Geographic weighted regression analysis of hot spots of anemia and its associated factors among children aged 6–59 months in Ethiopia: A geographic weighted regression analysis and multilevel robust Poisson regression analysis

INTRODUCTION: Anemia among children aged 6–59 months remains a major public health problem in low-and high-income countries including Ethiopia. Anemia is associated with significant consequences on the health of children such as under-five morbidity and mortality, increased risk of infection, and poor academic performance. The prevalence of anemia in Ethiopia has varied across areas. Therefore, this study aimed to investigate the geographic weighted regression analysis of anemia and its associated factors among children aged 6–59 months in Ethiopia. METHODS: This study was based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 8482 children aged 6–59 months was included. For the spatial analysis, Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used. Spatial regression was done to identify factors associated with the hotspots of anemia and model comparison was based on adjusted R(2) and Corrected Akaike Information Criteria (AICc). For the associated factors, the multilevel robust Poisson regression was fitted since the prevalence of anemia was greater than 10%. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association. RESULTS: The prevalence of anemia among children aged 6–59 months was 57.56% (95%CI: 56.50%, 58.61%) with significant spatial variation across regions in Ethiopia. The significant hot spot areas of anemia among children aged 6–59 months were detected in the central, west, and east Afar, Somali, Dire Dawa, Harari, and northwest Gambella regions. Mothers who had anemia, a child aged 23–59 months, mothers aged 15–19 years, and coming from a household with a poorer or poorest household were significant predictors of the spatial variations of anemia among children aged 6–59 months. In the multilevel robust Poisson analysis, born to mothers aged 30–39 (APR = 0.84, 95% CI: 0.76, 0.92) and 40–49 years (APR = 0.73, 95% CI: 0.65, 0.83), mothers who didn’t have formal education (APR = 1.10, 95% CI: 1.00, 1.20), Children in the poorest household wealth index (APR = 1.17, 95% CI: 1.06, 1.29), being 4–6 (APR = 1.08, 95% CI: 1.02, 1.13) and above 6 order of birth (APR = 1.15, 95% CI: 1.07, 1.23), children born to anemic mothers (APR = 1.24, 95% CI: 1.19, 1.29), children aged 24–59 months (APR = 0.70, 95% CI: 0.68, 0.73), stunted children (APR = 1.09, 95% CI: 1.04, 1.13) and underweight children (APR = 1.07, 95% CI: 1.03, 1.13) were significantly associated with anemia among children aged 6–59 months. CONCLUSION AND RECOMMENDATION: Anemia is still a public health problem for children in Ethiopia. Residing in a geographic area where a high proportion of children born to mothers aged 15–19 years, a child aged 6–23 months, coming from a household with poorer or poorest wealth index, and mothers with anemia increased the risk of experiencing anemia among children aged 6–59 months. Maternal education, maternal age, child age, household wealth, stunting, underweight, birth order, and maternal anemia were significant predictors of anemia among children. The detailed map of anemia hot spots among children aged 6–59 months and its predictors could assist program planners and decision-makers to design targeted public health interventions.