Figure 1 - uploaded by Ezra Gayawan
Content may be subject to copyright.
Source publication
Anaemia is a global public health problem affecting both developing and developed countries with major consequences for human health and socioeconomic development. This paper examines the possible relationship between Hb concentration and severity of anaemia with individual and household characteristics of children aged 6-59 months in Nigeria; and...
Contexts in source publication
Context 1
... Nigeria is divided into six geopolitical zones with each comprising of at least six states (totalling 36 al- together) and a Federal Capital Territory (FCT), Abuja. Figure 1 pre- sents the map of Nigeria showing the location of the states within the geographical zones and the FCT. ...
Context 2
... considered anaemic if their Hb concentration levels are below 11.0 g/dl. In a normal population, 2.5% of the population would be expected to fall below this threshold. Hence, iron deficiency anaemia would be considered a public health problem when the prevalence of Hb concentration exceeds 5.0% of the population. WHO regional estimates generated on anaemia for pre-school age children, pregnant and non-pregnant women indicate that the highest proportion of individuals affected by anaemia is in Africa (47.5–67.6%). 2 In Nigeria, according to the UNICEF 1993 par- ticipatory information collection (PIC) studies, the prevalence for anaemia in mothers is 24%. The highest prevalence of anaemia in children was recorded in South Eastern Nigeria (49.6%) and the lowest (10.5%) in North Eastern Nigeria. 10 Several other studies have documented evidence of high prevalence of anaemia in children of school age across some regions in Nigeria. 11,12 It is known that some key social determinants, especially social and demographic factors such as a mother’s education, wealth index, and family size, can affect various medical conditions. Studies that examine the prevalence and/or determinants of anaemia, at a national level in Nigeria, have not been adequately undertaken. Moreover, no attempt has been made to unravel the spatial pattern of Hb concentration and anaemic status of children after taking into account other possible determinants. Although the distribution of the risk of anaemia in pre-school children after adjusting for nutritional status, parasitic infections and other individual variables in West African countries has been mapped, the work was limited to Burkina Faso, Ghana and Mali. 13 Available reports on the geographical distribution of anaemia across Nigeria are based on the six geopolitical regions and show the existence of geographical variation. This has been found to be too coarse to allow for detailed discussions of spatial effects, as spatial effects of states within the same region can vary widely. 14 Therefore, this paper aims to examine the possible relationship between Hb concentration and severity of anaemia with individual and household characteristics of children aged 6-59 months; and the possible geographical variations of these outcome variables at a highly disaggregated state level in Nigeria. A Bayesian geoadditive modelling technique, which is a flexible approach that allows for joint modelling of fixed effects, nonlinear effects of metrical covariate and spatial effect, while at the same time controlling for the hierarchical nature of the data via random effects, was adopted. This study relies on data available from the 2010 Nigeria Malaria Indicator Survey (NMIS). With technical assistance from ICF International through Measure DHS, the nationally representative survey was implemented by the National Population Commission (NPC) and the National Malaria Control Programme (NMCP), alongside other malaria implementing partners. The survey was designed to provide information on malaria indicators and malaria prevalence at national and state level. Due to the strong association between anaemia and malaria, the NMIS included anaemia testing for children aged 6–59 months. Samples were realised through a two-stage probability sampling. At the first stage, 240 clusters consisting of 83 in urban and 157 in rural areas were selected from the sampling frame used during the 2006 Population and Housing Census of the Federal Republic of Nigeria. The final sample included 239 clusters because access to one of the clusters was prevented by inter-communal disturbances. Within each state, the number of households was distributed proportionately between urban and rural areas in accordance with the 2006 Nigeria Population Census. A complete listing of households was conducted, and a mapping exercise of each cluster was carried out from August through to September 2010. At the second stage, an average of 26 households was selected in each cluster by equal probability sampling. A total of 6197 households were selected, and of these, 5986 were