Figure 1: Trend of Anemia Prevalence in Gambia from 2013 to 2019/2020
Variable |
Characteristics |
Frequency and percentage in DHS Periods |
|
GDHS 2013 |
GDHS 2019 |
||
Region |
Banjul |
31 (1.4) |
26 (1.1) |
Kanifing |
325 (14.4) |
386 (16.1) |
|
Brikama |
765 (33.9) |
961 (40.1) |
|
Mansakanko |
130 (5.8) |
121 (5.0) |
|
Kerewan |
269 (11.9) |
277 (11.6) |
|
Kuntaur |
174 (7.7) |
145 (6.0) |
|
Janjanbureh |
188 (8.3) |
176 (7.3) |
|
Basse |
375 (8.3) |
308 (12.8) |
|
Place of residence |
Urban |
984 (43.6) |
1518 (63.3) |
Rural |
1273 (56.4) |
881 (36.7) |
|
Educational level of mother |
No education |
1388 (61.5) |
1139 (47.5) |
Primary education |
323 (14.3) |
424 (17.7) |
|
Secondary and above |
546 (24.2) |
836 (34.8) |
|
Source of drinking water |
Unimproved |
253 (11.2) |
175 (7.3) |
Improved |
2005 (88.8) |
2225 (92.7) |
|
Religion |
Islam |
2214 (98.0) |
2375 (99.0) |
Christianity |
44 (2.0) |
24 (1.0) |
|
Number of household members |
Small (1-4) |
124 (5.5) |
145 (6.0) |
Medium (5-9) |
790 (35.0) |
745 (31.1) |
|
Large (10 and more ) |
1344 (59.5) |
1509 (62.9) |
|
Sex of household head |
Male |
1859 (82.4) |
2037 (84.9 |
Ethnicity |
Mandinka /Jahanka |
727 (32.2) |
820 (34.2) |
Variable |
Characteristics |
Frequency and percentage in GDHS Periods |
|
GDHS 2013 |
GDHS 2019 |
||
Husbands educational level |
No education |
1386 (61.4) |
1311 (54.6) |
Primary education |
414 (18.4) |
517(21.6) |
|
Secondary and above |
457 (20.2) |
571 (23.8) |
|
Currently breastfeeding |
No |
840 (37.2) |
1069 (44.5) |
Yes |
1418 (62.8) |
1331 (55.5) |
|
Wealth index |
Poorest |
483 (21.4) |
569 (23.7) |
Poorer |
555 (24.6) |
505 (21.0) |
|
Middle |
407 (18.0) |
508 (21.2) |
|
Richer |
434 (19.2) |
406 (16.9) |
|
Richest |
379 (16.8) |
412 (17.2) |
|
Body mass index |
Thin |
258 (11.4) |
206 (8.6) |
Stunting |
No |
1766 (78.2) |
2075 (86.5) |
Underweight |
No |
1731 (76.7) |
1950 (81.3) |
Wasting |
No |
2001 (88.6) |
2257 (94.1) |
Sex of child |
Male |
1181 (52.3) |
1269 (52.9) |
Children age in month |
6-11 |
304 (13.5) |
285 (11.9) |
Diarrhea |
No |
1848 (81.8) |
1927 (80.3) |
Fever |
No |
1983 (87.8) |
2025 (84.4) |
Cough |
No |
1946 (86.2) |
1976 (82.4) |
Size of child at birth |
Small |
458 (20.3) |
349 (14.6) |
Variable |
Characteristics |
Frequency and percentage in GDHS Periods |
|
GDHS 2013 |
GDHS 2019 |
||
Child is twin |
Single birth |
2197 (97.3) |
2297 (98.7) |
Multiple birth |
61 (2.7) |
102 (4.3) |
|
Birth order number |
First |
447 (19.8) |
367 (15.3) |
Number of Under-five children |
Only one |
301 (13.3) |
385 (16.1) |
Mother anemia level |
Not anemic |
823 (36.5) |
1264 (52.7) |
Children Anemia level |
Not anemic |
635 (28.1) |
1289 (53.7) |
Table 1: Frequency and Proportion distribution of characteristics of the respondents and their children in Gambia
