Prevalence and factors associated with anemia among children under 5 years in South and Southeast countries: A multicountry analysis

Background: South and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore factors associated with anemia among children under 5 years across the seven selected south and southeast Asian countries.

Methods: Demographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, Nepal and Timor-Leste) conducted between 2011 and 2022 were analyzed. A total of 42,482 children under 5 years were included in the analysis. Multilevel logistic regression analysis was used to identify independent predictors of anemia.

Results: The pooled prevalence of childhood anemia across seven SSEA countries was 30.24% (95% CI: 29.79–30.68). Childhood anemia was significantly higher among (1) mothers with no formal education compared to secondary or higher education (Bangladesh: OR=1.38, India: OR=1.13, Myanmar: OR=1.25, Nepal: OR=1.61 and Timor-Leste: OR=1.29); (2) Father’s with primary education compared to secondary or higher education (Bangladesh: OR=1.29, Cambodia: OR=1.11, India: OR=1.11,Maldives: OR=1.23, Myanmar: OR=1.02, Nepal: OR=1.42 and Timor-Leste: OR=1.05); (3) Respondents from poor family  compared to those who belongs to rich family (Bangladesh: OR=1.69, Cambodia: OR=1.45, India: OR=1.23, Maldives: OR=1.11, Myanmar: OR=1.23 and Timor-Leste: OR=1.05); (4) Respondents from middle-class family  compared to those who belongs to rich family (Bangladesh: OR=1.39, Cambodia: OR=1.21, India: OR=1.14, Maldives: OR=1.36, Myanmar: OR=1.03, Nepal: OR=1.12 and Timor-Leste: OR=1.25); (5) Respondents from rural areas compared to urban areas (Bangladesh: OR=1.19, Cambodia: OR=1.13, India: OR=1.19 and Myanmar: OR=1.13).

Conclusion: Our study results indicate that residence, media access, paternal education level, respondents working status, mothers age at first birth, wealth index, baby’s delivery by caesarean section and number of antenatal visits during pregnancy are the factors significantly associated with children anemia. Sex of child and baby’s postnatal visit has no significant effect on childhood anemia. Higher odds of childhood anemia have been linked to rural background, poor wealth index, no formal education of parents, no media access and other factors. Factors identified in this study can be considered to develop effective anemia control and prevention strategies.       

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