Prevalence and Predictors of Anemia Among Preschool Children in Aqaba, Jordan: Evidence from a Comprehensive Health Center

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Tarek Salim Mahmoud Al-Moghrabi, 2. Yara Hasan Mohammad Khater, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8069642/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Anemia is a global public health problem. Childhood anemia is associated with detrimental effects on growth and development and increased morbidity and mortality. This study aims to estimate the prevalence and assess factors associated with anemia among children aged 9-59 months in Aqaba, Jordan, and compare findings with national data. Methods This facility-based cross-sectional study retrospectively analyzed de-identified secondary data in the Hakeem electronic health record and the center’s quality-improvement database at a comprehensive center in Aqaba, Jordan, between May 2024 and January 2025. During this period, a quality improvement project aimed to monitor and improve anemia screening, ultimately enhancing child health aged 9 months to 59 months. Hemoglobin results and demographic variables were extracted from existing records of the quality improvement project. Classification of anemia was according to the World Health Organization (WHO) thresholds. We used Descriptive statistics to summarize demographic data, and CHI-square tests and binary logistic regression to assess associations between anemia status, age, and sex. A p-value <0.05 was considered statistically significant. Results Out of the total of 1005 children included in the study, 497 (49.5%) were males, and 508 (50.5%) were females. Of the 497 males, 63 (12.7%) were anemic. Of the 508 females, 44 (8.7%) were anemic. The average age was 16.4 ± 9.2 months, and the average hemoglobin (Hb) level was 12.0 ± 0.9 g/dL. Male sex independently predicted anemia (OR = 1.53, 95% CI 1.02–2.29, p = 0.041). Conclusion The prevalence of anemia among children below the age of 5 years is notably lower than national estimates, suggesting potential benefits from improved health coverage, dietary fortification, and integrated supplemental programs. However, the higher risk among male children warrants targeted preventive strategies. Continued surveillance and prompt intervention remain essential to sustain and further reduce childhood anemia in Jordan. Anemia Childhood Jordan prevalence hemoglobin Introduction and Background Anemia is defined as a condition in which the number of circulating erythrocytes, which carry oxygen, is low to a level where it cannot meet metabolic demands. A hemoglobin (Hb) concentration level that is below the established normal threshold for the age and sex serves as a clinical diagnosis. (Gallagher, 2022) [ ] Anemia is a significant public health issue among women, youth, and particularly children worldwide. In recent reports, the World Health Organization (WHO) estimates that the prevalence of anemia is around 39% in children aged 6–59 months globally [ ]. Iron deficiency is the most common cause of anemia in early childhood has a substantial association with adverse effects on growth, neurocognitive development, and immunity [2]. Despite advancements in maternal and child health care, childhood anemia remains common in many populations and settings Beard, J. (2003). [ ] According to the Jordan Population and Family Health Survey 2023 [ ]The national prevalence of anemia in Jordan is 32%, which is similar in Aqaba, a southern district in Jordan, where one in three children also has anemia. Anemia is associated with impaired psychomotor development during childhood (PALA), which highlights the importance of studying and exploring the current status of Anemia in this age group. In Jordan, a strong relation was shown between the anemia status and age by a previous study, especially in children aged 36–59 months, and it was shown that almost half of the children (47%) were moderately anemic. Al-Suhiemat, A. et al. [ ]. The national survey [4] conducted in Aqaba in 2023, examined only a group of 74 children. This study aimed to estimate the prevalence and determinants of anemia among children aged 9–59 months in Aqaba, Jordan, using data from a large facility-based screening program in a larger sample size focusing on the effectiveness of previous screening in primary health care centers, which was held in Aqaba Primary Health Care as part of the Health Services Quality Accelerator (HSQA) project, funded by USAID and implemented through the University Research Co., LLC (URC) in partnership with the Jordan Ministry of Health. Methods Study Design and Setting This paper utilizes data previously collected and recorded as part of a quality-improvement project established at a comprehensive healthcare center in Aqaba, Jordan. The original QI project aimed to monitor and enhance anemia screening coverage for children aged 9 months to 59 months when they present to the center for vaccines and routine child health care. The QI project was implemented as part of the Health Services Quality Accelerator Activity (HSQA) initiated