Variable |
Characteristics |
GDHSs periods |
Point difference in anemia prevalence (2019/2020-2013) |
|
2013 |
2019 |
|||
Region |
Banjul |
59.4 |
36 |
-23.4 |
Place of residence |
Urban |
64.6 |
38.7 |
-25.9 |
Educational level of mother |
No education |
74.2 |
51.2 |
-23 |
Source of drinking water |
Unimproved |
78.3 |
42.5 |
-35.8 |
Religion |
Islam |
72.3 |
46.6 |
-25.7 |
Number of household member |
Small (1-4) |
79 |
48.3 |
-30.7 |
Sex of household head |
Male |
73.4 |
48.1 |
-25.3 |
Currently breastfeeding |
No |
67.7 |
42 |
-25.7 |
Ethnicity |
Mandinka /Jahanka |
72.9 |
41.1 |
-31.8 |
Variable |
Characteristics |
GDHSs periods |
Point difference in anemia prevalence |
|
2013 |
2019 |
|||
Husbands educational level |
No education |
76.1 |
51.2 |
-24.9 |
Primary education |
64.7 |
41.9 |
-22.8 |
|
Secondary and above |
65.4 |
39.1 |
-26.3 |
|
Wealth index |
Poorest |
76.6 |
63.6 |
-13 |
Poorer |
78.4 |
47.6 |
-30.8 |
|
Middle |
77.1 |
39.6 |
-37.5 |
|
Richer |
64.3 |
43.8 |
-20.5 |
|
Richest |
59.5 |
31.3 |
-28.2 |
|
Body mass index |
Thin |
72.5 |
55.6 |
-16.9 |
Stunting |
No |
69.7 |
43.7 |
-26 |
Underweight |
No |
69 |
43.1 |
-25.9 |
Wasting |
No |
70.8 |
46.3 |
-24.5 |
Sex of child |
Male |
74.6 |
48.9 |
-25.7 |
Child age in months |
6-11 |
79.3 |
45.3 |
-34 |
Diarrhea |
No |
71.5 |
45.1 |
-26.4 |
Fever |
No |
71.2 |
45.6 |
-25.6 |
Cough |
No |
71.4 |
46.1 |
-25.3 |
Size of child at birth |
Small |
69.2 |
54.4 |
-14.8 |
Child is twin |
Single birth |
72 |
45.8 |
-11.1 |
Variable |
Characteristics |
GDHSs periods |
Point difference in anemia prevalence |
|
2013 |
2019 |
|||
Number of under-five children |
Only one |
66.8 |
39 |
-27.8 |
Birth order number |
First |
74.3 |
47 |
-27.3 |
Mother anemia level |
Not anemic |
65.7 |
39.4 |
-26.3 |
Table 2: Anemia prevalence trend among under-five children by selected characteristics in the Gambia
Prevalence of anemia |
Cofe. |
95 % CI. |
Pct. |
E |
-0.0230 |
(-0.0374, -0.0087)* |
11.17 |
C |
-0.1831 |
(-0.2110, -0.1553)* |
88.83 |
R |
-0.2061 |
(-0.2301, -0.1822)* |
|
* Significance at 5% level of significance |
Table 3: Total multivariate decomposition analysis of anemia prevalence in Gambia, 2013–2019/20
Anemia prevalence |
Difference due to characteristics (E) |
Difference due to coefficients (C) |
||
Cofe. With 95 % CI |
Pct. |
Cofe. With 95 % CI |
Pct. |
|
Residence |
||||
Rural |
Ref. |
|
Ref. |
|
Urban |
-0.0137 (-0.0210, -0.0065)* |
6.66 |
0.0493 (-0.0045, 0.1031) |
-23.92 |
Education level of mother |
||||
No education |
Ref. |
|
Ref. |
|
Primary |
-0.0019 (-0.0041, 0.0002) |
0.94 |
-0.0046 (-0.0145, 0.0053) |
2.2 |
Secondary and + |
-0.0054 (-0.0096, -0.0011)* |
2.61 |
-0.0148 ()-0.0287, -0.0009)* |
7.19 |
