Characteristics of the study population
The dataset consisted of three thousand and four (n=3004) children under five years of age. However, this analysis only included two thousand four hundred and thirty-four (n=2434) children aged 6-59 months whose anaemia status was determined and were available. The proportion of male and female populations in the sample was 1228 (50.5%) and 1206 (49.6%), respectively, and the most represented age group were children aged 24–42 months (n=879, 36.1%). The majority (n=2296, 94.3%) had received malaria vaccine (Mosquirix); however, more than one-third (n=857, 35.2%) reported fever or malaria. Furthermore, more than 50% of the children (n=1335) lived in poor households, and nearly 62% (n=1508) were from rural areas. Also, the source of the most common household drinking water was dug well (41.2%).
Most of the children were from the Northern region (15.9%), were from poor households (54.85%) and had mothers who had no formal education (46.1%). Also, while nearly 27% of the mothers did not visit the Antenatal Clinic (ANC), about 47% of them visited the ANC 6-10 times.
Prevalence of anaemia
Overall, the prevalence of anaemia among children under five years (6-59months) in Ghana was 58.35% (95%CI=52.72-63.96). Also, a higher proportion of anaemia was observed among children with fever or malaria (66.27%, p<0.001). Similarly, the proportion of anaemia was higher among children whose mothers had no formal education (65.54%, p<0.001) and were younger than 25years (65.61%, p<0.001). Moreover, anaemia prevalence was significantly higher among children from poor households (66.67%, p<0.001) and those living in rural areas (62.74%, p<0.001). The distribution of anaemia prevalence among children in the regions of Ghana is Upper East (72.84%), Northern (67.87%), Central (66.20%), Upper West (62.57%), Brong Ahafo (59.36%), Volta (53.55%), Western (50.51%), Greater Accra (47.43%), Eastern (47.08%), and Ashanti (42.91%). The descriptive characteristics of the children, their mothers, households, and the distribution of anaemia prevalence across the child-related factors, maternal and household factors with respective p-values and 95% CI are shown in Table 1
Table 1 Prevalence of anaemia among Ghanaian under-5 children by demographics, maternal and household characteristics
Factors
|
Sample size (%)
|
Anaemia (n)
|
Prevalence of anaemia
|
p-value
|
Unweighted prevalence (95%CI)
|
Weighted prevalence (95%CI)
|
Total
|
2434(100.0)
|
1420
|
58.34(56.38-60.30)
|
58.35(52.72-63.96)
|
|
Child related factors
|
|
|
|
|
|
Sex of children
|
|
|
|
|
