PDF(Pubmed)
Abstract：
BACKGROUND: Anaemia continues to be a major public health challenge globally, including in Ethiopia. Previous studies have suggested that improved household environmental conditions may reduce anaemia prevalence; however, population-level evidence of this link is lacking in low-income countries. Therefore, this study aimed to examine the association between environmental factors and childhood anaemia in Ethiopia.
METHODS: In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6-59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05.
RESULTS: The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7-49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1-49.1) in 2005, 42.8% (95%CI: 41.8-43.8) in 2011, and increased to 57.4% (95%CI: 56.3-58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05-1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12-1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13-1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child\'s age (6-35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05-1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01-1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02-1.19), children from poor households (AOR: 1.18: 95%CI: 1.06-1.31), and rural residence (AOR: 1.23, 95%CI: 1.06-1.42).
CONCLUSIONS: In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies.
METHODS: In this study, we conducted an analysis of the data from the Ethiopian Demographic and Health Survey (EDHS), a nationally representative population-based survey conducted in Ethiopia between 2005 and 2016. The study included a total of 21,918 children aged 6-59 months. Children were considered anemic if their hemoglobin (Hb) concentration was less than 11.0 g/dl. To examine the association between environmental factors and anemia, we used multilevel mixed-effect models. These models allowed us to control for various confounding factors including: child, maternal, household and community-level variables. The study findings have been reported as adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) at a significance level of p < 0.05.
RESULTS: The study found the overall prevalence of childhood anaemia to be 49.3% (95%CI: 48.7-49.9) between 2005 and 2016 in Ethiopia. The prevalence was 47.6% (95%CI: 46.1-49.1) in 2005, 42.8% (95%CI: 41.8-43.8) in 2011, and increased to 57.4% (95%CI: 56.3-58.4) in 2016. The pooled data showed that children from households practising open defecation were more likely to be anaemic (AOR: 1.19, 95% CI: 1.05-1.36). In our survey specify analysis, the odds of anaemia were higher among children from households practising open defecation (AOR: 1.33, 95% CI: 1.12-1.58) in the EDHS-2011 and EDHS-2016 (AOR: 1.49, 95% CI: 1.13-1.90). In contrast, neither household water sources nor the time to obtain water was associated with anaemia after controlling for potential confounders. The other variables significantly associated with childhood anaemia include: the child\'s age (6-35 months), not fully vaccinated (AOR: 1.14, 95%CI: 1.05-1.24), children not dewormed in the last 6 months (AOR: 1.11, 95%CI: 1.01-1.24), children born to mothers not working (AOR: 1.10, 95%CI: 1.02-1.19), children from poor households (AOR: 1.18: 95%CI: 1.06-1.31), and rural residence (AOR: 1.23, 95%CI: 1.06-1.42).
CONCLUSIONS: In Ethiopia, about fifty percent of children suffer from childhood anemia, making it a serious public health issue. Open defecation is a major contributing factor to this scourge. To address this issue effectively, it is recommended to strengthen initiatives aimed at eliminating open defecation that involve various approaches, including sanitation infrastructure development, behavior change campaigns, and policy interventions. In addition, to reduce the burden of anemia in children, a multi-faceted approach is necessary, involving both prevention and treatment strategies.
摘要：
背景：贫血仍然是全球主要的公共卫生挑战，包括在埃塞俄比亚。先前的研究表明，改善家庭环境条件可能会降低贫血患病率；然而，低收入国家缺乏这种联系的人口水平证据。因此,本研究旨在探讨环境因素与埃塞俄比亚儿童贫血之间的关系.
