Prevalence of anemia and its associated factors among under-five age children in Shanan gibe hospital, Southwest Ethiopia

Anemia is a low number of red blood cells or a low hemoglobin or hematocrit in which the hemoglobin content of the blood is lower than normal range as a result of deficiency of one or more essential nutrients [1] or due to heavy blood loss, parasitic infections and congenital hemolytic diseases. Types of anemia includes iron deficiency anemia, sickle cell anemia, Vitamine deficiency anemia, Aplastic anemia, hemolytic anemia and anemia of inflammation [2] According to World Health Organization a child less than five years old is anemic if the blood hemoglobin is less than 110 g per liter (Hgb < 11.0 g/dl) [3].

Globally, approximately 1.62 billion people are affected by anemia [4] and approximately 36.4 to 61.9% of under five children in sub-Saharan Africa are also affected [5]. Similarly, it is considered to be a serious public health problem in Sub Saharan Africa in which, approximately 83.5 million children was affected and its prevalence of anemia was 67% [6]. The risk factors for anemia vary in different settings; they include intestinal worms, malaria, HIV infection, nutritional deficiencies, hematological malignancies and chronic diseases like sickle cell disease [6, 7].

Globally, anemia is a public health problem affecting people in both developed and developing countries with bad consequences of human health as well as social and economic development. It is also associated with increased morbidity and mortality [8]. Anemia affects all age group especially, under-five age children from low income families have a higher risk for developing anemia due to iron deficiency that occurs as a result of high demand for iron during the period of rapid growth [9].

In developing countries having low-and middle-income, the prevalence of anemia among 6–59 month age children was >20% based on latest demographic and heath survey (DHS) report rounds between 2005–2018, and it is classified as severe public health problem [10]. The problem is alarming in Sub-Saharan African Countries such as Kenya 48.9% [11]; Mali 55.8% [12] and Tanzania 79.6% [13]. Lack of awareness among the mothers about the problem coupled with their low educational status [14], poor nutritional practices and unhealthy food habits [15], low iron bioavailability of the diet [16], decreased physical activities [17], malaria and parasitic infestations are additional factors associated with lower hemoglobin (Hgb) level in children [18]. Factors including family size, low socio-economic status, illiteracy and ignorance are associated with anemia among under five children. Infection with Hook worm and intestinal helminthes causes gastro-intestinal blood loss resulting in depletion of iron stores and consequently also impaired erythropoietin [7]. This leads to mal-absorption and inhibition of appetite, there by worsening micronutrient deficiency and children anemia [19]. The consequence of anemia in under five age children include: decrease mental performance, low tolerance to infection, death from anemic heart failure [17, 19].

Although anemia remains a widespread public health problem in developed countries, it contributes significant proportion of children death in most developing countries including Ethiopia. As such, various factors like parasite have impact on cognitive development and physical growth, studies on the magnitude of anemia among under-five age children have paramount importance. Meanwhile, there is a limited study on the prevalence and associated factor of anemia among under-five age children in our study area. Therefore, this study aimed to determine the prevalence of anemia and its associated factors among under-five children in Shanan Gibe Hospital, Southwest Ethiopia.

Anemia has been continued to be a health problem on under five children [23] which adversely affects mental, physical and social development of the children [20]. This burden also affected middle and low income countries including Ethiopia in particular our study area. Hence, the prevalence of anemia was 48.9% at 95% CI (39.24–53.19) in the current study. As the result, other previous studies were compared with our study by categorizing in to low, comparable and high prevalence on the bases of CI of this study.

Accordingly, the prevalence of anemia in the current study was higher than previous studies reported in Huaihua (29.73%) [24], Senegal (30.7%) [25], Uganda 26·2% [15], Tanzania at Rombo district 37.9% [26]. The variation might be due to the variability of risk factors across different geographic regions, plus lower socioeconomic, large family size and maternal education status of under-five age children those factor which contribute increase the prevalence of anemia.