Sex of household head |
||||
Male |
Ref. |
|
Ref. |
|
Female |
0.0024 (0.0007, 0.0042) |
-1.18 |
-0.0005 (-0.0117, 0.0011) |
0.23 |
The educational level of the husband |
||||
No education |
Ref. |
|
Ref. |
|
Primary |
-0.0016 (-0.0031, -0.0001)* |
0.79 |
0.0092 (-0.0014, 0.0198) |
-4.45 |
Secondary and + |
-0.0009 (-0.0024,0.0006) |
0.46 |
0.0025 (-0.0092, 0.0141) |
-1.20 |
Wealth status of the household |
||||
Poorest |
Ref. |
|
Ref. |
|
Poorer |
-0.0059 (-0.0090, -0.0028)* |
2.87 |
-0.0246 (-0.0443, -0.0048)* |
11.92 |
Middle |
-0.0004 (-0.0007, -0.001)* |
0.20 |
-0.0068 (-0.0022, 0.0085) |
3.29 |
Richer |
-0.0032 (-0.0058, -0.0006)* |
1.56 |
0.0028 (-0.0121, 0.0178) |
-1.37 |
Richest |
-0.0014 (0.0022, -0.0005) |
0.60 |
0.0029 (-0.0095, 0.0154) |
-1.42 |
Stunting |
||||
No |
-0.0062 (-0.0107, -0.0017) |
3.02 |
-0.0076 (-0.0657, 0.0607) |
3.71 |
Yes |
Ref. |
|
Ref. |
|
Anemia prevalence |
Difference due to characteristics (E) |
Difference due to coefficients (C) |
||
Cofe. With 95 % CI |
Pct. |
Cofe. With 95 % CI |
Pct. |
|
Underweight |
||||
No |
-0.0045 (-0.0080, -0.0010)* |
2.19 |
0.0038 (-0.0530, 0.0607) |
-1.83 |
Yes |
Ref. |
|
Ref. |
|
Wasting |
||||
No |
0.0049 (0.0002, 0.0096) |
-2.37 |
0.0856 (-0.0091, 0.1802) |
-41.50 |
Yes |
Ref. |
|
Ref. |
|
Sex of children |
||||
Male |
Ref. |
|
Ref. |
|
Female |
-0.0001 (-0.0002, -0.0001)* |
0.07 |
-0.0075 (-0.0131, 0.0160) |
3.66 |
Age of children in months |
||||
0 to 5 |
Ref. |
|
Ref. |
|
6 to 11 |
-0.0001 (-0.0002, -0.0001)* |
0.05 |
0.0089 (-0.0135, 0.0312) |
-4.29 |
12 to 23 |
0.0000 (0.0000, 0.0002) |
-0.04 |
0.0199 (0.0004, 0.0393)* |
-9.63 |
24 to 35 |
-0.0018 (-0.0034, -0.0002)* |
0.87 |
0.0306 (0.0135, 0.0476)* |
-14.83 |
36 to 47 |
-0.0004 (-0.0005, -0.0003)* |
0.20 |
0.0120 (-0.0060, 0.0300) |
-5.81 |
48 to 59 |
-0.0137 (-0.0210, -0.0065)* |
6.66 |
-0.0148(-0.0287, -0.0009)* |
7.19 |
Birth type |
||||
Single birth |
0.0003 (-0.0006, 0.0013) |
-0.16 |
-0.0359 (-0.1839, 0.0112) |
17.44 |
Multiple births |
Ref. |
|
Ref. |
|
Size of children at birth |
||||
Small |
Ref. |
|
Ref. |
|
Average |
-0.0075 (-0.0146, -0.0003)* |
3.63 |
-0.0186 (-0.0390, 0.0018) |
9.03 |
Large |
0.0047 (0.0002, 0.0091) |
-2.26 |
-0.0340 (-0.0694, 0.0014) |
16.47 |
* Significance at 5% level of significance |
Table 4: Comprehensive multivariate decomposition analysis of anemia prevalence in Gambia, 2013 – 2019/20
Model |
AIC |
BIC |
Deviance |
The standard binary logistic regression model |
3398.525 |
3682.11 |
3302.525 |
The multilevel binary logistic regression model |
2941.192 |
3224.557 |
2843.192 |
Table 5: Standard logistic regression and mixed-effects logistic regression models comparison
Random effects parameters |
Null model |
Full model |
s2 |
0.296 (0.100, 0.879) |
