality of anemia among children in Ethiopia. We identified one anemia cluster (hotspot) in the eastern part of Ethiopia. Women anemia, stunting and high fertility were associated with anemia clustering. Conclusion : Anemia clustering was found in the eastern part of Ethiopia. We recommend that policy makers and programmers should especially target this area for accelerated reduction of anemia.