Subnational mapping of anemia and etiologic factors in the West and Central African Region

Abstract

Objectives:

Despite bold commitments to reduce anemia, little change in prevalence was observed over the past decade. We aimed to generate subnational maps of anemia among women of reproductive age (WRA), malaria transmission, and hemoglobinopathies to identify priority areas, but also explore their geographical overlap.

Design:

Using the most recent Demographic and Health Surveys (DHS), we first mapped anemia clusters across Sub-Sahara Africa (SSA) and identified the WCA as a major cluster. Geographic clusters with high anemia and related etiologic factors were identified using spatial statistics. Multilevel regression models were run to identify factors associated with any, moderate and severe anemia.

Settings:

West and Central African countries (n=17).

Participants:

WRA (n= 112,024) residing in 17 WCA countries.

Results:

There was a significant overlap in geographical clusters of anemia, malaria, and hemoglobinopathies, particularly in the coastal areas of the WCA region. Low birth interval (0.86 [0.77, 0.97]), number of childbirth (1.12 [1.02, 1.23]), being in the 15-19 age range (1.47 [1.09, 1.98])) were associated with increased odds of any anemia. Unimproved toilet facility and open defecation were associated with any anemia, whereas the use of unclean cooking fuel was associated with moderate/severe anemia (P<0.05). Access to health care facility, living in malaria prone areas, and hemoglobinopathies (HbC and HbS) were all associated with any, moderate or severe anemia.

Conclusion:

Interlinkages between infection, hemoglobinopathies, and nutritional deficiencies complicate the etiology of anemia in the WCA region. Without renewed efforts to integrate activities and align various sectors in the prevention of anemia, progress is likely to remain elusive.