occupied. Of the occupied households, 5895 were successfully interviewed, yielding a response rate of 99%. All children aged 6-59 months in these households were eligible to be tested for malaria and anaemia. After obtaining informed consent from the child’s parent or guardian, blood samples were requested and collected using a microcuvette to obtain a drop of blood from a finger prick or a heel prick in the case of young children with small fingers. Hb analysis was carried out on site using a battery-operated HemoCue analyser (HemoCue AB, Angelholm, Sweden), which produces a result within a minute. Data on Hb level and anaemic status from the survey was available for 5074 children. Other questions included in the survey were place of residence (urban or rural), mother’s educational level, household wealth index, sex of the child, age of the child, number of household members, whether child had malaria or fever in the last 2 weeks before the survey or not, geographical region and state of residence and these were used in this study. Administratively, Nigeria is divided into six geopolitical zones with each comprising of at least six states (totalling 36 al- together) and a Federal Capital Territory (FCT), Abuja. Figure 1 presents the map of Nigeria showing the location of the states within the geographical zones and the FCT. A semi-parametric approach within the Bayesian framework was adopted to examine the influence of covariates of different types and geographical locations of the child on Hb level and anaemic status (or severity of anaemia) while, at the same time, controlling for the hierarchical nature of the data as a result of the multistage selection technique that was used. Three outcome variables were considered in this study. First, continuous Hb level of the children was considered and modelled assuming a Gaussian distribution to the response variable. Second, a dichotomous variable that classifies children into anaemic or normal was explored. This follows a Binomial distribution whose dependence and effect on a predictor of interest can be modelled either through a probit or logit link model. We choose the probit link in this study. The third outcome variable considered was a four-level ordered categorical variable that categorised children according to the severity of anaemia: severe anaemic, moderate anaemic, mild anaemic and not anaemic (normal). The dependence of this variable was modelled assuming a cumulative probit model. The regression problem was considered with observations ( y i , x i , s i , v i , r ij ), i 1⁄4 1, . . . , 5074; j 1⁄4 1, 2 with y i being continuous, binary or ordered categorical; x i , the metrical covariate effect of child’s age, s [ { 1, . . . ,37 } ; the spatial covariate of the district (state) where the child resided in Nigeria during the survey. A further categorical covariate vector v 1⁄4 ( v , . . . , v )’ whose effect was ...
Similar publications
This paper analyzes the synergies/tradeoffs involved in the adoption of improved varieties of multiple crops in the mixed crop-livestock production systems of the highlands of Ethiopia A multivariate probit (MVP) model involving a system of four equations for the adoption decision of improved varieties of barley, potatoes, wheat and faba beans was...
This study establishes a toxicity assessment of the mixture of Fe3+, Mn2+, and Al3+ ions by employing a Probit dose-response model and an augmented simplex design. The toxicity of individual Fe3+, Mn2+, and Al3+ metal ions with respect to Escherichia coli DH5¡ is in the order of Mn2+ > Fe3+ > Al3+. The mixture of Fe3+, Mn2+, and Al3+ ions shows a h...
The length of exposure time to Bifenthrin on four strains of larger grain borer Prostephanus truncatus Horn (Coloeoptera: Bostrichidae) was studied in the laboratory at 28 -330C and 70 – 85% relative humidity. Five serial dilutions of the toxicant ranging from 0.031 to 0.0012 g/ml, including a control were used. Mortality was recorded at 3 hourly i...
O objetivo deste estudo é avaliar as características socioeconômicas e geográficas que determinam o perfil do indivíduo empreendedor das cinco regiões brasileiras. Para isso, utilizou-se a base de dados da Pesquisa Nacional por Amostra de Domicílios (PNAD) do ano de 2014, e, por fim, estima-se um modelo de probabilidade com distribuição normal prob...
Citations
... The findings show high likelihood for the shared risks of malaria and anemia among children below 24 months of age, and this is similar to what was obtained for the specific component of anemia. Findings from other African countries have similarly exhibited this pattern of relationship [4]. The first two years of life is a period of intense growth and development, making the children to have high demand for iron, but which may not be available in the required quantity particularly for children from low socioeconomic settings. ...
