Characteristics of study participants
A total of 649 children with a mean (SD) age of 1.8 (0.1) years of both sexes (male = 49.6% and female = 50.4%) were enrolled in the study. A greater proportion of the children were from the Ekona semi-rural community (42.1%) and the practice of MF by parents was common (60.6%). Majority of the parents/ caregivers had no formal education (43.1%) as shown in Table 1. The prevalence of fever, malaria parasite (MP), AMP and hypochromasia were 5.5%, 29.4%, 27.7% and 6.0% respectively with no statistically significant differences in prevalence by sex and age. The prevalence of microcytosis (70.9%) was common among the children with a significantly higher (P <0.001) occurrence in children 2.1-3.0 years (83.3%) of age when compared with the other age groups. Overall, thrombocytopenia was prevalent in 21.3% of the children with a statistically significant higher presence in those 2.1-3.0 years old (Table 1).
The mean Hb levels was significantly higher in males (9.5 (1.5) g/dL) while, females had significantly higher Hct (26.6 (4.0) %) and RBC counts (4.1 (1.0) x 1012/L) than their respective female and male counterparts. With regards to age, children 0.1-1.0 year’s old had highest mean WBC (9.0 (2.4) x 109 /L and RBC (4.2 (1.1) x 1012/ L) counts, those 1.1-2.0 years had highest RDW-CV (14.2 (7.7) %) while those 2.1-3.0 year’s old had highest, temperature (36.6 (0.7) oC), MCV (68.3 (5.6) fL, MCH 25.2 (3.4) pg) and lowest platelet counts (239.1(141.9)/L. The differences were statistically significant when compared with their equivalents as shown in Table 2.
Anaemia prevalence and type
Anaemia was prevalent in 84.0% (95% CI = 81.0 – 86.6%) of the children. Socio-demographic factors that significantly affected the prevalence of anaemia include age, sex and educational level where, children 0.1-1 year (88.3%, 95% CI = 83.3 – 92.0%), males (87.0, 95% CI = 82.8 – 90.2%) and children whose parents had no formal education (98.2%, 95% CI = 95.8 – 99.2%) had the highest prevalence. Although clinical factors did not significantly affect the incidence of anaemia, the prevalence was higher in those afebrile (84.0%, 95% CI = 80.9 – 86.7%), MP positive (84.8%, 95% CI = 79.0 – 89.2%), undernourished (87.2%, 95% CI = 82.4 – 90.8%), stunted (87.6%, CI = 82.5 – 91.4%), wasted (92.7%, 95% CI = 80.6 – 97.5%) and underweight than their counterparts as shown in Table 3.
Majority of the children had microcytic anaemia (59.3%, 95% CI = 55.5 – 63.0%). The prevalence of microcytic anaemia was significantly higher in males (64.6%, 95% CI = 59.2 – 69.6%) than females (54.1%, 95% CI = 48.7 – 59.5%); children whose parents had primary level of education (63.6%, 95% CI = 55.8 – 70.8%) than the others; those undernourished ( 64.3%, 95% CI = 58.1 – 70.0%) than not and those stunted (66.2%, 95% CI = 59.6 – 72.3%) than those non stunted (56.0%, 95% CI = 51.4 -60.6%) (Table 3).
Mild, moderate and severe anaemia occurred in 27.7% (180), 52.4% (340) and 3.7 (24) of the children respectively. The most common form of anaemia was moderate anaemia with the highest occurring in males (54.7%, 176), those 1.1-2.0 years old (56.3%, 125) and infants from Dibanda as shown in Fig. 1.
Moderate to severe anaemia (MdSA)
The prevalence of MdSA was 56.1% (364, 95% CI = 52.2 – 59.9%). Among the socio-demographic factors, educational level of parents/caregiver (P < 0.001) and site (P = 0.043) had a significant negative effect on the occurrence of MdSA. Children whose parents had no formal education and were from the Dibanda community had the highest prevalence of MdSA (88.6% and 64.6% respectively) when compared with the other levels of education and site. Although not significant the prevalence of MdSA was highest in children 1.1-2.0 years old (60.4%), males (59.3%) and those who had NBF (62.3%) as shown in Fig 2. With respect to clinical status, the prevalence of MdSA was significantly higher (P = 0.041) in children with SS (64.6 %) only even though, those febrile (63.9%) and children with MP (57.6%) had a higher prevalence as well than their counterparts (Fig 2).
Undernutrition and its forms
The distribution of HA, WA and WH z scores is shown in Figs 3 (a), (b) and (c). The majority of HA (74.6%) and WA (55.0%) z scores were in the negatives. The prevalence of undernutrition in the study population was 38.4% (95% CI = 34.7-42.2%). Stunting, underweight and wasting occurred in 31.3%, 13.1% and 6.3% of the children respectively. No statistically significant difference in the prevalence of undernutrition and its forms were observed by age, sex, educational level of parent/caregiver, type of infant feeding habits and febrile status. On the other hand, children from the Ekona community had significantly higher prevalence of undernutrition (45.8%) and stunting (41.0%) when compared with those of Dibanda (24.8%, 18.6%) and Muea (39.1%, 28.4%) respectively. The prevalence of underweight was significantly higher in MP negative children (15.1%) than those positive (8.4%) while stunting was significantly higher in those anaemic (33.2%) than non-anaemic (21.2%) as shown in Table 4.
Severe stunting (SS)
Overall, SS was prevalent in 17.1% (111, 95% CI = 14.4 – 20.2%) of the children. The prevalence of SS was highest in children 2.1-3.0 years old (19.5%), males (19.6%), those from Ekona (22.3%), children whose parent/caregiver had tertiary education (20.0%), had MF (17.6%), were febrile (19.4%) and had MdSA (18.3%) than their respective counterparts. However, only the difference in prevalence of SS by site (P < 0.001) and status of MdSA (0.041) were statistically significant (Fig. 4).
Determinants of MdSA and SS
The binomial logistic regression model revealed the age group (0.1–1.0 year, P = 0.042 and 1.1–2.0 years, P = 0.008), educational level (No formal education, P < 0.001 and primary education P = 0.028) and SS (P = 0.035) as significant determinants of MdSA. Children whose parent had no formal/ primary education were 33.8 and 2.6 times at odds of having MdSA than their counterparts as shown in Table 5. The only significant determinant of SS was MdSA (P = 0.035). On the contrary, based on the odds ratios the age group 0.1-1 year (OR = 0.56, P = 0.043) and site (Dibanda, OR = 0.29, P = 0.001) demonstrated a significant protective effect against SS (Table 5).