Peer-reviewed article

Anemia and Its Associated Factors Among Children Aged 6-23 Months in Nine Sub-Saharan African Countries: A Multilevel Proportional Odds Model Using the Latest Demographic and Health Survey (DHS) Data.

Wondmeneh TG · 19 Jun 2026

Abstract

Background Anemia remains highly prevalent among children aged 6-23 months in sub-Saharan Africa. Previous estimates relied on outdated World Health Organization (WHO) hemoglobin cutoffs, which may have overestimated the burden. This study assessed anemia prevalence and associated factors using the updated 2024 WHO thresholds in nine sub-Saharan African countries. Methods A cross-sectional analysis was conducted using recent Demographic and Health Survey data (2021-2024). A weighted sample of 14,480 children aged 6-23 months was included. A multilevel proportional odds model was applied to identify factors associated with anemia severity. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was declared at p < 0.05. Results The overall prevalence of anemia was 62.04% (95% CI: 61.3-62.8), including 2.94% severe, 31.96% moderate, and 28.14% mild anemia. Female children had higher odds of being in less severe anemia categories compared with males (AOR = 1.40, 95% CI: 1.27-1.45). Higher maternal education (secondary or higher: AOR = 1.37, 95% CI: 1.23-1.52), health insurance coverage (AOR = 1.74, 95% CI: 1.55-1.96), adequate antenatal care (AOR = 1.09, 95% CI: 1.01-1.17), deworming (AOR = 1.14, 95% CI: 1.06-1.23), and adequate dietary diversity (AOR = 1.25, 95% CI: 1.10-1.41) were associated with lower anemia severity. In contrast, fever (AOR = 0.75, 95% CI: 0.67-0.81), underweight status (AOR = 0.87, 95% CI: 0.78-0.97), and multiple births (AOR = 0.65, 95% CI: 0.49-0.85) were associated with more severe anemia. Conclusion Anemia remains a major public health problem in the included countries despite the use of updated WHO thresholds. Interventions targeting maternal education, child nutrition, infection prevention, and access to healthcare services are essential to reduce anemia severity.