Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis

Sunuwar, Dev Ram; Singh, Devendra Raj; Pradhan, Pranil Man Singh; Shrestha, Vintuna; Rai, Pushpa; Shah, Sunil Kumar; Adhikari, Bipin

doi:10.1186/s12889-023-15265-y

BMC Public Health

Table 3 Multivariable multilevel logistic regression (MMLR) analysis of individual and community level factor associated with childhood anemia (n = 167,017)

From: Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis

Individual-and community-level characteristics	Bangladesh	Cambodia	India	Maldives	Myanmar	Nepal
Individual-and community-level characteristics	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)
Fixed effect
Individual-level factors
Child-level factors
Sex of child
Male	NA	Ref	NA	Ref	NA	NA
Female	NA	0.88 (0.75–1.03)	NA	0.88 (0.70–1.07)	NA	NA
Child age (months)
6–11	Ref	Ref	Ref	Ref	Ref	Ref
12–23	0.77 (0.52–1.15)	0.60 (0.44–0.82)**	1.07 (1.02–1.12)**	0.72 (0.49–1.09)	1.02 (0.72,1.45)	0.95 (0.62–1.47)
24–35	0.27 (0.18–0.40)***	0.24 (0.18–0.33)***	0.65 (0.62–0.68)***	0.67 (0.45–1.05)	0.39 (0.28–0.55)***	0.45 (0.29–0.69)***
36–47	0.24 (0.16–0.36)***	0.19 (0.14–0.26)***	0.41 (0.39–0.43)***	0.69 (0.46–1.04)	0.26 (0.18–0.37)***	0.28 (0.14–0.34)***
48–59	0.18 (0.12–0.28)***	0.14 (0.11–0.21)***	0.30 (0.29–0.32)***	0.48 (0.32–0.75)***	0.21 (0.14–0.29***	0.22 (0.14–0.34)***
Recent fever
No	NA	Ref	Ref	NA	Ref	NA
Yes	NA	1.29 (1.07–1.55)**	1.03 (1.00-1.07)*	NA	1.08 (0.88–1.34)*	NA
Recent diarrhea
No	Ref	Ref	Ref	NA	Ref	NA
Yes	0.81 (0.63–1.24)	1.09 (0.85–1.41)	1.07 (1.02–1.12)**	NA	0.69 (0.53–0.89)	NA
Children stunted
Not stunted	Ref	Ref	Ref	NA	NA	Ref
Stunted	1.33 (1.08–1.63)**	1.42 (1.17–1.73)***	1.29 (1.25–1.33)***	NA	NA	1.27 (0.97–1.67)*
Children underweight
Not underweight	NA	Ref	Ref	NA	NA	Ref
Underweight	NA	1.18 (0.93–1.49)	1.22 (1.18–1.26)***	NA	NA	1.18 (0.87–1.59)
Children wasted
Not wasted	NA	Ref	Ref	NA	NA	Ref
Wasted	NA	1.15 (0.85–1.54)	1.05 (1.02–1.09)**	NA	NA	1.27 (0.83–1.90)
Mothers and household-level factors
Mothers age (years)
15–24	Ref	Ref	Ref	NA	Ref	Ref
25–34	0.84 (0.67–1.03)	0.89 (0.73–1.08)	0.94 (0.91–0.96)***	NA	0.79 (0.62–1.01)	0.98 (0.77–1.24)
35–49	0.91 (0.65–1.30)	0.99 (0.77–1.29)	0.84 (0.81–0.88)***	NA	0.78 (0.59–0.99)*	0.77 (0.51–1.15)
Mothers education level
No education	NA	Ref	Ref	NA	Ref	Ref
Primary	NA	0.99 (0.78–1.28)	0.84 (0.81–0.88)***	NA	1.19 (0.92,1.53)	0.75 (0.54–1.04)
Secondary or above	NA	0.79 (0.59–1.05)	0.76 (0.73–0.78)***	NA	1.02 (0.76–1.38)	0.68 (0.50–0.93)*
Wealth quintile
Poorest	Ref	Ref	Ref	Ref	Ref	Ref
Poor	0.85 (0.63–1.15)	0.99 (0.77–1.26)	0.91 (0.87–0.94)***	1.06 (0.81–1.38)	0.91 (0.72–1.15)	0.76 (0.55–1.01)