by the Ministry of Health in collaboration with USAID. In the period between May 2024 and January 2025, a total of 1,005 children were screened and included in the dataset analyzed in this study. For the current study, these data were retrospectively retrieved from the Hakeem electronic health record and the center’s QI database. The original data were collected by professional health care workers and entered into digital reporting by the quality improvement team in the center for monitoring and feedback. The present analysis follows a cross-sectional design, using this dataset to calculate anemia prevalence and explore associations between hemoglobin status, age, and sex. Although the data represent a facility-based rather than a randomly selected sample or a community-based sample, this center, being a comprehensive center, serves several surrounding neighborhoods with socioeconomic diversity and a large pediatric population in the city of Aqaba, which offers valuable insight into anemia patterns among preschool-aged children in this segment of the Aqaba community. In the original QI project, healthcare providers measured hematocrit from capillary blood collected from the fingertip and converted it to hemoglobin levels. Low readings were confirmed by venous blood sampling. Classification of anemia followed the standard cutoffs: mild (10.0–10.9 g/dL), moderate (7.0–9.9 g/dL), and severe (below 7.0 g/dL), Classification of anemia followed the standard cutoffs of WHO (2011) [ ]. The QI project was conducted at a comprehensive primary health care center in Aqaba, Jordan. This center was chosen for its broad coverage of the local population. It also serves as the largest provider of routine child health and vaccination services in the region. This ensured access to a diverse pediatric population from various socioeconomic backgrounds. Data collection took place between May 2024 and January 2025. Participants Eligible participants were children aged 9 to 59 months who attended the health center during the study period. Exclusion criteria included any child with a known chronic condition that could affect hemoglobin concentration, such as hemoglobinopathies, chronic kidney disease, or malignancy. No restrictions were applied regarding sex, ethnicity, or socioeconomic status. The final sample included 1,005 children attending the center for vaccination or routine care. Data Sources and Measurements Healthcare professionals with the necessary training collected the data. Hemoglobin levels were screened using a portable fingertip hemoglobinometer, and any low readings were verified through venous sampling. The procedure ensured high measurement accuracy and minimized potential errors. In addition to hemoglobin levels, demographic data, including the child’s age, sex, and place of residence, were recorded on structured data sheets designed for the study. Bias Minimization Several steps were taken to minimize bias. The study setting, where children commonly visit for vaccinations, offered a natural, diverse sample of the target age group. Verification of fingertip readings through venous sampling minimized measurement bias. All data collectors received standardized training to maintain consistency and reliability in measurements and data entry. Study Size The final study sample included 1,005 children, representing all eligible participants during the data collection period. This sample size provided adequate statistical power to detect associations between anemia status and selected demographic variables while representing the general child population of Aqaba. Ethical Approval and Consent to Participate The Health Services Quality Accelerator (HSQA) oversight committee approved the original quality-improvement project. The Jordan Ministry of Health, USAID, and the University Research Co., LLC (URC) collaborated jointly to put it into implementation. The Research Committee and Institutional Review Board (IRB) in Jordanian Ministry of Health (MOH) gave approval for this secondary analysis with No. (MOH/REC/2025/532). Before retrieval and analysis, all data were completely anonymised. Because hemoglobin screening was part of the normal health and vaccination services for children at Ministry of Health primary care clinics, parents or guardians did not need to give formal consent; they gave verbal or implied consent as part of normal clinical care. Data Collection and Validation The original data had been collected as part of routine service evaluation under the HSQA project. For this retrospective analysis, the research team extracted and validated de-identified records by cross-checking hemoglobin results and demographic data from the Hakeem system. Data Analysis We used Jamovi software (version 2.7) to do the statistical analysis in the R statistical environment. Descriptive statistics were used to describe the characteristics of the participants, giving an extensive understanding of the study population. We used Chi-square tests and binary logistic regression, which are both types of inferential statistics, to look at the links between anemia status and demographic factors, including age and sex. All statistical approaches followed accepted guidelines for epidemiological analysis as detailed in prior studies [ , , ], hence ensuring the validity and reliability of the results. Results General Characteristics of the Study The analysis included 1,005 children between the ages of 6 and 59 months. 