Study Explores High Prevalence of Anemia in Children Under 5 Years Old in Ghana

Published on: 

Investigators studied factors that could be associated with anemia in children < 5 years old, such as gender, age in years, type of birth (single or multiple), birth order, preceding birth interval in months (<18 months, 18+ months, or 1st born), and fever or no fever in the past 2 weeks (with malaria and without). Other factors related to mother or caregiver characteristics and household characteristics.

The risk of anemia was higher in children in Ghana who were < 2 years old, male, had teen mothers, lived in non-Christian homes, had mothers not covered with health insurance, resided in either the upper west or central region, and born to poorer households, according to a new study.1

Globally, there is a 42.6% anemia prevalence, leading to a 45% prevalence of children deaths. In the WHO African region, even more children face anemia, with the prevalence sitting at 68%. In regions where malaria is widespread, prevalence of anemia is 49% – 76%.

Anemia during pregnancy may lead the offspring to have low iron levels. If a pregnant woman fails to consume enough iron, vitamins, and minerals, they put their baby at risk of developing anemia, as a newborn requires a substantial amount of iron for rapid growth. Thus, a mother’s actions impact their child’s iron levels. Other factors that may contribute to a mother succumbing to anemia is not visiting the antenatal/postnatal clinic, a level of education, diarrhea, malaria, fever, parasitic infestations, poor sanitation, and maternal anemia.

The investigators, led by Justice K. Aheto, PhD, of the department of biostatistics at the University of Ghana, wanted to find the anemia prevalence among children < 5 years old in Ghana and conducted a multilevel analysis of the cross-sectional 2019 Ghana Malaria Indicator Survey. The team used both fixed and random effects (multilevel) logistic regression models to identify critical factors associated with anemia.

The same included 2434 children, and of them, 54% of the children under 5 years old were anemic (95% CI, 52.0 – 57.0). Children < 5 years old were defined with anemia if their hemoglobin level was below 11 g/dL.

The study had 200 clusters—103 of the clusters were rural, and 97 were urban. The survey included information from the 10 regions in Ghana at the time, even though Ghana now has 16 regions. Only the 10 original regions were used. The study examined 3 independent variables—child characteristics, mother or caregiver characteristics, and household characteristics.

Child characteristics included sex of child, age in years, type of birth (single or twins), birth order, proceeding birth interval in months (<18 years old, 18+ months, or 1st born), fever or no fever in the past 2 weeks (and fever with either malaria or no malaria). Meanwhile mother or caregiver characteristics included age group (15-19, 20-29, 30-39, 40-49), number of children (1 child, 2-3 children, 4-5 children, 6 + children), highest education (no education, primary, secondary, higher), literacy level (cannot read at all, able to read only parts of a sentence, or able to read entire sentence), religion (catholic/Christians, Islam, or Others), ethnicity (Akan, Ewe, Mole-Dagbani, Others), numbers of births for last 5 years, access to health insurance (no access, registered but not covered, or registered and covered).

For the household characteristics, this included region of residence, place of residence (rural or urban), age group of household head in years, sex of household head, type of cooking fuel (non-solid fuel or solid fuel), floor material (improved or unimproved material), roof material (improved/unimproved material), drinking water source (improved/unimproved), toilet facility (improved/unimproved, and household wealth quintile (poorest, poor, middle, rich, or richest).

After doing the analysis, the investigators found the younger the child, the more likely they were to be anemic. Infants were 66.7% more likely to be anemic than other children < 5 years old.

The risk was especially high for infants aged 6 – 11 months old (adjusted odds ratio [aOR]= 3.59; CI, 2.54 – 5.08), infants aged 12 – 23 months old (aOR = 2.97; CI, 2.08 – 4.23), children with malaria (aOR = 1.53; CI, 1.13 – 2.06), children whose mothers were not covered with health insurance (aOR = 1.45; CI, 1.21 – 1.74) or were not even registered for insurance (aOR = 1.49; CI, 1.15 – 1.93), children with teen mothers (aOR = 2.21; CI, 1.36 – 3.57), children with non-Christian mothers (Islam [aOR = 1.53; CI, 1.17 – 2.00), children from poorer households (poorest [aOR = 3.01; CI, 1.64 – 5.51]; poorer [aOR = 2.56; CI, 1.65 – 3.98]); middle (aOR = 2.03; CI, 1.32 – 3.11) and richer (aOR = 1.78; CI, 1.19 – 2.64), and children who resided in either Upper East (aOR = 2.03; CI, 1.26 – 3.26) or Central (aOR = 2.52; CI, 1.42 – 4.47) regions.

Even though the investigators compared the prevalence of anemia in rural and urban settings in Ghana and found it is more common in rural areas, the fixed and multilevel multivariable analysis did not show differentials in anemia prevalence between the 2 areas.

“This suggests that implementing interventions in just rural areas is not the best approach but instead, it is imperative we go further to identify what demographic of children is associated with anemia within these rural areas,” wrote the investigators.

The investigators suggested having “targeted community-level public health interventions” since the chance of developing anemia varies from one to community to the next in Ghana.

Interventions are already in place to lower the prevalence of anemia worldwide. Another study focusing on a Ghana population found the prevalence of anemia in children < 5 years had reduced from 78% in 2008 to 66% in 2014 and again to 54% in 2019, showing that anemia interventions improve the condition in the population.2

“This shows that although Ghana's anemia prevalence is lower than most developing countries, it is still a severe public health concern, which needs specific geographic, behavioral, community, and individual interventions to reduce it drastically,” the investigators wrote.1


  1. Aheto JMK, Alhassan Y, Puplampu AE, Boglo JK, Sedzro KM. Anemia prevalence and its predictors among children under-five years in Ghana. A multilevel analysis of the cross-sectional 2019 Ghana Malaria Indicator Survey. Health Sci Rep. 2023;6(10):e1643. Published 2023 Oct 22. doi:10.1002/hsr2.1643
  2. USAID, Ghana: Landscape Analysis of Anemia and Anemia Programming; 2016.