方法：在本研究中，我们对埃塞俄比亚人口与健康调查(EDHS)的数据进行了分析，2005年至2016年在埃塞俄比亚进行了一项具有全国代表性的基于人口的调查.该研究共纳入21,918名6-59个月的儿童。如果儿童的血红蛋白（Hb）浓度低于11.0g/dl，则视为贫血。为了检查环境因素与贫血之间的关系，我们使用了多级混合效应模型。这些模型使我们能够控制各种混杂因素，包括：儿童，母性,家庭和社区层面的变量。研究结果已被报道为调整后的优势比（AORs）以及95％的置信区间（CI），显著性水平为p<0.05。
结果：研究发现，2005年至2016年间，埃塞俄比亚儿童贫血的总体患病率为49.3%(95CI:48.7-49.9)。2005年患病率为47.6％（95CI：46.1-49.1），2011年为42.8％（95CI：41.8-43.8），2016年增加至57.4％（95CI：56.3-58.4）。汇总数据显示，开放式排便家庭的儿童更有可能贫血（AOR：1.19，95％CI：1.05-1.36）。在我们的调查指定分析中，在EDHS-2011和EDHS-2016(AOR:1.49,95%CI:1.13-1.90)中,开放式排便家庭的儿童患贫血的几率较高.相比之下,在控制了潜在的混杂因素后,家庭水源和取水时间均与贫血无关.与儿童贫血显著相关的其他变量包括：儿童年龄（6-35个月），未完全接种疫苗（AOR：1.14，95CI：1.05-1.24），在过去6个月内没有驱虫的儿童（AOR：1.11，95CI：1.01-1.24），母亲不工作所生的孩子(AOR:1.10,95CI:1.02-1.19)，来自贫困家庭的儿童(AOR：1.18:95CI：1.06-1.31)，和农村住宅（AOR：1.23，95CI：1.06-1.42）。
结论：在埃塞俄比亚，大约50%的儿童患有儿童贫血，使其成为严重的公共卫生问题。露天排便是造成这一祸害的主要因素。为了有效地解决这个问题，建议加强旨在消除涉及各种方法的露天排便的举措，包括卫生基础设施的发展，行为改变运动，和政策干预。此外,减轻儿童贫血的负担，多方面的方法是必要的，涉及预防和治疗策略。
方法：在本研究中，我们对埃塞俄比亚人口与健康调查(EDHS)的数据进行了分析，2005年至2016年在埃塞俄比亚进行了一项具有全国代表性的基于人口的调查.该研究共纳入21,918名6-59个月的儿童。如果儿童的血红蛋白（Hb）浓度低于11.0g/dl，则视为贫血。为了检查环境因素与贫血之间的关系，我们使用了多级混合效应模型。这些模型使我们能够控制各种混杂因素，包括：儿童，母性,家庭和社区层面的变量。研究结果已被报道为调整后的优势比（AORs）以及95％的置信区间（CI），显著性水平为p<0.05。
结果：研究发现，2005年至2016年间，埃塞俄比亚儿童贫血的总体患病率为49.3%(95CI:48.7-49.9)。2005年患病率为47.6％（95CI：46.1-49.1），2011年为42.8％（95CI：41.8-43.8），2016年增加至57.4％（95CI：56.3-58.4）。汇总数据显示，开放式排便家庭的儿童更有可能贫血（AOR：1.19，95％CI：1.05-1.36）。在我们的调查指定分析中，在EDHS-2011和EDHS-2016(AOR:1.49,95%CI:1.13-1.90)中,开放式排便家庭的儿童患贫血的几率较高.相比之下,在控制了潜在的混杂因素后,家庭水源和取水时间均与贫血无关.与儿童贫血显著相关的其他变量包括：儿童年龄（6-35个月），未完全接种疫苗（AOR：1.14，95CI：1.05-1.24），在过去6个月内没有驱虫的儿童（AOR：1.11，95CI：1.01-1.24），母亲不工作所生的孩子(AOR:1.10,95CI:1.02-1.19)，来自贫困家庭的儿童(AOR：1.18:95CI：1.06-1.31)，和农村住宅（AOR：1.23，95CI：1.06-1.42）。
结论：在埃塞俄比亚，大约50%的儿童患有儿童贫血，使其成为严重的公共卫生问题。露天排便是造成这一祸害的主要因素。为了有效地解决这个问题，建议加强旨在消除涉及各种方法的露天排便的举措，包括卫生基础设施的发展，行为改变运动，和政策干预。此外,减轻儿童贫血的负担，多方面的方法是必要的，涉及预防和治疗策略。