497 (49.5%) of these were males, and 508 (50.5%) were females. The average age was 16.4 ± 9.2 months, and the average hemoglobin (Hb) level was 12.0 ± 0.9 g/dL. The World Health Organization (WHO, 2020) (13) defines anemia for kids aged 6 to 59 months as Hb < 11.0 g/dL. Of those with this condition, 107 (10.6%) were anemic and 898 (89.4%) were not. Table 1 shows a summary of the participants’ characteristics. Table 1 Characteristics of the study population (N = 1,005) Variable Category/Unit n (%) Mean ± SD Age (months) 16.4 ± 9.2 6–11 416 (41.4%) 12–23 491 (48.9%) 24–59 98 (9.8%) Sex Female 508 (50.5%) Male 497 (49.5%) Hemoglobin (g/dL) 12.0 ± 0.9 Anemia status No Anemia 898 (89.4%) Anemia 107 (10.6%) How common is anemia by sex? Of the 497 males, 63 (12.7%) were anemic. Of the 508 females, 44 (8.7%) were anemic (Table 2.1 ). This difference was statistically significant (χ²(1) = 3.84, p = 0.0499) (Table 2.2 ). There was no significant difference in mean Hb values between sexes. Table 2.1 Anemia Prevalence by sex in children 6 to 59 months old Sex Anemic n (%) Non-anemic n (%) Male 63 (12.7%) 434 (87.3%) Female 44 (8.7%) 464 (91.3%) Total 107 (10.6%) 898 (89.4%) Table 2.2 Chi-square test to see if there is a causal association between sex and anemia status Chi-square df p-value 3.84 1.0 0.0499 Anemia Prevalence by Age Group There were three age groups for the children: 6 to 11 months (n = 416), 12 to 23 months (n = 491), and 24 to 59 months (n = 98). The rates of anemia were 10.6%, 10.6%, and 11.2%, respectively (Table 3.1 ). There was no statistically significant connection between age group and anemia status (χ²(2) = 0.04, p = 0.981) (Table 3.2 ). Table 3.1 Anemia prevalence by age group in children aged 6–59 months. Age group (months) Anemic n (%) Non-anemic n (%) 6–11 44 (10.6%) 372 (89.4%) 12–23 52 (10.6%) 439 (89.4%) 24–59 11 (11.2%) 87 (88.8%) Total 107 (10.6%) 898 (89.4%) Table 3.2 Chi-square test to find a link between age group and anemia status Chi-square df p-value 0.04 2.0 0.9811 Anemia Predictors We did a binary logistic regression with anemia (yes/no) as the dependent variable and age (in months) and sex (male vs. female) as the independent variables. Being male was strongly linked to an increased likelihood of having anemia (OR = 1.53, 95% CI [1.02–2.29], p = 0.041), but age was not a strong predictor (OR = 0.99, 95% CI [0.97–1.01], p = 0.456). The model also explained a minimal fraction of the variance (Nagelkerke R² = 0.010) (Table 4 ). Table 4 Binary logistic regression analysis of anemia predictors Predictor OR 95% CI (lower) 95% CI (upper) p-value Sex (Male vs Female) 1.53 1.02 2.29 0.0413 Age (months) 0.99 0.97 1.01 0.4557 A summary of the results The overall prevalence of anemia in this population was 10.6%, significantly lower than the 33.1% reported nationally for Jordanian children under five years (Department of Statistics Jordan, 2023) ( 14 ). Anemia was considerably more prevalent in males, demonstrating no variation with age. Regression analysis validated that only sex persisted as an independent predictor. Most of the anemic children had moderate anemia, which shows just how essential it is to maintain screening and provide nutritional help. Discussion This study presents a secondary analysis of data collected from a quality improvement (QI) project at a comprehensive health-care center in Aqaba, Jordan, that mainly aimed at investigating the prevalence and predictors of anemia among children aged 9–59 months in the southern part of Jordan, specifically, Aqaba, Jordan. As well, the study sought to generate and update locally relevant data to complement existing national data with the goal of supporting future health planning, informing evidence-based decision-making, and ensuring appropriate healthcare is provided for anemic children through screening programs and guidelines-based treatment plans. The main results showed that 10.6% of the children in this facility-based population, which included 1,005 kids, had anemia. This is a lot less than the previous national rate of 33.1% for kids under five years old in Aqaba from the 2023 Jordan Population and Family Health Survey (JPFHS) (Department of Statistics). [ ] Notably, the odds for male children to be anemic were significantly higher than for females, identifying sex as a statistically significant predictor. Although the study utilized a facility-based sample rather than a randomly selected community sample, the center serves a diverse range of urban neighborhoods, allowing valuable insight into anemia patterns among children who access routine health services in this catchment area. In contrast, this study found no statistically significant association between age and anemia status, challenging earlier