Community and Individual level Factors Associated with Anemia among Lactating mothers in Ethiopia using data from Ethiopian Demographic and Health Survey, 2016; Multilevel analysis

Abstract Introduction: Maternal anemia is a worldwide public health problem especially in developing countries including Ethiopia. The burden of anemia among lactating mothers in Ethiopia was higher than those who are neither pregnant nor breastfeeding. To date, there is limited evidence on community level determinates of anemia among lactating mothers in Ethiopia. Therefore, this study aimed to assess the individual and community level determinants of anemia among lactating mothers in Ethiopia.Methods: Secondary data analysis was employed using 2016 Ethiopian demographic and health survey. A total of 4658 (weighted samples) breastfeeding women were included in the current study. Multilevel logistic regression model was used to identify individual and community level determinants of anemia during lactation. Finally, adjusted odds ratio with 95% confidence interval was reported.Results: The overall prevalence of anemia was 28.3% (95% CI; 26.7, 30.0). With the higher regional prevalence in Somali (68%) and Afar (47%) regions. using modern contraceptive method [AOR = 0.71; 95% CI: 0.58, 0.87]; Poorer [AOR= 0.77; 95% CI: 0.61, 0.98], middle [AOR = 0.74; 95% CI: 0.56, 0.97] rich [AOR = 0.64; 95% CI: 0.46, 0.85], richest [AOR = 0.66; 95% CI: 0.43, 0.98] wealth index; working within the 12 months preceding the survey [AOR = 0.77; 95% CI: 0.64, 0.92]; and taking iron during pregnancy [AOR = 0.82; 95% CI: 0.68, 0.98] were associated with lower odds of anemia. Whereas, female household head [AOR = 1.22; 95% CI: 1.01, 1.49] having two births [AOR = 1.27; 95% CI: 1.04, 1.55], three to four births [AOR = 1.53; 95% CI: 1.14, 2.06] and higher community illiteracy [AOR = 1.06; 95% CI: 1.06, 1.70] were associated with the increased odds of anemia during lactation.Conclusion: In this study the prevalence of anemia among lactating mothers was high. It was affected by both community and individual-level factors. Therefore focusing on family planning services especially on modern contraceptive methods, child spacing and improving community literacy will help to reduce anemia during lactation.