In sub-Saharan Africa, malaria and anemia contribute substantially to the high burden of morbidity and mortality among under-five children. In Rwanda, both diseases have remained public health challenge over the years in spite of the numerous intervention programs and policies put in place. This study aimed at understanding the geographical variations between the joint and specific risks of both diseases in the country while quantifying the effects of some socio-demographic and climatic factors. Using data extracted from Rwanda Demographic and Health Survey, a shared component model was conceived and inference was based on integrated nested Laplace approximation. The study findings revealed similar spatial patterns for the risk of malaria and the shared risks of both diseases, thus confirming the strong link between malaria and anaemia. The spatial patterns revealed that the risks for contracting both diseases are higher among children living in the districts of Rutsiro, Nyabihu, Rusizi, Ruhango, and Gisagara. The risks for both diseases are significantly associated with type of place of residence, sex of household head, ownership of bed net, wealth index and mother’s educational attainment. Temperature and precipitation also have substantial association with both diseases. When developing malaria intervention programs and policies, it is important to take into account climatic and environmental variability in Rwanda. Also, potential intervention initiatives focusing on the lowest wealth index, children of uneducated mothers, and high risky regions need to be reinforced.
... The paucity of published evidence on anemia among school-aged children in the three states hindered our efforts to compare states' specific prevalence data. Nevertheless, our overall prevalence is lower than the 73% reported by Bamidele in Osun [40], and the 69% reported by Gayawan [41] for all the six southwestern states. Also, the prevalence appears lower than the WHO threshold of 40% that portrays anemia as a severe public health problem within an area [42]. ...
Schistosomiasis and anemia, are one of the leading global public health problem among children between age 5 and 14 years in marginalized settings. In this study, we provide prevalence and intensity data for both conditions in three southwestern states of Nigeria, where such are lacking. Epidemiological assessment involving parasitological analysis of urine and blood samples was conducted among 1783 consenting school-aged children in Ondo, Osun, Ekiti States of Nigeria. Participants’ age and sex data were obtained using field forms, and statistical analysis was performed in R software with a significance level of 95%. An overall prevalence of 26.8% and 29.5% was recorded for urinary schistosomiasis and anemia, respectively. Prevalence varied by location with (40.3% and 29.8%) in Ondo (34.4% and 37.5%) in Osun and (13.4% and 20.9%) in Ekiti for urinary schistosomiasis and anemia, respectively (p=0.00). Schistosoma infections were found among males (28.7%, p=0.05) and children between the age 9–11 years (30.0%, p=0.01). About 36% of children with anemia was also infected with schistosomiasis. Children who were positive for schistosomiasis (OR:1.51; 95% CI: 1.19, 1.93; p=0.001) and between the age category 15–16 years, (OR:1.86; 95% CI: 1.12, 3.09; p<0.05) were twice likely to become anemic. Our findings have shown that children infected with schistosomiasis are twice likely to become anemic than those without infection. It is important to complement ongoing MDA programmes targeted at schistosomiasis with nutrition intervention programs for example micronutrient supplementation for better impact and cost-effectiveness.
... It is a multilingual nation and home to over 250 ethnic groups speaking over 500 languages, reflecting the great cultural diversity in the country (Reed & Mberu, 2014). Located in West Africa (Figure 1), it is made up of 36 states-with each state divided into local government areas-and the Federal Capital Territory, Abuja (Gayawan, Arogundade, & Adebayo, 2014) ( Figure 2). In each state, five or more languages are spoken. ...
Nigerian Pidgin (hereafter NP) is the most widely spoken language in Nigeria, but many Nigerians view it negatively, as they associate it with uneducated people in the country and often caricature it as a bad form of English. However, attitudes towards NP in the diaspora and its role as a marker of social identity within and outside Nigeria have not been researched. Through informal interviews and focus group discussions with 10 Nigerians (5 men; 5 women) in Canada, I find that the participants choose NP as the language they use to express their identity as Nigerians in Canada. While the women embraced Standard English, the men had more positive attitudes towards NP suggesting covert prestige. Therefore, this study provides a good pilot project for analyzing attitudes towards NP and its role as a language of identity for Nigerians in the diaspora.
... Significant differences in the determinants of undernutrition between the zones was observed. Studies (Gayawan et al., 2014;Gayawan et al., 2019aGayawan et al., , 2019bMagalhaes et al., 2011) that analyzed country-wide variation of anemia and stunting did not examine the spatial variation, urban-rural disparities and clustering of CAS among U5C. Gawayan et al. (2019b) examined the spatial distribution and relationships among indicators of childhood malnutrition and found a regional divide in the pattern of concentration of malnutrition in specific states. ...