research in Jordan by Al-suhiemat et al. [5], which suggests older preschool children are more likely to be anemic compared to their younger counterparts. The notable sex-related difference could be explained by the biological determinants, including greater iron requirements during male infants’ rapid growth; another key role may be behavioral factors, such as feeding practices, which may also play a role (Ruiz-Canela et al., 2017) [ ]. Key results in context The study objective was to compare anemia prevalence to national figures and explore demographic factors. The results showed a considerably lower prevalence level, suggesting heterogeneity within regions of Jordan and possibly within the city of Aqaba itself. The observed difference in prevalence between different sexes showed that boys experience a higher prevalence of anemia, which was a key finding. In contrast, the fact that no association was found between age and anemia challenges previous Jordanian data, which had reported older preschool children being more affected by anemia than younger children. This could reflect recent improvements in health interventions, including an integrated anemia screening program during vaccination visits and broader micronutrient supplementation programs. Comparison with other studies The 10.6% prevalence reported here is not only below the national estimate but also well below global estimates, which place anemia prevalence at around 39% in children under five (WHO 2021) [ ]. For regional comparison, studies from Egypt (47%) (Al Ghwass et al., 2015) [ ], Saudi Arabia (25–30%) (AlQuaiz et al., 2013) [ ], and Morocco (31%) (El Ati et al., 2012) [ ], Show that the prevalence in Aqaba is much lower. This suggests that Aqaba may represent a relatively advantaged group, possibly due to better healthcare coverage represented by around 43 healthcare centers across the district in addition to 5 hospitals, governmental and private, dietary diversity fostered by urbanization, and successful local supplementation programs. In contrast with Al-Suhiemat et al. (2020) [5], who reported that older preschoolers (36–59 months) were at increased risk of having anemia, our study did not show an effect of age on the children's anemia status. This could be the result of recent national and local health interventions to combat childhood anemia. Jordan’s Ministry of Health has strengthened micronutrient supplementation programs and linked anemia screening with child vaccination visits, which may have reduced age-related disparities. Limitations Several limitations in this study should be noted. The cross-sectional nature of the study provides the prevalence of anemia at one point in time, limiting the ability to infer causal relationships between anemia and its predictors. Additionally, the use of fingertip blood samples to measure hemoglobin could introduce measurement errors. However, venous sampling confirmation of fingertip hemoglobin values improved measurement accuracy by reducing misclassification bias. Moreover, as this was a retrospective analysis of routinely collected data, the study did not account for potential confounders such as parental level of education, diet, and socioeconomic status, which could affect anemia prevalence and severity. The findings suggest that Aqaba achieved meaningful progress in reducing childhood anemia compared with national averages. This improvement could reflect strong health system coverage, effective dietary supplementation, and the integration of anemia screening within routine pediatric and vaccination services. Despite this progress, anemia remains a significant public health issue due to its well-established effects on child growth, immune function, and neurocognitive development (Beard, 2003; Pala et al., 2010) [ ]. The comparatively low prevalence observed in this study should be interpreted cautiously. Socioeconomic and dietary factors were not examined, and children from the extremes of socioeconomic status may have been underrepresented, which could have contributed to a lower overall estimate. However, measurement accuracy was strengthened by confirming fingertip hemoglobin values with venous sampling, thereby minimizing misclassification bias. Interpretation The results suggest that Aqaba has achieved meaningful progress in reducing childhood anemia compared with national averages. This could reflect improved health coverage, dietary supplementation, and integration of screening into routine pediatric and vaccination services. However, anemia remains a concern as it can impair growth, immunity, and neurocognitive development (Beard, 2003; Pala et al 2010) [16]. The higher prevalence among boys emphasizes the need for targeted monitoring and intervention for male children. The lower prevalence compared with other governorates should be interpreted cautiously. Socioeconomic status and dietary confounders were not assessed in this study, and children from the extremes of socioeconomic status may have been underrepresented. Nevertheless, the results of this study are directly applicable to the population of Aqaba