Haemoglobin Level and Associated Factors among Children Age 6 To 59 Months in Central Highland of Ethiopia

Special Article - Malnutrition

Int J Nutr Sci. 2020; 5(1): 1038.

Haemoglobin Level and Associated Factors among Children Age 6 To 59 Months in Central Highland of Ethiopia

Ferede A1*, Abera M2 and Belachew T2

¹Department of Public Health, Arsi University, Ethiopia

²Department of Population and Family Health, Jimma University, Ethiopia

*Corresponding author: Abebe Ferede, Department of Public Health, Arsi University, College of Health Science, Asella, Ethiopia

Received: January 20, 2020; Accepted: February 10, 2020; Published: February 17, 2020


Iron deficiency anaemia in their children has less attention in developing countries where illiteracy is burden is high. There is not study that assessed Haemoglobin level of the children in the central high lands of Ethiopia.

Methods: Community based cross sectional study was carried out among women and their index children to determine haemoglobin level of children age 6 to 59 months in Central Highland of Ethiopia from January to July 2018.

A multistage sampling involving random sampling 8 districts and then 16 clusters Kebeles (smallest unit of administrations) from distracts. Finally, 1012 households, mothers/care givers, and their children 6 to 59 months were selected with systematic sampling technique. Study participants were interviewed using structured interviewer administered questionnaire to assess their knowledge and attitude about prevention of IDA. Child anthropometric measurements and blood samples were collected and analysed. Binary and linear logistic regressions were analysed using IBM SPSS Statistics version 21. Statistical significance was declared at P<0.05.

Results: High proportion (76.7%, n=776) of women had age 20 to 35 years. Low proportion (41.3%, n=418) of women knew the use of specific foods rich on iron. The mean haemoglobin concentration of children was 128.23g/L (+17.3) and 184 (18.4%) of had anemia, which was higher (24.1%) among age group 6-23 months. Multivariable linear regression analysis showed that age was positively associated with haemoglobin level (β = 0.172, CI=0.01, 0.33). For one month increase in age Hb concentration increased by 0.170 mg/dl.

Conclusion: The magnitude of anemia was moderate among young children. Milk consumption and young children was associated with to poor dietary intake behavior increased the risk of anemia. High proportion of young children was the most vulnerable group of IDA. Educating and empowering women will prevent children from developing IDA at their early life. Datary intake Behavioural Change Communication (BCC) is one of an attentive approach in increasing women’s knowledge attitude in self monitoring view of routinely modification of used household foods making into complementary food with efficient iron nutrient.

Keywords: Anemia; Children; Dietary behavior; Central highland; Ethiopia


B: β-Coefficient; CI: Confidence Intervallic; C: Centimetre; SD: Standard Division; ENA: Emergency Nutrition Assessment; HAZ: Height-For-Age Z Scores; MUAC: Mid Upper Arm Circumference; WHZ: Weight For Height Z Score; WHZ: Weight for Height; HAZ: Height for Age Z Score; Pv: P-Values; VIF: Variance Inflation Factors


Iron Deficiency (ID) among children is also associated with impaired mental and physical development and could cause cognitive disturbances without clinical situation of anemia [1]. The risk of iron deficiency is high among children 2-6 months due to their rapid growth failure of dietary iron intake in meeting their needs [2]. Untreated iron deficiency can affect a child growth and development [3]. The prevalence of anemia among children in Africa was estimated to be 46% [4]. Iron deficiency anemia affected 45% of children aged less than 5 years in developing countries [5].

According to WHO global database sources, currently the prevalence of IDA in children 6 to 59 months excesses to 46% in selected countries in east and southern Africa. From Africa countries, Uganda leading by 72.6% [6] and followed by Malawi was 625% [7]. However, a trend analysis for anemia indicated that in East Africa the trend of anemia among children aged 6–59 months declined from 74% in 1995 to 55% in 2011 [8].

According to WHO out of 0.8 million deaths, 1.5% can be attributed to iron deficiency each year. In terms of the loss of healthy life, expressed in disability-adjusted life years (DALYs), irondeficiency anemia results in 25 million DALYs lost (or 2.4% of the global total) [4].

Few studies showed that iron supplementation predicts greater increase in weight gain [9]. Currently, a significant reduction in prevalence of anemia among children became 7% in developed countries and even in same European countries estimated to 2%–6% among children. It is stated that enhancing enriched foods and the use of supplements contributed for the reduction IDA [10].