The current anemia prevalence among under five children was analogous with studies indicated in Palestine 33.5% [27], South Kivu 39.6% [18], Ghana (41%) [28], Cape Verde 51.8% [29] and in Ethiopia (44.83%) [30], Wollo (41.1%) [20], Filtu Town, Somali region (41.7%) [31], Duggina Fanigo District of Wolaita Zone 51.4% [32] and Amhara region (41.43%) [33]. In contrast, a high prevalence e of anemia had been reported in sub-Saharan Africa (64.1%) [34], East Africa (75%) [35], Brazil (56.6%) [36], Malawi 56.9% [4], Togo (70.9%) [37], Tanzania, Bugando Medical Centre (77.2%) [38], Arusha District in Tanzania (84.6%) [39], Kenyan Coast (76·3%) [40], Mali (58%), Tanzania (57%), and Mozambique (54%) [27], Ghana 78.4% [41]. This variation might be due to the mothers having the problem with their low monthly income or parasitic infestations of children which are contributing factors associated with lower hemoglobin (Hgb) level in children.

According to factors in the current study, being rural residence (AOR = 6.11; P = 0.002) was associated with anemia in the current study. Beside this, analogs association of rural residence finding was reported in Amhara region [33, 42]. As such, studies indicated that the distribution of anemia is more prevalent among children from rural resident compared to urban ones [43]. This is because of low socioeconomic status, low serving of iron-rich foods, lack of adequate nutrition information or dietary intake and due to and a high number of illiterates in rural areas as compared to urban [44].

Family low income (AOR = 6.27; P = 0.004) was the identified associated factor with anemia among under five children in current study which was previously reported in Ethiopia like Wollo [20] and Filtu Town, Somali region [31]. This factor could be associated with anemia due to high family income with higher wealth quintile are more likely to provide balanced macro and micronutrients (minerals and vitamins) to their children and children from a lower economic status are vulnerable to various nutritional disorders including anemia [45]. On the other hand, family size greater than five (AOR = 3.12; P = 0.002) P < 0.05 was another identified factors associated with anemia among under five children which was founded in sub-Saharan Africa [34]. So, having large family size was reported factor associated with as anemia due to an increase in the number of children might lead to a risk of communicable disease transmission, and competition for food, consequently, nutritional deficiencies [46] Thus, children with rural residence, low income family and family size greater than five in home were 6.11, 6.27 and 3.12 times more likely to develop anaemia among under five children by adjusting other confounding factors, respectively.

On the other hand, intestinal parasites such as E. histolytica (AOR =3.37; P = 0.005), Hookworm (AOR = 6.09; P = 0.001), and T. trichuria (AOR = 2.79; P = 0.002) contributed to anemia in children. Similar findings of E. histolytica was report in Health Center, North Ethiopia [47], while Hookworm findings also reported in Kenyan coast [39], Ethiopia particularly, Yirgacheffee [48] and Harbu Town [49]. This association might be due to significantly low level of serum iron in E. histolytica infected children due to E. histolytica needs great levels of iron to stay alive and reproduction [50]. T. trichiura and hookworm can cause massive amounts of blood loss and decreased hemoglobin levels [51]. So, anemia is positively associated with intestinal parasite which might be due to lack of hygiene related practices, Red Blood Cell (RBC) destruction and feeding, and loss of appetite caused by worms [52]. Similarly, the blood loss that can occur in T. trichiura infection is likely to contribute to anemia [51, 53].

As the result, children infected with E. histolytica, Hookworm and T. trichuria were 3.37, 6.09 and 2.79 times more likely to develop anaemia by adjusting other confounding factors, respectively. This study is limited due to the fact that present study didn’t differentiate the types of anemia as it was due to iron, vitamin B12, folic deficiency or the RBC morphological effect and hemoparasites were not assessed for factors associated with anemia among under five children.

The prevalence of anemia among under five age children was high. The study also revealed that the most important associated factors for anemia are rural resident, family size greater than five in home, low family income, infection with E. hislotytica, Hookworm and T. trichuria are the factors associated with anemia in this study. Therefore, there should be a continuous health education for their parents on factors of anemia in addition to massive and routine deworming for intestinal parasites to reduce the burden of anemia among children in hospitals.