0.003
|
Male
|
1228(50.45)
|
753
|
61.32(58.59-64.05)
|
61.31(56.47-66.16)
|
|
Female
|
1206(49.55)
|
667
|
55.31(52.50-58.12)
|
55.30(58.56-62.06)
|
|
Age of children (Months)
|
|
|
|
|
<0.001
|
6-23
|
869(35.70)
|
600
|
69.04(65.97-72.12)
|
69.05(62.54-75.54)
|
|
24-42
|
879(36.11)
|
523
|
59.50(56.25-62.75)
|
59.49(53.01-65.98)
|
|
43-59
|
686(28.18)
|
297
|
43.29(39.58-47.01)
|
43.29(36.61-49.97)
|
|
Child had fever/malaria
|
|
|
|
|
<0.001
|
No
|
1577(64.79)
|
852
|
54.03(51.56-56.49)
|
54.03(48.23-59.82)
|
|
Yes
|
857(35.21)
|
568
|
66.28(63.11-69.45)
|
66.27(60.60-71.95)
|
|
Took malaria vaccine
|
|
|
|
|
0.041
|
No
|
138(5.87)
|
69
|
50.00(41.62-58.38)
|
50.00(43.85-54.14)
|
|
Yes
|
2296(94.33)
|
1351
|
58.84(56.83-60.86)
|
58.84(53.08-64.60)
|
|
Maternal factors
|
|
|
|
|
|
Mother’s education status
|
|
|
|
|
<0.001
|
No education
|
1123(46.14)
|
736
|
65.54(62.76-68.32)
|
65.54(61.79-69.28)
|
|
Primary
|
983(40.39)
|
536
|
54.53(51.41-57.64)
|
54.52(48.98-60.07)
|
|
Secondary
|
213(8.75)
|
102
|
47.89(41.16-54.61)
|
47.88(41.63-54.14)
|
|
Tertiary
|
115(4.72)
|
46
|
40.00(31.00-48.99)
|
40.00(30.95-49.05)
|
|
Mother’s age (years)
|
|
|
|
|
<0.001
|
15-24
|
535(21.98)
|
351
|
65.61(61.58-69.64)
|
65.61(61.94-69.28)
|
|
25-34
|
1179(48.44)
|
672
|
57.00(54.17-59.83)
|
56.99(49.00-64.99)
|
|
35-44
|
649(26.66)
|
349
|
53.78(49.93-57.62)
|
53.78(48.40-59.15)
|
|
>44
|
71(2.92)
|
48
|
67.61(56.64-78.57)
|
67.61(58.42-76.80)
|
|
Ethnicity
|
|
|
|
|
<0.001
|
Akan
|
791(32.50)
|
407
|
51.45(47.97-55.94)
|
51.45(43.07-59.83)
|
|
Ewe
|
361(14.83)
|
193
|
53.46(48.31-58.62)
|
53.46(47.16-59.77)
|
|
Ga
|
98(4.03)
|
49
|
50.00(40.04-59.96)
|
50.00(36.65-63.35)
|
|
Grusi
|
237(9.74)
|
146
|
61.60(55.40-67.81)
|
61.60(57.12-66.08)
|
|
Mole-dagbani
|
848(34.84)
|
562
|
66.27(63.09-69.46)
|
66.27(59.74-72.80)
|
|
Others
|
99(4.07)
|
63
|
63.64(54.11-73.17)
|
63.64(55.69-71.59)
|
|
Number of ANC visit
|
|
|
|
|
<0.001
|
No visit
|
654(26.87)
|
332
|
50.76(46.93-54.60)
|
50.77(42.56-58.97)
|
|
1-5
|
456(18.73)
|
294
|
64.47(60.07-68.87)
|
64.48(56.85-72.10)
|
|
6-10
|
1146(47.08)
|
691
|
60.30(57.46-63.13)
|
60.29(55.35-65.25)
|
|
>10
|
178(7.31)
|
103
|
57.87(50.59-65.14)
|
57.86(49.96-65.77)
|
|
Religion
|
|
|
|
|
<0.001
|
Christianity
|
1727(70.95)
|
942
|
54.55(52.20-56.90)
|
54.54(48.53-60.56)
|
|
Islam
|
583(23.95)
|
390
|
66.90(63.07-70.72)
|
66.89(59.31-74.48)
|
|
Traditional
|
51(2.10)
|
32
|
62.75(49.33-76.15)
|
62.74(52.82-72.67)
|
|
Others
|
73(3.00)
|
56
|
76.71(66.94-86.48)
|
76.71(69.90-8352)
|
|
p-value<0.05 was considered statistically significant.