Anemia and stunting are serious public health problems among children in sub-Saharan Africa and Nigeria in particular. This paper examined the prevalence of co-occurrence of anemia and stunting (CAS) in rural and urban areas, identified predictors of CAS in rural and urban areas, analyzed the spatial pattern of CAS, identified the variables associated with the spatial variation of CAS and map the spatial distribution of CAS. Data from 2018 Nigerian Demographic and Health Survey, spatial statistical techniques, multivariable logistic regression and geographically weighted Poisson regression were employed. There was no significant differences between the observed and expected frequency of CAS. Prevalence of CAS varied spatially in rural/urban areas, states and zones. Children that were still breastfeeding, male, with low maternal educational level, living in North West zone and poor households have high risk of being anemic and stunted concurrently. Overall, children in poor households and those that experienced diarrhea were more likely to have co-occurrence of anemia and stunting in rural and urban areas. Nationally, prevalence of CAS exhibited a clustered pattern. Hotspots clustered in the North West zone while coldspots were mostly in the south. There was significant spatial variations in the relationships between CAS and the explanatory variables across the states. Health agencies and policymakers need to implement and strengthen nutrition-specific interventions particularly in high-risk areas.
... In the case of underfive children, low functional hemoglobin concentrations causes severe anemia and prevents quick recovery [3]. Iron deficiency is the most common cause of anemia, which occurs in situation where there is insufficient amount of iron in the red blood cells [4]. Malaria parasites attack the red blood cells by feeding on iron in the blood cell, causing a shortage in hemoglobin (Hb) concentration level. ...
... Findings from other African countries have similarly exhibited this relationship [4]. The first two years of life is a period of intense growth and development which comes with high demand for iron, but which may not be sufficiently available especially for children from low socio-economic households. ...
Malaria and anemia jointly account for the high morbidity and mortality among under-five children in sub-Saharan Africa including Rwanda. Notwithstanding different intervention programs and policies to address such double burden in Rwanda, the rate of infection remains a public health challenge. This study aimed at understanding the geographical variations between the joint and specific risks of both diseases in the country while quantifying the effects of some socio-demographic and climatic factors. Using data extracted from Rwanda Demographic and Health Survey, a shared component model was conceived and inference was based on integrated nested Laplace approximation. The study findings revealed similar spatial patterns for the risk of malaria and the shared risks of both diseases, thus confirming the strong link between malaria and anaemia. The spatial patterns revealed that the risks for contracting both diseases are higher among children living in the districts of Rutsiro, Nyabihu, Rusizi, Ruhango, and Gisagara. The risks for both diseases are significantly associated with type of place of residence, sex of household head, ownership of bed net, wealth index and mother's education level. Temperature and precipitation also have substantial association with both diseases. When developing malaria intervention programs and policies, it is important to take into account climatic and environmental variability in Rwanda. Also, potential intervention initiatives focusing on those living in rural areas, the lowest wealth index, children whose uneducated mothers, and high risky regions need to be reinforced.
... Literature also shows that anaemia in children can be influenced by place of residence, region, diarrhea or fever, low nutritional status of children, and household socioeconomic status [8][9][10][11]. Maternal characteristics such as age, education level, number of births, religion, access to media, nutritional indicators like underweight, and overweight have also been reported to be important risk factors of anaemia [8,10,11]. These have been investigated across different countries including sub-Saharan African region [9][10][11][12]. ...
... Literature also shows that anaemia in children can be influenced by place of residence, region, diarrhea or fever, low nutritional status of children, and household socioeconomic status [8][9][10][11]. Maternal characteristics such as age, education level, number of births, religion, access to media, nutritional indicators like underweight, and overweight have also been reported to be important risk factors of anaemia [8,10,11]. These have been investigated across different countries including sub-Saharan African region [9][10][11][12]. ...
... Maternal characteristics such as age, education level, number of births, religion, access to media, nutritional indicators like underweight, and overweight have also been reported to be important risk factors of anaemia [8,10,11]. These have been investigated across different countries including sub-Saharan African region [9][10][11][12]. A study conducted in India showed that children who had an experience of diarrhoea in seven days preceding the survey were more likely to be anaemic [8]. ...