Middle	0.75 (0.53–1.06)	0.81 (0.61–1.09)	0.89 (0.85–0.93)***	0.89 (0.66–1.18)	0.87 (0.66–1.16)	1.05 (0.71–1.59)
Richer	0.53 (0.37–0.76)***	0.93 (0.68–1.28)	0.85 (0.81–0.89)***	1.16 (0.67–1.70)	0.77 (0.57–1.05)	0.91 (0.58–1.42)
Richest	0.52 (0.36–0.76)**	0.60 (0.42–0.86)**	0.87 (0.82–0.92)***	2.60 (0.96–7.07)	0.90 (0.62–1.30)	0.55 (0.32–0.94)*
Maternal anemia
Not anemic	Ref	Ref	Ref	Ref	Ref	Ref
Anemic	1.66 (1.33–2.07)***	1.56 (1.32–1.84)***	1.62 (1.59–1.67)***	1.44 (1.16–1.78)**	1.59 (1.34–1.91)***	1.71 (1.36–2.15)***
Community-level factors
Place of residence
Urban	Ref	Ref	Ref	Ref	NA	Ref
Rural	0.97 (0.76–1.24)	1.01 (0.79–1.29)	0.93 (0.88–0.96)***	0.86 (0.45–1.61)	NA	1.08 (0.84–1.39)
Community maternal anemia ^a
Low	Ref	Ref	Ref	Ref	Ref	Ref
High	1.21 (0.97–1.51)*	1.31 (1.09–1.57)**	1.72 (1.66–1.78)***	1.35 (1.08–1.69)**	1.33 (1.08–1.64)**	1.72 (1.34–2.23)***
Community parity ^b
Low	Ref	NA	Ref	NA	Ref	Ref
High	1.04 (0.84–1.30)	NA	0.94 (0.91–0.98)	NA	0.89 (0.72–1.11)	0.97 (0.74–1.27)
Community wealth ^c
Low	Ref	Ref	Ref	Ref	Ref	Ref
High	1.02 (0.78–1.33)	1.13 (0.86–1.48)	0.80 (0.76–0.84)***	0.90 (0.70–1.15)	1.04 (0.81–1.35)	0.78 (0.55–1.10)*
Community female education ^d
Low	NA	Ref	Ref	Ref	Ref	Ref
High	NA	0.98 (0.75–1.21)	0.75 (0.73–0.80)***	0.97 (0.78–1.49)	0.96 (0.81–1.35)	1.02 (0.75–1.39)
Community safe water access ^e
Low	NA	NA	NA	Ref	NA	Ref
High	NA	NA	NA	1.07(0.83–1.38)		1.01(0.77–1.31)
Community toilet facility ^f
Low	NA	Ref	Ref	NA	NA	Ref
High	NA	0.99 (0.78–1.24)	1.16 (1.11–1.21)***	NA		1.05 (0.78–1.42)
Random effect
Community-level variance (SE)	0.097 (0.089)	0.281 (0.071)***	0.929 (0.019)***	0.143 (0.074)**	0.306 (0.072)***	0.355 (0.110)***
ICC (%)	1	4.3	18.2	2.3	8.2	4.4
PCV (%)	71	44	21	47	4	56
Model fit statistics
AIC	2426.6	4053.4	191292.0	2313.6	3713.4	2193.5
BIC	2532.1	4217.7	191550.7	2406.1	3839.1	2330

*p < 0.05, **p < 0.01, ***p < 0.001; aOR = adjusted odds ratio; CI: confidence interval; Ref: reference category; SE: standard error; ICC: intra-class correlation; PCV: percentage change in variation; AIC: Akaike information criterion, BIC: Bayesian information criterion; ^amean percent of women with Hb levels less than 12 g/dL; ^bmean percent of women with fertility rate of 5 children and above; ^cmean percent of households wealth quintiles categorized richer and richest and above; ^dmean percent of women with primary education level and above; ^emean percent of households with access to improved water source; ^f mean percent of household with access to improved toilet facility; NA: Not applicable

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ISSN: 1471-2458

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