@article{314c642b975742edac5f9b48c56e257c,
title = "Effect of individual, household and regional socioeconomic factors and PM2.5 on anaemia: a cross-sectional study of sub-Saharan African countries",
abstract = "There is limited knowledge on the effect of contextual and environmental factors on the risk of anaemia, as well as the spatial distribution of anaemia in the Sub-Saharan Africa region. In this study, we used multi-country data from the Demographic & Health survey (DHS) with 270,011 observations and PM2.5 data from NASA, applied to the spatial risk pattern of anaemia in the SSA region. The prevalence of anaemia amongst women (41%) was almost twice that of men (22%). A Bayesian hierarchical model showed that individual household, neighbourhood and regional socioeconomic factors were significantly associated with the likelihood of being anaemic. 1 μg/m3 increase in cumulative lifetime PM2.5 exposure accounted for 1% (β = 0.011, CI = 0.008 – 0.015) increase in the likelihood of being anaemic. The results suggest the need for a multidimensional approach to tackle anaemia in the Sub-Saharan African region and identify high-risk areas for target intervention policies or programs.",
keywords = "Anaemia, Bayesian spatial analysis, Demographic and health survey, Multilevel modelling, R-INLA, Sub-Saharan Africa",
author = "Amegbor, {Prince M.} and Borges, {Sergio S.} and Alex Pysklywec and Sabel, {Clive E.}",
note = "Funding Information: Prince M. Amegbor and Clive E. Sabel were supported by Big Data Centre for Environment and Health (BERTHA) funded by the Novo Nordisk Foundation Challenge Programme (grant NNF17OC0027864 ). We are also grateful to the NASA Socioeconomic Data and Applications centre (SEDAC), the USAID DHS programme, and Uganda Bureau of Statistics for the data used in this study. Funding Information: The data for our study came from the DHS and SEDAC. The DHS program is a nationally representative survey of 95 countries, including 44 Sub-Saharan African countries. ICF International implements DHS in collaboration with Statistics Bureaus of representative countries with the aim of collecting and disseminating accurate nationally representative data on fertility, family planning, maternal and child health, gender, HIV/AIDS, malaria and nutrition. The program is mainly funded by the United States Agency for International Development (USAID) with financial and technical support from national governments other organisations, such as the United Nations Children's Fund (UNICEF), Bill and Melinda Gates Foundation (BMGF), the United Nations Population Fund (UNFPA), and the World Health Organization (WHO). In each country, women aged 15 to 49 years, who are members of selected households and others who spent the night before the survey in the selected households are eligible to be interviewed. In addition, men aged 15 to 54 years from half of the sampled households who are usual members and those who spent the night before the survey are interviewed. DHS surveys use a two-stage cluster sample design. The first stage entails the selection of random census enumeration areas (EAs) from a complete list of all EAs from the national population and housing census. EAs are the smallest geographic units defined for the census purpose. In the DHS surveys, the EAs are further clustered into geographic regions (administrative regions or zone) based the country's administrative regions and rural-urban residence. The second stage entails a random selection of households in each selected EA in each of the clusters. DHS data from twenty-six Sub-Saharan African countries from surveys conducted between 2006 and 2019 were used in this study. The data represent the most recent DHS survey for Sub-Saharan African countries with geographic information (sampled points or locations) and haemoglobin data. Funding Information: Prince M. Amegbor and Clive E. Sabel were supported by Big Data Centre for Environment and Health (BERTHA) funded by the Novo Nordisk Foundation Challenge Programme (grant NNF17OC0027864). We are also grateful to the NASA Socioeconomic Data and Applications centre (SEDAC), the USAID DHS programme, and Uganda Bureau of Statistics for the data used in this study. Publisher Copyright: {\textcopyright} 2021 The Author(s)",
year = "2022",
month = feb,
doi = "10.1016/j.sste.2021.100472",
language = "English",
volume = "40",
pages = "1--11",
journal = "Spatial and Spatio-temporal Epidemiology",
issn = "1877-5845",
publisher = "Elsevier Limited",
}