due to the enormous diversity of the population this comprehensive center serves. Measurement reliability was enhanced by confirming fingertip hemoglobin values with venous sampling, which reduces misclassification bias. Generalizability & Implications: The findings of this study are directly applicable to Aqaba and potentially to other urban communities with similar health infrastructure. They are less generalizable to rural Jordanian communities, where limited healthcare access and different dietary practices may result in different prevalence rates. The relatively low prevalence of childhood anemia in Aqaba suggests local public health initiatives were effective and should be maintained. However, the high prevalence in boys emphasizes the importance of targeted interventions like nutritional counseling for families with male infants. Future research efforts should assess the effect of education, socioeconomic status, and dietary factors. Conclusion This study found a 10.6% prevalence of anemia among children aged 9–59 months in Aqaba, which is substantially lower than the most recent national estimate for Jordan. The findings suggest that improved health coverage, dietary fortification, and integration of anemia screening within routine vaccination programs may have contributed to this decline. Male sex was identified as an independent predictor of anemia, highlighting the need for targeted preventive and nutritional interventions among boys during early childhood. While the results are encouraging, ongoing monitoring remains essential to sustain these gains and ensure equity across regions. Future research should investigate socioeconomic, dietary, and environmental determinants of anemia to better understand the regional variations observed and to guide evidence-based national strategies for reducing childhood anemia in Jordan. Abbreviations PALA: psychomotor development during childhood, QI: Quality Improvement. USAID: U.S. Agency for International Development. HSQA: Health Services Quality Accelerator Activity. Declarations Acknowledgments and declaration: This study is a secondary analysis of data gathered for the Ministry of Health and USAID Health Services Quality Accelerator (HSQA) project, which the University Research Co., LLC (URC) is carrying out. The authors thank the HSQA team and the staff of the Aqaba Comprehensive Health Center for their contributions to data collection and quality improvement activities. Competing interests : The authors declare that they have no competing interests Funding : This analysis received no specific funding beyond the USAID-supported HSQA project. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Author's Contribution: TSMA and YHMK conceptualized the study and developed the overall methodology. YHMK conducted the original data collection as part of the quality improvement project and managed access to facilities and resources. YHMK and MHMK curated and validated the dataset. TSMA and THA performed the formal statistical analyses and interpreted the results. MHMK and THA prepared the tables and figures. TSMA supervised the study and provided overall guidance throughout the research process. THA and TSMA drafted the initial manuscript, and THA and MHMK critically revised and edited the final version. All authors read and approved the final manuscript. References Gallagher P. G. (2022). Anemia in the pediatric patient. Blood , 140 (6), 571–593. https://doi.org/10.1182/blood.2020006479 World Health Organization. (2024). Prevalence of anaemia in children under 5 years (%) . Global Health Observatory (GHO) data. Retrieved October 16, 2025, from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-children-under-5-years-(-) Beard J. Iron deficiency alters brain development and functioning. J Nutr. 2003 May;133(5 Suppl 1):1468S-72S. doi: 10.1093/jn/133.5.1468S. PMID: 12730445. Statistics (DoS). [Jordan D of, Program TD. Jordan Population and Family Health Survey 2023 - final report. 2024 Aug 15 [cited 2024 Dec 29]; Available from: https://dhsprogram.com/publications/publication-FR388-DHS-Final-Reports.cfm Al-Suhiemat, A. A., Shudifat, R. M., & Obeidat, H. (2020). 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Ann Afr Med, 14 (1), 25–31. https://doi.org/10.4103/1596-3519.148725 AlQuaiz, A. M., et al. (2013). Iron deficiency anemia and risk factors in preschool children in Riyadh, Saudi Arabia. J Trop Pediatr, 59 (6), 460–466. https://doi.org/10.1093/tropej/fmt044 El Ati, J., et al. (2012). Prevalence of anaemia and iron deficiency in North Africa. Public Health Nutr, 15 (10), 1825–1833. https://doi.org/10.1017/S1368980011002881 Pala, E., Erguven, M., Guven, S., Erdogan, M., & Balta, T. (2010). Psychomotor development in children with iron deficiency and iron-deficiency anemia. Food and nutrition bulletin , 31 (3), 431–435. https://doi.org/10.1177/156482651003100305 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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09:57:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":782835,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8069642/v1/a4b62b54-84ae-451f-86a5-b4fc00fad2ec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Predictors