SPATIAL DISTRIBUTION AND DETERMINANTS OF ANAEMIA AMONG WOMEN OF REPRODUCTIVE AGE IN ETHIOPIA USING MIXED-EFFECT ORDINAL LOGISTIC REGRESSION MODEL

Abstract

Background: Anaemia is a condition characterized by a low blood hemoglobin concentration (120 g/L in non-pregnant women and below 110 g/L in pregnant women). It primarily affects women of reproductive age (WRA) and who suffer from anaemia has experienced detrimental effects on their mental development and future social functioning. Objectives: This study aimed to assess the spatial distribution and determinants of anaemia among women of reproductive age in Ethiopia. Methods: The study participants were all the WRA who were confirmed to anaemia from the 2019 EMDHS data source. The survey considered 8885 WRA; of which 1483 severe, 534 moderate, 1778 mild and 5090 none anaemia levels were included in this study. The study variable was defined as the ordinal level of anaemia (none, mild, moderate and severe) based on the WHO cut-off points. In this study, Moran’s-I, was used to investigate the presence of spatial autocorrelation. A mixed effect ordinal logistic regression model used allowed to analyze random and fixed effects of some covariates, spatial effects, and other fixed covariates. Inference used a full GLMM and several methods can be used to assess the goodness of fit in GLMMs, including the AIC and BIC techniques. Results: Out of 8885 WRA; included in this study 1483(16.7%) were found at a severe level of anemic. Due to the BIC model selection criteria, the GLMM model was found to be appropriate. From the model Individual factors (age group, religion, wealth index and marital status) and community factors (cooking fuel type, number of children, access to electricity, and having refrigerators) are found to be determinants, significant determinants of anaemia status among WRA and the spatial analysis demonstrated a clustered pattern of anaemia distribution, confirmed by the global Moran's I statistic (0.146652, p-value < 0.001). Conclusion: The finding revealed a spatial variation of anaemia status among WRA across the regions of Ethiopia with higher prevalence in the eastern parts of the country specifically in Somali and Harari regions. The application of the GLMM provided a more detailed understanding of the factors influencing anaemia status.