Analysis of risk factors of child anemia in Amhara region of Northern Ethiopia 公开

Zeleke, Nina (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/pc289j84n?locale=zh
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Abstract

Introduction: Anemia is an important risk factor for child health and development. Anemia can have a devastating impact on child cognitive development and impair healthy growth (Ngure et al., 2014; Stevens et al., 2013). There are intertwined factors that contribute to child anemia. These factors can be broadly categorized as biological, socioeconomic, and environmental. Environmental Enteropathy (EE) is a disorder caused by infection and inflammation in the small intestine. This condition affects the absorption of iron, which leads to iron-restricted red blood cell production, which in turn causes anemia (Ngure et al., 2014). There is limited evidence that connects environmental risk factors to childhood anemia via the EE route.

Objective: The overall objective of the study was to analyze the risk factors of anemia among children aged 6-36 months in three districts of the Amhara region of Ethiopia.

Method: The data analyzed for this study were generated from Nutrition at the Center Program's cross-sectional baseline survey, which was administered in February 2014. A total of 374 children, aged 6-36 months, and 395 mothers of childbearing years were included in the anemia testing. This study employed binary logistic regression analysis to examine the proposed relationship of the outcome variable and independent variables.

Results: About half of the children (48.7%) in the study area were anemic. The risk of EE negatively affects child's anemia status [Odds Ratio (OR)=0.839; 95% CI 0.687 to 1.026]. The likelihood of a child having anemia increases with the risk of EE, which means children living in a household with poor a) sanitation (i.e. poor toilet facility and child open defecation); b) water quality, and c) hygiene condition (i.e. poor maternal handwashing practices) are more likely to be anemic. Childhood anemia was significantly higher among children born from anemic mothers (70.3% versus 46.4%, p<0.05). That means mothers with anemia were over 4 times more likely to have an anemic child (OR=4.262; 95% CI 1.828 to 9.938). Children who received minimum dietary diversity (20%) were less likely to be anemic, compared to those who had a more homogeneous diet (OR=0.183; 95% CI 0.056 to 0.601).

Conclusion: The analytical results suggest that poor household WASH conditions lead to increased EE, which in turn contributes to childhood anemia. Access to improved household WASH conditions could potentially reduce a child's risk of (EE), which also reduces childhood anemia. WASH interventions should be integrated into efforts to reduce childhood anemia. Improving child dietary diversity, especially in area where bioavailability of iron is low, is an important component of childhood anemia reduction interventions. This also implies that multisector collaboration is vital to improving childhood anemia. Furthermore, interventions that focus on improving maternal anemia must be integrated into efforts that address childhood anemia, since maternal anemia is the strongest determinant of childhood anemia.

Table of Contents

Chapter I: Introduction ------------------------------------------------------------------------------------3
Context of Project: ----------------------------------------------------------------------------------------3
Problem Statement: ---------------------------------------------------------------------------------------5
Objectives: -------------------------------------------------------------------------------------------------6
Chapter II: Literature Review -----------------------------------------------------------------------------7
Anemia Prevalence in Ethiopia ----------------------------------------------------------------------------9
Determinants of Child Anemia ----------------------------------------------------------------------------10
Household Socioeconomic and Environmental Conditions and Child Anemia --------------------------14
Environmental Enteropathy (EE) and Child Anemia -----------------------------------------------------15
Social Capital and Child Health ---------------------------------------------------------------------------17
Key Study Hypotheses ------------------------------------------------------------------------------------18
Chapter III: Survey Methodology, Variables, Measurements, and Model -----------------------------19
N@C Program Overview: ---------------------------------------------------------------------------------19
Survey Sites ----------------------------------------------------------------------------------------------20
Study Population -----------------------------------------------------------------------------------------23
Study Design ---------------------------------------------------------------------------------------------23
Survey Methodology -------------------------------------------------------------------------------------23
Sampling -------------------------------------------------------------------------------------------------24
Sampling Frame -----------------------------------------------------------------------------------------24
Sample Size Determination -----------------------------------------------------------------------------25
Selection of Participants --------------------------------------------------------------------------------26
Survey Instrument ---------------------------------------------------------------------------------------27
Survey Interviewers -------------------------------------------------------------------------------------28
Data Collection -------------------------------------------------------------------------------------------29
Data Cleaning and Entry ---------------------------------------------------------------------------------29
Data Analysis --------------------------------------------------------------------------------------------30
Statistical Model -----------------------------------------------------------------------------------------30
Study Variables and Measures --------------------------------------------------------------------------31
Summary of Dichotomous Variables -------------------------------------------------------------------42
Chapter IV: Results -------------------------------------------------------------------------------------46
Descriptive Statistics: ----------------------------------------------------------------------------------46
Bivariate Analysis: --------------------------------------------------------------------------------------49
Multivariate Analysis: -----------------------------------------------------------------------------------50
Chapter V: Discussion and Conclusion -----------------------------------------------------------------54
Policy Implications/Recommendations: ----------------------------------------------------------------57
Limitations: ----------------------------------------------------------------------------------------------58
Conclusion: ----------------------------------------------------------------------------------------------59
References: ---------------------------------------------------------------------------------------------60
Annex A: CARE Ethiopia N@C Baseline Household Survey Instrument -----------------------------63
A. Household identification and summary ------------------------------------------------------------63
B. Child Information -----------------------------------------------------------------------------------65
C.Mother's Information --------------------------------------------------------------------------------66
D. Basic information of household characteristics ---------------------------------------------------68
E. Agriculture production, access to food -------------------------------------------------------------70
F. Food preservation and storage ----------------------------------------------------------------------76
G. Agriculture Extension --------------------------------------------------------------------------------77
H. Coping Strategy Index [Omitted for Ethiopian Baseline] ------------------------------------------77
I. Household Hunger Scale -----------------------------------------------------------------------------77
J. Women's Diet Diversity Score -----------------------------------------------------------------------78
K. Maternal health/pregnancy --------------------------------------------------------------------------79
L. Infant and Young Child Feeding Practices (IYCF) ---------------------------------------------------81
M. Responsive Feeding ----------------------------------------------------------------------------------85
N. Childhood illness -------------------------------------------------------------------------------------86
O. Drinking water ---------------------------------------------------------------------------------------86
P. Hand washing, sanitation and disposal of child's feces --------------------------------------------88
Q. Women's Empowerment -----------------------------------------------------------------------------92
Mobility --------------------------------------------------------------------------------------------------92
Community Social Capital ------------------------------------------------------------------------------93
Household Decision-making ----------------------------------------------------------------------------93
Gender Attitude and Belief: Tolerance of Intimate Partner Violence ---------------------------------98
R. Community group and Government safety net participation --------------------------------------99
S. Mother's Anthropometry and Hemoglobin ----------------------------------------------------------102
Z. Child's Anthropometry and Hemoglobin ------------------------------------------------------------102

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