of Anemia Among Preschool Children in Aqaba, Jordan: Evidence from a Comprehensive Health Center","fulltext":[{"header":"Introduction and Background","content":"\u003cp\u003eAnemia is defined as a condition in which the number of circulating erythrocytes, which carry oxygen, is low to a level where it cannot meet metabolic demands. A hemoglobin (Hb) concentration level that is below the established normal threshold for the age and sex serves as a clinical diagnosis. (Gallagher, 2022) [\u003ca class=\"FNLink\" href=\"#Fn1\" id=\"#FNLinkFn1\"\u003e\u003c/a\u003e]\u003c/p\u003e \u003cp\u003eAnemia is a significant public health issue among women, youth, and particularly children worldwide. In recent reports, the World Health Organization (WHO) estimates that the prevalence of anemia is around 39% in children aged 6\u0026ndash;59 months globally [\u003ca class=\"FNLink\" href=\"#Fn2\" id=\"#FNLinkFn2\"\u003e\u003c/a\u003e]. Iron deficiency is the most common cause of anemia in early childhood has a substantial association with adverse effects on growth, neurocognitive development, and immunity [2]. Despite advancements in maternal and child health care, childhood anemia remains common in many populations and settings Beard, J. (2003). [\u003ca class=\"FNLink\" href=\"#Fn3\" id=\"#FNLinkFn3\"\u003e\u003c/a\u003e]\u003c/p\u003e \u003cp\u003eAccording to the Jordan Population and Family Health Survey 2023 [\u003ca class=\"FNLink\" href=\"#Fn4\" id=\"#FNLinkFn4\"\u003e\u003c/a\u003e]The national prevalence of anemia in Jordan is 32%, which is similar in Aqaba, a southern district in Jordan, where one in three children also has anemia. Anemia is associated with impaired psychomotor development during childhood (PALA), which highlights the importance of studying and exploring the current status of Anemia in this age group. In Jordan, a strong relation was shown between the anemia status and age by a previous study, especially in children aged 36\u0026ndash;59 months, and it was shown that almost half of the children (47%) were moderately anemic. Al-Suhiemat, A. et al. [\u003ca class=\"FNLink\" href=\"#Fn5\" id=\"#FNLinkFn5\"\u003e\u003c/a\u003e]. The national survey [4] conducted in Aqaba in 2023, examined only a group of 74 children.\u003c/p\u003e \u003cp\u003e This study aimed to estimate the prevalence and determinants of anemia among children aged 9\u0026ndash;59 months in Aqaba, Jordan, using data from a large facility-based screening program in a larger sample size focusing on the effectiveness of previous screening in primary health care centers, which was held in Aqaba Primary Health Care as part of the Health Services Quality Accelerator (HSQA) project, funded by USAID and implemented through the University Research Co., LLC (URC) in partnership with the Jordan Ministry of Health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis paper utilizes data previously collected and recorded as part of a quality-improvement project established at a comprehensive healthcare center in Aqaba, Jordan. The original QI project aimed to monitor and enhance anemia screening coverage for children aged 9 months to 59 months when they present to the center for vaccines and routine child health care.\u003c/p\u003e \u003cp\u003eThe QI project was implemented as part of the Health Services Quality Accelerator Activity (HSQA) initiated by the Ministry of Health in collaboration with USAID.\u003c/p\u003e \u003cp\u003eIn the period between May 2024 and January 2025, a total of 1,005 children were screened and included in the dataset analyzed in this study.\u003c/p\u003e \u003cp\u003eFor the current study, these data were retrospectively retrieved from the Hakeem electronic health record and the center\u0026rsquo;s QI database. The original data were collected by professional health care workers and entered into digital reporting by the quality improvement team in the center for monitoring and feedback. The present analysis follows a cross-sectional design, using this dataset to calculate anemia prevalence and explore associations between hemoglobin status, age, and sex.\u003c/p\u003e \u003cp\u003eAlthough the data represent a facility-based rather than a randomly selected sample or a community-based sample, this center, being a comprehensive center, serves several surrounding neighborhoods with socioeconomic diversity and a large pediatric population in the city of Aqaba, which offers valuable insight into anemia patterns among preschool-aged children in this segment of the Aqaba community.\u003c/p\u003e \u003cp\u003eIn the original QI project, healthcare providers measured hematocrit from capillary blood collected from the fingertip and converted it to hemoglobin levels. Low readings were confirmed by venous blood sampling. Classification of anemia followed the standard cutoffs: mild (10.0\u0026ndash;10.9 g/dL), moderate (7.0\u0026ndash;9.9 g/dL), and severe (below 7.0 g/dL), Classification of anemia followed the standard cutoffs of WHO (2011) [\u003ca class=\"FNLink\" href=\"#Fn6\" id=\"#FNLinkFn6\"\u003e\u003c/a\u003e].