0.212 (0.069, 0.624) |
ICC |
0.0826 (0.029, 0.211) |
0.061 (0.021, 0.165) |
MOR |
1.52 |
1.44 |
PCV |
Ref. |
0.284 |
LR test: LR = 295.86, p-value = <0.001 |
Table 6: Random effect parameters for the mixed-effects logistic regression model
Variable |
Characteristics |
COR (95% CI) |
P-value |
AOR (95% CI) |
P-value |
Mother anemia level |
Not anemic (0) |
Ref. |
|
Ref. |
|
Anemic (1) |
1.630 (1.377, 1.934)* |
<0.001 |
1.577 (1.308, 1.902)* |
<0.001 |
|
Number of under-five children |
Only one (0) |
Ref. |
|
Ref. |
|
2 to 3 (1) |
1.281 (0.983, 1.670) |
0.066 |
1.114 (0.827, 1.500) |
0.477 |
|
3 and more (2) |
1.467 (1.147, 1.878)* |
0.002 |
1.225 (0.883, 1.698) |
0.225 |
|
Birth order of children |
Firs (0) |
0.920 (0.699, 1.212) |
0.555 |
1.090 (0.783, 1.517) |
0.609 |
2 to 3 (1) |
0.986 (0.788, 1.232) |
0.900 |
1.206 (0.925, 1.574) |
0.169 |
|
4 to 5 (2) |
1.027 (0.808, 1.306) |
0.827 |
1.149 (0.878, 1.504) |
0.311 |
|
6 and more (3) |
Ref. |
|
Ref. |
|
|
Birth type of children |
Single (0) |
Ref. |
|
Ref. |
|
Multiple (1) |
2.257 (1.484, 3.432)* |
<0.001 |
1.879 (1.181, 2.989)* |
0.008 |
|
Birth size of children |
Small (0) |
Ref. |
|
Ref. |
|
Average (1) |
0.754 (0.585, 0.972)* |
0.030 |
0.900 (0.679, 1.192) |
0.462 |
|
Large (2) |
0.687 (0.533, 0.887)* |
0.004 |
0.882 (0.661, 1.177) |
0.392 |
|
Cough |
No (0) |
Ref. |
|
Ref. |
|
Yes (1) |
1.033 (0.829, 1.287) |
0.773 |
1.075 (0.836, 1.384) |
0.571 |
|
Fever |
No (0) |
Ref. |
|
Ref. |
|
Yes (1) |
1.114 (0.884, 1.404) |
0.361 |
1.007 (0.765, 1.302) |
0.987 |
|
Diarrhea |
No (0) |
Ref. |
|
Ref. |
|
Yes (1) |
1.289 (1.044, 1.592)* |
0.018 |
1.003 (0.756, 1.214) |
0.722 |
|
Age of children in month |
0 to 11 (0) |
2.357 (1.703, 3.261)* |
<0.001 |
2.148 (1.488, 3.100)* |
<0..001 |
12 to 23 (1) |
4.236 (3.210, 5.591)* |
<0.001 |
3.953 (2.909, 5.372)* |
<0.001 |
|
24 to 35 (2) |
3.418 (2.583, 4.522)* |
<0.001 |
3.575 (2.661, 4.802)* |
<0.001 |
|
36 to 47 (3) |
2.136 (1.619, 2.818)* |
<0.001 |
2.064 (1.546, 2.757)* |
<0.001 |
|
48 to 59 (4) |
Ref. |
|
Ref. |
|
Variable |
Characteristics |
COR (95% CI.) |
P-value |
AOR (95% CI) |
P-value |
Wasting |
No (0) |
Ref. |
|
Ref. |
|
Yes (1) |
1.011 (0.702,1.500) |
0.926 |
1.840 (1.203, 2.814)* |
0.005 |
|
Underweight |
No (0) |
Ref |
|
Ref. |
|
Yes (1) |
1.925 (1.548, 2.393)* |
<0.001 |
1.661 (1.241, 2.221)* |
<0.001 |
|
Stunting |
No (0) |
Ref. |
|
Ref. |
|
Yes (1) |
2.132 (1.656, 2.746) |
|
1.481 (1.094, 2.004)* |
0.011 |
|
Body mass index of mother |
Thin (0) |
Ref. |
|
Ref. |
|
Normal (1) |
0.774 (0.568, 1.055) |
0.105 |
0.888 (0.632, 1.248) |
0.495 |
|
Overweight (2) |
0.715 (0.520, 0.988)* |
0.040 |
1.017 (0.708, 1.459) |
0.929 |
|
Wealth status of the household |
Poorest (0) |
Ref. |
|
Ref. |
|
Poorer (1) |
0.660 (0.507, 0.859)* |