Anaemia continues to be a burden especially in developing countries that not only affects the physical growth and cognitive development of children but also increases their risk to death. Over the past decade, the prevalence of anaemia among Ugandan children has been unacceptably high. Despite this, spatial variation and attributable risk factors of anaemia are not well explored at national level. The study utilized the 2016 Uganda Demographic and Health Survey (UDHS) data with a weighted sample of 3805 children aged 6-59 months. Spatial analysis was performed using ArcGIS version 10.7 and SaTScan version 9.6. This was followed by a multilevel mixed-effects generalized linear model for the analysis of the risk factors. Estimates for population attributable risks (PAR) and fractions (PAF) were also provided using STATA version 17. In the results, intra-cluster correlation coefficient (ICC) indicates that 18% of the total variability of anaemia was due to communities within the different regions. Moran's index further confirmed this clustering (Global Moran's index = 0.17; p-value<0.001). The main hot spot areas of anaemia were Acholi, Teso, Busoga, West Nile, Lango and Karamoja sub-regions. Anaemia prevalence was highest among boy-child, the poor, mothers with no education as well as children who had fever. Results also showed that if all children were born to mothers with higher education or were staying in rich household, the prevalence would be reduced by 14% and 8% respectively. Also having no fever reduces anaemia by 8%. In conclusion, anaemia among young children is significantly clustered in the country with disparities noted across communities within different sub-regions. Policies targeting poverty alleviation, climate change or environment adaptation, food security as well interventions on malaria prevention will help to bridge a gap in the sub regional inequalities of anaemia prevalence.
... Several studies using nationally representative [11][12][13][14][15], health facility-based [16][17][18][19][20], school-and community-based cross-sectional data [21][22][23][24][25][26] have examined demographic, social, economic, household, nutritional, environmental, health system and spatial/geographical factors predicting childhood anaemia status. ...
Background
Anaemia among children under age five is a major public health issue. Although anaemia prevalence is declining in Ghana, the severity among anaemic children is worsening. This study aims to investigate the determinants of anaemia severity among children aged 6 to 59 months in Ghana.
Method
The study utilized a weighted sample of 1,258 children with anaemia with data obtained from the 2019 Ghana Malaria Indicator Survey. The predictor variables included maternal, household child and health system characteristics. SPSS version. At the multivariate level, three different multinomial logistic models were run with selected predictor variables. All tests were conducted at the 95% confidence level.
Results
The overall anaemia prevalence among children under age five was 43.5%. Of these, 2.6% were severely anaemic, 48.5% were moderately anaemic, and 48.9% had mild anaemia. The multinomial analysis showed that maternal, household, child and health system factors significantly predicted anaemia levels among anaemic children. The results indicate that a lower likelihood of anaemia severity is likely to be found among children whose mothers belong to Pentecostal/Charismatic faith (AOR = 0.18-model I; AOR = 0.15-model III) and children who tested negative for malaria (AOR = 0.28-model II and III). Again, a higher probability of anaemia severity was found among anaemic children whose mothers were not aware of NHIS coverage of malaria (AOR = 2.41-model II, AOR = 2.60-model III). With regard to moderate anaemia level, children who belong to the poorest, poorer and middle household wealth index had a higher likelihood of being moderately anaemic compared to those in rich households. Similarly, anaemic children who were less than 12 months old (AOR = 2.21-model II, AOR = 2.29-model III) and those between the ages of 1–2 years (AOR = 1.84-model II, AOR = 1.83-model III) were more likely to have moderate anaemia levels.
Conclusion
The study findings show the importance of understanding the interrelation among different factors that influence anaemia severity among children under age five as critical in developing strategies and programmes aimed at addressing childhood anaemia.
... Map of Nigeria showing the study areas (36 states), extracted from Gayawan et al 2014.16 ...