|
Table 1 Prevalence of anaemia among Ghanaian under-5 children by demographics, maternal and household characteristics (continued)
Factors
|
Sample size (%)
|
Anaemia (n)
|
Prevalence of anaemia
|
p-value
|
Unweighted prevalence (95%CI)
|
Weighted prevalence (95%CI)
|
Household factors
|
|
|
|
|
|
Wealth Index
|
|
|
|
|
<0.001
|
Poor
|
1335(54.85)
|
890
|
66.67 (64.14-69.20)
|
66.67(62.37-70.96)
|
|
Middle
|
476(19.56)
|
261
|
54.83(50.35-59.31)
|
54.83(49.16-60.50)
|
|
Rich
|
623(25.60)
|
269
|
43.18(39.28-47.07)
|
43.18(39.58-46.77)
|
|
Place of residence
|
|
|
|
|
|
Rural
|
1508(61.96)
|
946
|
62.73(60.29-65-17)
|
62.74(55.76-69.70)
|
|
Urban
|
926(38.04)
|
474
|
51.19(47.96-54.41)
|
51.18(44.56-57.81)
|
|
Source of drinking water
|
|
|
|
|
<0.001
|
Dug well
|
1002(41.17)
|
625
|
62.38(59.37-65.38)
|
62.38(56.59.68.16)
|
|
Pipe
|
717(29.46)
|
413
|
57.60(53.98-61.22)
|
57.60(51.19-64.01)
|
|
Rainwater
|
62(2.55)
|
47
|
75.81(65.05-86.56)
|
75.80(67.40-84.21)
|
|
River/lake
|
193(7.93)
|
124
|
64.25(57.47-71.03)
|
64.24(52.44-76.05)
|
|
Sachet water
|
460(18.90)
|
211
|
45.87(41.31-50.43)
|
45.87(41.09-50.65)
|
|
Region
|
|
|
|
|
<0.001
|
Ashanti
|
261(10.72)
|
112
|
42.91(36.89-48.93)
|
42.91(39.60-46.22)
|
|
Brong Ahafo
|
251(10.31)
|
149
|
59.36(53.27-65.45)
|
59.36(38.08-80.65)
|
|
Central
|
216(8.87)
|
143
|
66.20(59.88-72.53)
|
66.20(51.26-81.15)
|
|
Eastern
|
189(7.76)
|
89
|
47.09(39.95-54.23)
|
47.08(44.68-49.50)
|
|
Greater Accra
|
156(6.41)
|
74
|
47.44(39.57-55.30)
|
47.43(42.19-52.67)
|
|
Northern
|
386(15.86)
|
262
|
67.88(63.21-72.54)
|
67.87(57.50-78.25)
|
|
Upper East
|
232(9.53)
|
169
|
72.84(67.11-78.58)
|
72.84(67.75-77.94)
|
|
Upper West
|
334(13.72)
|
209
|
62.57(57.37-67.78)
|
62.57(47.83-77.32)
|
|
Volta
|
211(8.67)
|
113
|
53.55(46.81-60.30)
|
53.56(41.05-66.06)
|
|
Western
|
198(8.13)
|
100
|
50.51(43.52-57.49)
|
50.51(36.86-64.15)
|
|
p-value<0.05 was considered statistically significant.
|
Factors associated with anaemia
In the crude regression analysis (model 1), female children under 5 years were 22% less likely to have anaemia compared to male children under 5 years [cOR=0.78, 95%CI=0.66-0.92, p<0.001]. Also, children aged 24-42months [cOR=0.66, 95% CI=0.54-0.80, p<0.001] and 43-59months [cOR= 0.34 (95% CI=0.27-0.42), p<0.001] were 34% and 66% respectively less likely to have anaemia compared to children aged 6-23months. Additionally, children with fever or malaria were 67% more likely to have anaemia than children who had no fever or malaria [cOR=1.67, 95%CI=1.41-2.00, p<0.001]. However, child whose mother has some form of education, living in an urban area and has a middle or rich wealth index were less likely to have anaemia. Moreover, children who were in a household that uses pipe [cOR=0.82, 95% CI=0.67-0.99, p=0.046] and sachet water [cOR= 0.51, 95% CI=0.41-0.64, p<0.001] as their source of drinking water were 18% and 49% respectively less likely to have anaemia.
