Peer-reviewed article
Childhood Anemia and Maternal Media Exposure in Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis Across Ghana, Nigeria, and Tanzania
Enock Adu Bonsu, Daniel Ebo, Dorcas Doku ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at whether mothers' exposure to media (radio, TV, newspapers, internet) is linked to anemia in young children in Ghana, Nigeria, and Tanzania. Using large national health surveys covering nearly 43,000 children, the researchers found that children of mothers with more media exposure had somewhat lower rates of anemia. The pattern was consistent across all three countries. Media exposure was also linked to mothers attending antenatal care and taking iron supplements, though these did not fully explain the anemia link. The authors caution that this is an observational study and cannot prove that media exposure directly causes lower anemia rates.
Key points
- Each additional weekly media channel used by mothers was linked to a 5.4% lower odds of childhood anemia (OR 0.946, 95% CI 0.917–0.976)
- Results were consistent across six sensitivity analyses (OR range 0.914–0.961) and did not differ by country (I²=0%)
- Media exposure predicted antenatal care attendance and iron supplementation use, but these did not explain (mediate) the anemia association
- 61.5% of hemoglobin data was missing and was addressed using a two-stage multiple imputation method
- Authors state intervention studies are needed before media-based approaches could be recommended for anemia control
Limitations
The cross-sectional design cannot establish whether media exposure causes lower anemia or rule out reverse causation and other unmeasured household factors; media exposure was measured only as frequency of use, not content or quality.
Abstract
Abstract Objectives To examine the association between maternal media exposure and childhood anemia in three sub-Saharan African countries, and to develop a two-stage multiple imputation approach for substantial hemoglobin outcome missingness in Demographic and Health Survey (DHS) data. Design Multi-country cross-sectional analysis of nationally representative DHS data. Setting Community-based household surveys in Ghana (2022), Nigeria (2023–24), and Tanzania (2022). Participants 42,944 children aged 6–59 months across 2,621 clusters. Primary and secondary outcome measures The primary outcome was anemia (altitude-adjusted hemoglobin <11.0 g/dL, WHO criteria); the primary exposure was a composite maternal media score (0–4 channels). Given 61.5% hemoglobin missingness, we imputed altitude-adjusted hemoglobin using multilevel Gaussian models and derived anemia deterministically, then estimated associations using population-averaged generalized estimating equations (pre-specified primary analysis), with six sensitivity analyses and exploratory mediation analysis. Results Media exposure was significantly associated with reduced anemia odds (OR 0.946, 95% CI 0.917 to 0.976, p<0.001; FMI 32.5%), a 5.4% reduction per additional weekly channel. Estimates were consistent across six sensitivity analyses (OR range 0.914–0.961), with no heterogeneity by country (I²=0%, p=0.482). Media exposure predicted antenatal care attendance and iron supplementation (both p<0.001), but neither mediated the anemia association. Conclusions Maternal media exposure was consistently associated with reduced childhood anemia across three sub-Saharan African settings. A two-stage multiple imputation approach addressed substantial (61.5%) outcome missingness while maintaining stable estimates, offering a transferable framework for DHS-based analyses. Prospective and intervention studies are needed before media-based communication can be recommended as a complementary anemia-control strategy. Strengths and Limitations of This Study This is among the first multi-country analyses to directly examine maternal media exposure and childhood anemia using nationally representative biomarker data from three sub-Saharan African countries. A validated two-stage multiple imputation approach addressed substantial (61.5%) hemoglobin missingness, with robustness confirmed across six pre-specified sensitivity analyses. The cross-sectional design precludes establishing temporality and cannot rule out reverse causation or residual confounding from unmeasured household factors. Maternal media exposure was measured as frequency of channel use only, without capturing content, quality, or health-specific programming. Mediation analysis relied on a single imputed dataset with non-clustered models, limiting direct comparability with the primary GEE-based estimate.