0.002 |
0.682 (0.505, 0.921)* |
0.013 |
|
Middle (2) |
0.526 (0.397, 0.697)* |
<0.001 |
0.559 (0.393, 0.796)* |
<0.001 |
|
Richer (3) |
0.665 (0.488, 0.909)* |
<0.010 |
0.753 (0.507, 1.132) |
0.172 |
|
Richest (4) |
0.340 (0.287, 0.556)* |
<0.001 |
0.449 (0.287, 0.702)* |
<0.001 |
|
Ever breast feed |
No (0) |
Ref. |
|
Ref. |
|
Yes (1) |
0.700 (0.591, 0.830)* |
<0.001 |
0.789 (0.634, 0.981)* |
0.033 |
|
Husband education level |
No education (0) |
Ref. |
|
Ref. |
|
Primary (1) |
0.873 (0.701, 1.089) |
0.227 |
0.990 (0.772, 1.270) |
0.937 |
|
secondary + (2) |
0.825 (0.665, 1.024) |
0.081 |
1.036 (0.807, 1.331) |
0.871 |
|
Sex of household head |
Male (0) |
Ref. |
|
Ref. |
|
Female (1) |
0.682 (0.536, 0.867)* |
0.002 |
0.739 (0.568, 0.962)* |
0.024 |
|
Family size |
Small (0) |
Ref. |
|
Ref. |
|
Medium (1) |
0.737 (0.509, 1.068) |
0.107 |
0.739 (0.492, 1.111) |
0.146 |
|
Large (2) |
0.883 (0.616, 1.265) |
0.496 |
0.829 (0.535, 1.286) |
0.403 |
|
Religion |
Islam (0) |
Ref. |
|
Ref. |
|
Christianity (1) |
0.305 (0.110, 0.846)* |
0.022 |
0.779 (0.221, 2.743 |
0.698 |
Variable |
Characteristics |
COR (95% CI.) |
p-value |
AOR (95% CI) |
P-value |
Source of dirking water |
Unimproved (0) |
1.005 (0.720, 1.403) |
0.976 |
1.023 (0.700, 1.500) |
0.905 |
Improved (1) |
Ref. |
|
Ref. |
|
|
Education level of mother |
No education (0) |
Ref. |
|
Ref. |
|
Primary (1) |
0.962 (0.760, 1.216) |
0.743 |
0.872 (0.763, 1.130) |
0.301 |
|
Secondary + (2) |
0.812 (0.700, 1.034) |
0.113 |
0.925 (0.724, 1.184) |
0.537 |
|
Ethnicity |
Mandinka/Jahanka (0) |
Ref. |
|
Ref. |
|
Wollof (1) |
1.305 (0.986, 1.728) |
0.063 |
1.274 (0.936, 1.736) |
0.124 |
|
Jola/Karoninka (2) |
1.232 (0.854, 1.696) |
0.202 |
1.039 (0.722, 1.497) |
0.836 |
|
Fula (3) |
1.241 (0.969, 1.589) |
0.087 |
1.047 (0.795, 1.379) |
0.745 |
|
Serere (4) |
0.508 (0.283, 0.912)* |
0.023 |
0.420 (0.217, 0.814)* |
0.010 |
|
Serahuleh (5) |
0.828 (0.580, 1.182) |
0.299 |
0.883 (0.600, 1.300) |
0.526 |
|
Creole/Aku Marabout (6) |
0.210 (0.014, 3.052) |
0.253 |
0.275 (0.015, 4.923) |
0.380 |
|
Manjago (7) |
0.092 (0.008, 1.061) |
0.056 |
0.099 (0.007, 1.441) |
0.091 |
|
Bambara (8) |
0.889 (0.386, 2.049) |
0.783 |
0.743 (0.308, 1.791) |
0.508 |
|
Other (9) |
1.020 (0.305, 3.414) |
0.974 |
1.405 (0.376, 5.249) |
0.613 |
|
Non-Gambian (10) |
1.128 (0.841, 1.500) |
0.432 |
1.000 (0.724, 1.384) |
0.995 |
|
* Significance at 5% level of significance |
Table 7: Simple and multiple multilevel binary logistic regression analysis of determinants of anemia prevalence among under-five in Gambia, 2019/20
Figure 1: Trend of Anemia Prevalence in Gambia from 2013 to 2019/2020
Figure 2: Trend of prevalence of anemia over time across regions of Gambia 2013, 2019/20
Tables at a glance
Figures at a glance