In the adjusted regression analysis (model 2), the findings showed that females were less likely to get anaemia than males [aOR= 0.74, 95% CI=0.62-0.88, p<0.001]. Again, children who were 24-42 and 43-59 months old were 36% and 67% times respectively less likely to get anaemia compared to children who were 6-23months old [aOR= 0.64, 95% CI=0.51-0.79, p<0.001] and [aOR= 0.33, 95% CI=0.25-0.42, p<0.001] respectively. Also, children whose mother had some forms of education, thus primary [aOR= 0.78, 95% CI=0.62-0.97, p<0.027], secondary [aOR= 0.65, 95% CI=.46-0.92, p<0.015], and tertiary [aOR= 0.60, 95% CI=.0.38-0.96, p<0.034], were less likely to have anaemia. However, children with fever or malaria were more likely to have anaemia [aOR= 1.55, 95% CI=1.28-1.87, p<0.001]. Moreover, children who lived in middle [95% CI=0.51-0.88, p=0.005] and rich [95% CI=0.36-0.70, p<0.001] wealth index households were 0.67 and 0.50 times less likely to be anaemic. Regarding residence, living in urban areas showed a negative association with childhood anaemia compared to living in rural areas [aOR= 0.86, 95% CI=0.68-1.09, p<0.003]. Finally, the mother’s age, ethnicity and number of antenatal clinic visits showed no significant association with childhood anaemia in the multivariate model. See table 2 for the logistic findings on the crude and adjusted indicators of childhood anaemia.
Table 2 Factors associated with anaemia in children under-5 years in Ghana
Factors
|
Model 1
|
Model 2
|
cOR(95%CI)
|
p-value
|
aOR(95%CI)
|
p-value
|
Child related factors
|
|
|
|
|
Sex of children
|
|
|
|
|
Male
|
Ref
|
|
Ref
|
|
Female
|
0.78(0.66-0.92)
|
0.003
|
0.74(0.62-0.88)
|
0.001
|
Age of children (Months)
|
|
|
|
|
6-23
|
Ref
|
|
Ref
|
|
24-42
|
0.66(0.54-0.80)
|
<0.001
|
0.64(0.51-0.79)
|
<0.001
|
43-59
|
0.34(0.27-0.42)
|
<0.001
|
0.33(0.25-0.42)
|
<0.001
|
Child had fever/malaria
|
|
|
|
|
No
|
Ref
|
|
Ref
|
|
Yes
|
1.67(1.41-2.00)
|
<0.001
|
1.55(1.28-1.87)
|
<0.001
|
Took malaria vaccine
|
|
|
|
|
No
|
Ref
|
|
Ref
|
|
Yes
|
1.42(1.01-2.02)
|
0.042
|
1.21(0.83-1.78)
|
0.315
|
Maternal factors
|
|
|
|
|
Mother’s education status
|
|
|
|
|
No education
|
Ref
|
|
Ref
|
|
Primary
|
0.63(0.53-0.75)
|
<0.001
|
0.78(0.62-0.97)
|
0.027
|
Secondary
|
0.48(0.36-0.65)
|
<0.001
|
0.65(0.46-0.92)
|
0.015
|
Tertiary
|
0.35(0.24-0.52)
|
<0.001
|
0.60(0.38-0.96)
|
0.034
|
Mother’s age (years)
|
|
|
|
|
15-24
|
Ref
|
|
Ref
|
|
25-34
|
0.69(0.56-0.86)
|
0.001
|
0.88(0.70-1.12)
|
0.303
|
35-44
|
