Prevalence of anaemia among children under five in Sub-Saharan Africa
Anaemia among children in SSA has remained a public health concern for decades, targeting children aged between 6 and 59 months. With a prevalence of about 61% (95% CI: 61–62), childhood anaemia is a serious public health concern in SSA; this is a severe public health problem in SSA according to WHO’s classification ≥ 40% (20). According to several researches, many nations in the SSA region have higher rates of anaemia prevalence, ranging from 37–82% in Rwanda and Mali, respectively (21, 22). As this investigation proved, the prevalence estimates of anaemia and regional variation differed from country to country. The availability of healthcare facilities and insufficient nutritional consumption, amongst many others, could all contribute to these country variations. In a survey conducted between 2010 and 2018 in 15 African countries, nearly 65% of children in SSA was anaemic, with the highest rates observed in Mali, 82%. Similarly, in the present analysis, the overall prevalence of anaemia in children under five years of age was 82%, of which 88% was in the younger age groups (23, 24).
Several children, maternal, household, and community factors are suspected of having played a role in this high prevalence of childhood anaemia. It is, however, essential to understand that the symptoms of anaemia are not uniformly distributed across population densities and regions, as the rural population seems especially at risk. This may be attributed to differences in the rural context, such as disparities in resources, services, education, and culture on diet and income (25).
In congruence with a previous study (26), this study found that younger children were at a higher risk of anaemia, as evidenced by the fact that children aged 43–59 months are 66% less likely to be anaemic than those aged 6–23 months. This might be due to the nutritional requirements during this rapid growth and development period and the increase in blood volume of younger children (27). This highlights that the risk of anaemia in children may be reduced by focused intervention targeting child age. Nutritional interventions for young children were proven to significantly reduce the risk of anaemia by providing fortified food to children aged 6–23 months (28, 29).
Breastfeeding is of paramount importance in the growth and development of the child. However, inappropriate breastfeeding can result in child mortality (30). Our research found that children who were still breastfeeding were 1.20 times more likely to be anaemic than children who never breastfed. Recent studies showed that prolonged breastfeeding without the timely introduction of complementary feeding contributed to the occurrence of anaemia in infants and toddlers, and it may worsen the severity of preexisting anaemia in children (31, 32).
Malnutrition is one of the risk factors contributing to child morbidity and mortality related to anaemia. A recent study revealed that malnourished children are highly exposed to micronutrient deficiencies like vitamin A, B12, iron, and folate, which are most important in hematopoiesis; their deficiency eventually leads to child anaemia (33). Our study found that underweight children had 1.31 times higher odds of anaemia than their counterparts. The findings were consistent with previous research (14, 34, 35).
In addition, our research found that acute respiratory infection was a significant predictor of anaemia in children under five, with children who had acute respiratory infections 1.2 times more likely to be anaemic than their counterparts; similar findings highlighted acute respiratory infection as one of the comorbidities associated with anaemia in children (36). A recent study showed acute infections, ranging from viral to bacterial, like Streptococcal infections and tuberculosis, are risk factors for anaemia (37, 38); apart from anaemia of chronic inflammation that induces hepcidin overexpression and interferes with iron bioavailability (39), acute infections induce reversible bone marrow suppression and haemolysis, resulting in anaemia (37).
The study also found that children who received iron supplementation were less likely to be anaemic than children who were not given iron supplements. The result showed that children who were not given iron supplements were 17% more likely to be anaemic than children who were given iron supplements. Iron supplementation is a common intervention used to prevent iron deficiency anaemia. Iron storage may be reduced by dietary deficiencies that lower immunity and cause repeated infections (14, 40). Low nutritional status is linked to weakened immunity and the vitamin deficiency necessary for erythropoiesis. As a result, infections and intestinal infestations compound the impact of micronutrient deficits in producing anaemia (41). In addition, a deficiency in micronutrients such as iron, folic Acid, and vitamin B12, which are necessary for synthesising haemoglobin and DNA during the development of erythrocytes, increases the risk of anaemia in malnourished children (41).
Vitamin A plays a vital role in red blood cell synthesis by releasing iron from the body's tissues into the bloodstream and strengthening immunity. According to our study findings, children who were supplemented with vitamin A were less likely to develop anaemia than children who did not. This contrasts with the previous study, which found no association between vitamin A and anaemia in children (42). However, different studies showed similar results to our research findings (43–45). This might be explained by vitamin A's role in iron absorption and metabolism, reduction in iron-deficient erythropoiesis, and amelioration of haemoglobin homeostasis (46).
Maternal occupation can impact health behaviours and nutritional status, indirectly influencing child anaemia. Working mothers, especially those in low-income occupations, may find it challenging to maintain a healthy diet mainly due to financial limitations and restricted access to healthcare. Occupation is directly related to socioeconomic status, where higher-paying jobs provide better well-being for the mother and the child. A study conducted in Ethiopia found reduced odds of anaemia among working women, highlighting this association and indicating that employment may improve access to anaemia-prevention tools (47). Women empowerment is therefore a very important measure to reducing child anaemia among other childhood developmental issues.