Page 251 - Special Topic Session (STS) - Volume 2

STS489 Danielle J.R. et al.
children, and affects their cognitive and physical development. In severe cases,
these effects are irreversible. According to the most recent estimates of the
World Health Organization (WHO), the highest anaemia prevalence of 42.6%
in 2011 occurred in children under the age of five years old, which translated
to just over 273 million children suffering from anaemia globally. In Africa, the
prevalence of anaemia in children was estimated at 62.3% in 2011 (WHO,
2011). Despite the decrease in the prevalence of anaemia in high-income
countries, anaemia remains a significant public health problem in many low
and middle income countries, particularly in sub-Saharan Africa where
anaemia is a major contributor to childhood morbidity and mortality (Abdo et
al., 2018).
The causes of anaemia are multifactorial and interrelate in a complex way.
Such causes include iron deficiency, other micronutrient deficiencies such as
folate, vitamin B12 and vitamin A; intestinal parasites such as soil-transmitted
helminths (STH) and Schistosoma; malaria, HIV infection, and chronic diseases
such as sickle cell disease. Many of these factors contribute to the etiology and
as well as the severity of anaemia through several mechanisms, either through
the direct destruction of infected red blood cells and/or through the lack of the
ability of the red blood cells to absorb iron. While iron deficiency is the most
common cause of anaemia in developed countries, there are many other
contributing factors in less developed countries.
Since 2012, the WHO advocates for global nutrition targets by 2025 with a
comprehensive implementation plan on maternal, infant and young child
nutrition, where the WHO strives for goals of achieving a 50% reduction of
anaemia in women of reproductive age by 2025 (WHO, 2014). However,
childhood anaemia has no such direct goals in place and thus has not received
adequate attention. Nevertheless, the WHO and UNICEF have recommended
that strategies for anaemia control be built into a country’s primary health care
system and existing programmes such as maternal and child health, integrated
management of childhood illness, roll-back malaria, deworming (including
routine anthelmintic control measures) and stop-tuberculosis (WHO and
UNICEF, 2004). These control strategies are expected to be tailored to local
conditions by taking into account the specific etiology and prevalence of
anaemia in a given setting and population group. Accordingly, studies on
anaemia control should be cognisant and account for the spatial variation of
anaemia in the population. Failure to account for the spatial heterogeneity of
anaemia and the possible causes of the spatial heterogeneity can cause
ecological confounding (see Mainardi, 2012 and references therein).
This study investigates the spatial variation of anaemia in children aged 6
to 59 months as well as determines the significant risk factors associated with
anaemia in these children in 4 sub-Saharan African countries jointly, namely
Kenya, Malawi, Tanzania and Uganda.

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