0.61(0.48-0.77)
|
<0.001
|
0.76(0.58-0.99)
|
0.041
|
>44
|
1.09(0.65-1.86)
|
0.739
|
1.27(0.71-2.26)
|
0.419
|
Ethnicity
|
|
|
|
|
Akan
|
Ref
|
|
Ref
|
|
Ewe
|
1.08(0.84-1.39)
|
0.527
|
1.05(0.75-1.47)
|
0.757
|
Ga
|
0.94(0.62-1.44)
|
0.786
|
0.99(0.62-1.60)
|
0.985
|
Grusi
|
1.51(1.13-2.04)
|
0.006
|
0.86(0.58-1.27)
|
0.446
|
Mole-dagbani
|
1.85(1.52-2.26)
|
<0.001
|
1.30(0.90-1.87)
|
0.165
|
Others
|
1.65(1.07-2.54)
|
0.023
|
1.11(0.65-1.89)
|
0.700
|
Number of ANC visit
|
|
|
|
|
No visit
|
Ref
|
|
Ref
|
|
1-5
|
1.76(1.38-2.25)
|
<0.001
|
1.17(0.89-1.57)
|
0.253
|
6-10
|
1.47(1.21-1.79)
|
<0.001
|
1.09(0.87-1.34)
|
0.430
|
>10
|
1.33(0.95-1.86)
|
0.093
|
1.20(0.12-1.76)
|
0.365
|
Religion
|
|
|
|
|
Christianity
|
Ref
|
|
Ref
|
|
Islam
|
1.68(1.38-2.05)
|
<0.001
|
1.37(1.04-1.80)
|
0.023
|
Traditional
|
1.40(0.79-2.50)
|
0.248
|
1.10(0.59-2.07)
|
0.008
|
Others
|
2.75(1.58-4.72)
|
<0.001
|
1.11(0.65-1.13)
|
0.759
|
cOR: crude odds ratio, aOR: adjusted odds ratio, 95% CI: 95% confidence interval
|
Table 2 Factors associated with anaemia in children under-5 years in Ghana (continued)
Factors
|
Model 1
|
Model 2
|
cOR(95%CI)
|
p-value
|
aOR(95%CI)
|
p-value
|
Household factors
|
|
|
|
|
Wealth Index
|
|
|
|
|
Poor
|
Ref
|
|
Ref
|
|
Middle
|
0.61(0.49-0.75)
|
<0.001
|
0.67(0.51-0.88)
|
0.005
|
Rich
|
0.38(0.31-0.46)
|
<0.001
|
0.50(0.36-0.70)
|
<0.001
|
Place of residence
|
|
|
|
|
Rural
|
Ref
|
|
Ref
|
|
Urban
|
0.62(0.53-0.74)
|
<0.001
|
0.86(0.68-1.09)
|
0.003
|
Source of drinking water
|
|
|
|
|
Dug well
|
Ref
|
|
Ref
|
|
Pipe
|
0.82(0.67-0.99)
|
0.046
|
1.19(0.93-1.52)
|
0.150
|
Rainwater
|
1.90(1.04-3.43)
|
0.036
|
2.45(1.29-4.67)
|
0.006
|
River/lake
|
1.08(0.97-1.50)
|
0.622
|
0.92(0.64-1.32)
|
0.659
|
Sachet water
|
0.51(0.41-0.64)
|
<0.001
|
1.14(0.81-1.60)
|
0.448
|
Region
|
|
|
|
|
Ashanti
|
Ref
|
|
Ref
|
|
Brong Ahafo
|
1.94(1.37-2.76)
|
<0.001
|
1.64(1.11-2.41)
|
0.012
|
Central
|
2.60(1.79-3.79)
|
<0.001
|
2.62(1.74-3.96)
|
<0.001
|
Eastern
|
1.18(0.81-1.73)
|
0.379
|
1.24(0.81-1.88)
|
0.319
|
Greater Accra
|
1.20(0.81-1.79)
|
0.369
|
1.78(1.11-2.83)
|
0.016
|
Northern
|
2.81(2.03-3.89)
|
<0.001
|
1.57(1.03-2.39)
|
0.037
|
Upper East
|
3.57(2.44-5.21)
|
<0.001
|
2.10(1.31-3.37)
|
0.002
|
Upper West
|
2.22(1.60-3.10)
|
<0.001
|
1.18(0.75-1.85)
|
0.481
|
Volta
|
1.53(1.06-2.21)
|
0.022
|
1.23(0.78-1.94)
|
0.375
|
Western
|
1.36(0.94-2.00)
|
0.106
|
1.24(0.83-1.86)
|
0.293
|
cOR: crude odds ratio, aOR: adjusted odds ratio, 95%CI: 95% confidence interval
|