Multinomial logistic regression analysis of the determinants of anaemia severity among children aged 6-59 months in Ghana: New evidence from the 2019 Malaria Indicator Survey

Background: Anaemia among children under age five is a major public health issue. Although anaemia prevalence is declining in Ghana, the severity among anaemic children is worsening. This study aims to investigate the determinants of anaemia severity among children aged 6 to 59 months in Ghana. Method: The study utilized data from 1,258 children with anaemia from the 2019 Malaria Indicator Survey. The independent variables included child, maternal, health, household and system characteristics. Analyses were conducted at the univariate, bivariate and multivariate levels. At the multivariate level, three different multinomial logistic models were run to include interactive terms between selected independent variables. All tests were conducted at the 95% confidence level. Results: The overall anaemia prevalence among children under age five was 43.5%. Of these, 2.6% were severely anaemic, and 48.5% and 48.9/5 had moderate and mild anaemia, respectively. The multinomial analysis showed that maternal, household, child and health system factors significantly predicted anaemia levels among children with anaemia. The results indicate that anemic children whose mothers reside in urban areas (AOR=3.87; C. I: 1.11-13.48), children whose mothers are unaware of NHIS coverage of malaria (AOR=3.00; C.: 1.31-6.88) were more likely to have severe anaemia. Again, a lower probability of being severely anaemic was found among anaemic children whose household heads were aged 30-39 years and children who tested negative for malaria. With regard to moderate anaemia level, children who belong to the poorest and poorer household wealth index had a higher likelihood of being moderately anaemic. Similarly, children with anaemia who were less than 12 months old (AOR=1.72; C. I: 1.06-2.80) and mothers of anaemic children who were not aware of NHIS coverage of malaria (AOR=1.33; C.I: 1.00-1.77) were more likely to have moderate anaemia levels. Furthermore, anemic children whose household heads were aged 50-59 years (AOR=0.52; CI: 0.29-0.93) and three-year-old anemic children (AOR=0.59; C.: 0.38-0.90) had a lower likelihood of being moderately anaemic. Conclusion: The study findings show the importance of understanding the interaction among factors that influence anaemia levels among children under age five as critical in developing strategies and programmes aimed at addressing childhood anaemia.