Determinants of anemia severity levels among children aged 6–59 months in Ethiopia: Multilevel Bayesian statistical approach

Anemia is a widespread public health problem that afects all stages of life particularly preschool
children and pregnant mothers. Anemia among children had signifcant impact on their growth,
development, school performance and mortality. Diferent strategies like deworming of young
children, vitamin A supplementation for children aged 6–59 months, and ferrous sulphate
supplementation and provision of insecticide treated bed net for pregnant women were designed to
control and prevent anemia. Also, previous studies on anemia factors were conducted but they were
not considering the ordered nature of anemia. Therefore, this study aimed to identify the factors of
anemia severity levels among children aged 6–59 months in Ethiopia by using ordinal analysis based
on Bayesian hierarchical statistical approach. A secondary data analysis was conducted using the 2016
Ethiopian Demographic and Health Survey data. A total of 8483 weighted children were included.
Due to the ordered nature of the anemia and nested nature of DHS data, ordinal logistic regression
model based on hierarchical Bayesian statistical approach was employed to identify the determinants
of anemia severity levels. In this study, moderate anemia level was found to be the commonest type
which accounts around 29.4%. Female children, poorer, middle, and richest wealth index, primary
maternal education and having ANC visit had lower risk of having higher order of anemia. Moderate
maternal anemia and stunted children had higher chance of having higher order of anemia. Children
age had signifcant diferent efect on mild and moderate anemia. Meanwhile, multiple birth/s and
deworming had efect on moderate anemia. In addition, normal birth weight had also signifcant
and diferent efect on mild and severe anemia and history of feverlike illness on mild anemia. The
prevalence of anemia among children aged 6–59 months anemia was found to be a severe public
health problem. Children age, sex, maternal education, child stunting, history of fever, multiple birth,
birth weight, provision of deworming and maternal anemia was found to be the most important
factors for child anemia severity levels. Therefore, intervention eforts to control and prevent anemia
in Ethiopia requires targeting of these hindering factors.