Prevalence and factors associated with anaemia among children aged 6 to 59 months in Namutumba district, Uganda: a cross- sectional study
This study assessed the prevalence and non-infectious factors associated with anaemia among children aged 6 to 59 months in Namutumba district in Uganda. We found that 58.8% of the children aged 6 to 59 months were anaemic. Anaemia prevalence was highest among the male children (61.3%) and those aged 12 to 23 months (68.5%) followed by children aged 6 to 11 months, (63.5%). The prevalence of malnutrition was also very high with 27.7% of the children having chronic malnutrition/stunting and 5.3% with acute malnutrition/wasting. Factors associated with anaemia included; number of children in a household, respondents education level, area of residence, stunting, and child’s age.
The most prevalent conditions were moderate and mild anaemia, probably because mild and moderate anaemia is usually asymptomatic and may remain undetected and untreated [5, 19]. The prevalence of anaemia among the children was slightly lower than the East central regional average of 67.5% reported in the 2011 Uganda Demographic and Health Survey [11] but remains unacceptably high and is much higher than the prevalence in several sub-Saharan Africa countries such as Mali, Benin, Ethiopia, Senegal and the Middle East [9, 20–23]. Anaemia impairs the children’s immune system, leads to growth retardation and in severe cases may cause death if not well managed [24]. However, mothers can be taught and supported to prevent childhood anaemia at community level. The prevalence of anaemia in this region is of severe public health significance, well above the 40% WHO threshold, and clearly demands more aggressive interventions [14].
The high prevalence of anaemia in this district happens within the context of high levels of malnutrition with close to one third of the children having malnutrition. Stunting was significantly associated with anaemia unlike other nutrition indices such as wasting and underweight. Both stunting and anaemia (IDA) may be caused by malnutrition, and thus follow a similar causal pathway that is; feeding children less than four times a day and low dietary diversity [9, 25–28]. Both anaemia and stunting may result from failure to meet micronutrient requirements, including iron [29, 30]. Although the food consumption score was not significantly associated with anaemia, there was a high proportion of children with borderline and poor food consumption score with anaemia than those who had an acceptable food consumption score. This may be attributed to lack of diversified meals [9]. Presence of fever in the past three weeks was not significantly associated with anaemia in this study. However, the high levels of anaemia and chronic malnutrition might have been caused by infection diseases such as Malaria. Infections and especially malaria are major causes of anaemia in Africa [31].
According to the recent Uganda malaria indicator survey [32], malaria prevalence among children under five years was highest in the East Central region (where Namutumba lies), where 36% of children tested positive for malaria. Thus interventions to address anaemia and chronic malnutrition should be delivered in an integrated manner in order to comprehensively address the anaemia and various underlying problems.
Child age (6 to 23 months) was significantly associated with anaemia. The prevalence of anaemia was highest among the youngest age groups and generally reduced with increase in the age of the children [26, 27, 33, 34]. Iron stores are generally depleted among children by 6 months of age while the blood volume doubles from 4 to 12 months after birth. Thus, the dietary sources of iron are very important to keep up with this rapid rate of red blood cell synthesis and anaemia may result if the dietary sources are inadequate [1, 2].
The prevalence of anaemia was higher in the rural Bulange sub-county (79.0%) compared to Namutumba and Magada sub-counties probably due to higher levels of illiteracy and poorer access to health services, including health education [22]. Indeed, the prevalence of anaemia dropped with increase in the mother’s or caregiver’s level of education, as reported in other studies [1, 20, 26, 35, 36]. Although not significantly associated with anaemia, one third of the mothers/caregivers in this district did not know how to prevent anaemia, an indicator of the need for more education.
Families with seven or more children were less likely to have anaemic children compared to those with more children and the prevalence of anaemia increased with increasing number of children in the family. High maternal parity has been associated with anaemia as a high number of children impacts on the ability to feed them appropriately [37]. Most mothers, who had one to three children, were young mothers and two out of every three children among these young mothers had anaemia. Young mothers generally have challenges with child care due to limited resources and experience with child care and their children may have poorer health outcomes [38].
These findings highlight anaemia and underlying malnutrition among children as major challenges among rural communities in Eastern Uganda. There is need to concomitantly prioritize interventions to prevent anaemia and malnutrition in these communities in order to realize the much needed reduction of morbidity and mortality among infants and children in Uganda and other countries in sub-Saharan Africa.
Study limitations
Some potential causes of anaemia (e.g.,; infections and other diseases), and the type of anaemia were not assessed. Also, as a cross sectional study, causality could not be established for any of the associated variables.
Strength of the study
This household survey highlights the magnitude of anaemia in a rural district, one of the major and persistent contributors to childhood morbidity and mortality in Uganda and sub-Saharan Africa that has not received adequate attention.