In Ethiopia, the prevalence of anemia among children 6 to 59 months is increasing from time to time ranging from 44% in 2011 to 56% in 2016 [11,12]. From limited study, a study conducted in districts of Kilte Awulaelo, Northern Ethiopia indicates that about 37.3% of children were anaemic [13]. There was no study was conducted in the study area knowledge and attitude of mothers about anemia and haemoglobin level of children.


Study design and area

Community based Cross sectional study design was used for initial assessment for behaviour change communication intervention in Central highland of Ethiopia from January to July 2018.

Study population

All mothers or care givers who had children age 6 to 59 months lived in the selected kebles where found in central highland of Ethiopia considered as study population. One hundred twelve mothers with their children 6 to 59 months were study subjects.

Sample size estimation: Sample size was determined using Gpower computer software version 3.0 with the following assumptions. A desired precision of 0.05, a power (1-β err probability) of 0.95 and design effect of 2 a final size of 1012 was estimated.

Sampling procedure

Multistage sampling method was used to select 8 districts (5 distracts and 3 rural towns), 16 Kebeles (smallest unit of administration) were randomly selected from selected districts in the Central Highland of Ethiopia. At the final stage, 1012 mothers/care givers and their pair children age 6 to 59 months were selected with systematic sampling from selected Kebeles.

Blood sample analysis for hemoglobin: Each child’s blood sample properly taken and collected by trained laboratory technologists and Hb was determined using HemoCue Hb 301® analyzer. Each participant’s hand was warmed and relaxed. Study participant’s mother or guardian was informed about required blood sample from child to analysis hemoglobin concentration, the need safe and precise finger prick at child’s finger to prevent minimum risk. Consequently, after mother / guardian agreed, she was asked to have firm comfortable hold of her child, and immobilize the finger to be punctured, to prevent sudden movement and accidental injury.

The hemoglobin results were adjusted for altitude and categorized into no Anemia (Hb >110g/L) as normal, anemic (Hb < 110 g/L) and Hb<70 g/L was defined asd severe abemia [14].

Anthropometric measurements: weight and height measurements were taken and converted into Weight for Height Z score (WHZ) to measure thinness and Height for Age Z score (HAZ) to measure stunting based on the cut-off values of the WHO standard [15].

Weight measured in kilogramme without shoes and with slight cover dress, using a battery-powered digital scale for children for who were able to stand and hanging spring scale for children < 2 years to the nearest 100gm. The weight scale was calibrated to zero before taking the next measurement.

Height was measured makin the child barefooted to the nearest 1cm using a stadiometer (a vertical tape fixed perpendicular to the ground on the wall) used for children age >24 months. Recumbent length board was used for children age less than 24 months. During measurement, the individual child relaxed with no shoes and lied on the length board parallel to the long axis of the board and then measurement was taken using 2 trained data collectors.

Data processing and analysis

HAZ and WHZ were analysed using Emergency Nutrition Assessment (ENA) software and communicated according to the World Health Organization (WHO) Child Growth Standards.

Stunting is defined as height for age (HAZ) < -2 Z score (standard deviation (SD)). Wasting was defined as Weight relevant to Height (WHZ) < -2SD [15].

Data were entered into EpiData: 3.0 version and transferred into Statistical Package for Social Science statistical (SPSS) software for windows, version 21 for analysis. Descriptive statistical methods were used for presenting data using proportions and frequencies. Bivariate and multivariable logistic regression models were used to identify the likelihood of anemia among children. Odds ratios with 95% of Confidence Intervals (CIs) were computed to assess the presence and degree of association between independent variables and anemia. A P-value less than 0.05 was used to declare a statistically significant association with anemia.

Linear regression model was used to assess predictors of children’s haemoglobin concentration and correlation was declared at beta coefficient (B) and 95% CI. About the assumptions of linear regression analysis, variables linearity, homoscedasticity and normality of the distribution were checked with scatter plot and histogram graphs. Finally, independence of the predictor variables and the absence of their intercorrelation assessed with collinearity statistics where Variance Inflation Factors (VIF) less than 10 and tolerance greater than 0.1 were used as sign of model fitness.


A total of 1012 women and their pair children participated in the study with a response rate of 100%. High proportion (76.7%, n=776) of women found at age 20 to 35 years, but 51.38% of them were attended elementary school or illiterate. Most (81.3%, n=823) of mothers participated in this study had family members <5 and 447(44.2%) had considerable monthly income <1000 Birr (Table 1).