Background: Monkeypox is a rare disease caused by infection with the Monkeypox virus (MPXV). Although monkeypox existed and declined in the past, its re-emergence is simultaneous with the rise in cases recently.Methods: This study utilized a non-interventional, anonymous, self-administered web-based survey through a descriptive cross-sectional design to collect data from medical/health students (undergraduate, graduate, and postgraduate students). The E-questionnaire was administered from 22nd July to 5th August through social media, and the data collected and extracted through an excel spreadsheet was analyzed using IBM SPSS Statistics 26.0.Results: A total of 203 respondents were obtained from 22nd July to 5th August, out of which 109 (53.7%) were females, 92 (45.3%) were males with 18-25 years (63.5%), 25-30 years (26.6%), <30 years (7.4%) and <18 years (2.5%) age groups. Of the total respondents, 94.1% have heard about monkeypox before, 59.1% believed that monkeypox could be managed, 80.8% believed that monkeypox is zoonotic but can be transferred from human to human, and the majority (60.1%) are aware of the symptoms of monkeypox.Conclusions: Medical/health students across social media show a relatively high knowledge of the Monkeypox virus with significant knowledge gap regarding the evolving epidemiologic and clinical manifestations, and the variety of components implicated in monkeypox transmission. Nonetheless, the knowledge is to be sustained and reinforced through continued awareness on social media and in rural areas with a high percentage of basic internet coverage and literacy. In order to direct proper surveillance, data collecting, readiness, and response operations, public health/surveillance capacities in Nigeria must be urgently developed.
... Spatial variation in these risk factors influences the patterns of disease risk and transmission [12]. Spatial mapping of single diseases is a well established method for identifying the geographical locations that are most at risk, thus creating a more effective delivery system of limited resources [12][13][14][15][16]. Such an approach for joint spatial modelling includes the multivariate conditional autoregressive (MCAR) model [17,18]. ...
Background
Malaria and anaemia contribute substantially to child morbidity and mortality. In this study, we sought to jointly model the residual spatial variation in the likelihood of these two correlated diseases, while controlling for individual-level, household-level and environmental characteristics.
Methods
A child-level shared component model was utilised to partition shared and disease-specific district-level spatial effects.
Results
The results indicated that the spatial variation in the likelihood of malaria was more prominent compared to that of anaemia, for both the shared and specific spatial components. In addition, approximately 30% of the districts were associated with an increased likelihood of anaemia but a decreased likelihood of malaria. This suggests that there are other drivers of anaemia in children in these districts, which warrants further investigation.
Conclusions
The maps of the shared and disease-specific spatial patterns provide a tool to allow for more targeted action in malaria and anaemia control and prevention, as well as for the targeted allocation of limited district health system resources.
... The commonest causes of anaemia in under five age group include malaria, haemoglobinopathies (sickle cell disease), septicaemia and malnutrition from poor feeding and parasitic infestations [6][7][8][9][10] . Most mortalities occur due to moderate or severe anaemia in this age group 8,11,12 . Factors associated with under-five anaemia include lack of knowledge about causes of anaemia by the parents, poor health seeking behaviour, poverty, low parental socioeconomic and educational status, and lack of access to quality care 8,11,12 . ...
This study used a nationally representative cross-sectional data from 2018 Nigeria Demographic Health Survey (NDHS) to investigate the prevalence and factors associated with anaemia in children aged less than five years in Nigeria. Anaemia was defined as haemoglobin level <11.0g/dl, while explanatory variables included parental profile, social and environmental factors. Descriptive analyses and multivariable Poisson regression models were fitted using Stata 15 software. Associated factors were quantified using Prevalence Ratio (PR) with 95% confidence interval (CI). Of the 5834 children aged 6-59 months, 51.9% were male. The prevalence of anaemia among under-five children was 71.6% (95% CI: 69.9-73.2). Childhood anaemia was associated with history of maternal anaemia (PR 1.06; CI 1.05-1.08); having underweight mothers (PR 1.02; CI 1.00-1.05); being a Muslim (PR 1.05; CI 1.02-1.08), Igbo (PR 1.07; CI 1.01-1.14) and Hausa (PR 1.04; CI 1.01-1.07) ethnic group. Further, children from South-South (PR 1.09; CI 1.06-1.13) and South-West (PR 1.06; CI 1.02-1.10) and those currently breastfeeding (PR 1.06; CI 1.04-1.07) had higher risk of anaemia. However, children from middle (PR 0.94; CI 0.91-0.97), or higher wealth indices were less likely to have anaemia. Maternal socio-economic and nutritional characteristics were identified as key predictors of under-five anaemia. Strategies are needed to mitigate the effect of poverty and tweak new and existing nutritional intervention programs to make them responsive to socio-cultural peculiarities across the various geo-political regions of Nigeria.