\u003c/p\u003e \u003cp\u003e The QI project was conducted at a comprehensive primary health care center in Aqaba, Jordan. This center was chosen for its broad coverage of the local population. It also serves as the largest provider of routine child health and vaccination services in the region. This ensured access to a diverse pediatric population from various socioeconomic backgrounds. Data collection took place between May 2024 and January 2025.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eEligible participants were children aged 9 to 59 months who attended the health center during the study period. Exclusion criteria included any child with a known chronic condition that could affect hemoglobin concentration, such as hemoglobinopathies, chronic kidney disease, or malignancy. No restrictions were applied regarding sex, ethnicity, or socioeconomic status. The final sample included 1,005 children attending the center for vaccination or routine care.\u003c/p\u003e\n\u003ch3\u003eData Sources and Measurements\u003c/h3\u003e\n\u003cp\u003eHealthcare professionals with the necessary training collected the data. Hemoglobin levels were screened using a portable fingertip hemoglobinometer, and any low readings were verified through venous sampling. The procedure ensured high measurement accuracy and minimized potential errors. In addition to hemoglobin levels, demographic data, including the child\u0026rsquo;s age, sex, and place of residence, were recorded on structured data sheets designed for the study.\u003c/p\u003e\n\u003ch3\u003eBias Minimization\u003c/h3\u003e\n\u003cp\u003eSeveral steps were taken to minimize bias. The study setting, where children commonly visit for vaccinations, offered a natural, diverse sample of the target age group. Verification of fingertip readings through venous sampling minimized measurement bias. All data collectors received standardized training to maintain consistency and reliability in measurements and data entry.\u003c/p\u003e\n\u003ch3\u003eStudy Size\u003c/h3\u003e\n\u003cp\u003eThe final study sample included 1,005 children, representing all eligible participants during the data collection period. This sample size provided adequate statistical power to detect associations between anemia status and selected demographic variables while representing the general child population of Aqaba.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e \u003cp\u003e The Health Services Quality Accelerator (HSQA) oversight committee approved the original quality-improvement project. The Jordan Ministry of Health, USAID, and the University Research Co., LLC (URC) collaborated jointly to put it into implementation. The Research Committee and Institutional Review Board (IRB) in Jordanian Ministry of Health (MOH) gave approval for this secondary analysis with No. (MOH/REC/2025/532). Before retrieval and analysis, all data were completely anonymised. Because hemoglobin screening was part of the normal health and vaccination services for children at Ministry of Health primary care clinics, parents or guardians did not need to give formal consent; they gave verbal or implied consent as part of normal clinical care.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection and Validation\u003c/h2\u003e \u003cp\u003eThe original data had been collected as part of routine service evaluation under the HSQA project. For this retrospective analysis, the research team extracted and validated de-identified records by cross-checking hemoglobin results and demographic data from the Hakeem system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eWe used Jamovi software (version 2.7) to do the statistical analysis in the R statistical environment. Descriptive statistics were used to describe the characteristics of the participants, giving an extensive understanding of the study population. We used Chi-square tests and binary logistic regression, which are both types of inferential statistics, to look at the links between anemia status and demographic factors, including age and sex. All statistical approaches followed accepted guidelines for epidemiological analysis as detailed in prior studies [\u003ca class=\"FNLink\" href=\"#Fn7\" id=\"#FNLinkFn7\"\u003e\u003c/a\u003e, \u003ca class=\"FNLink\" href=\"#Fn8\" id=\"#FNLinkFn8\"\u003e\u003c/a\u003e, \u003ca class=\"FNLink\" href=\"#Fn9\" id=\"#FNLinkFn9\"\u003e\u003c/a\u003e], hence ensuring the validity and reliability of the results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eGeneral Characteristics of the Study\u003c/h2\u003e \u003cp\u003eThe analysis included 1,005 children between the ages of 6 and 59 months. 497 (49.5%) of these were males, and 508 (50.5%) were females. The average age was 16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2 months, and the average hemoglobin (Hb) level was 12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 g/dL.\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO, 2020) (13) defines anemia for kids aged 6 to 59 months as Hb \u0026amp;lt; 11.0 g/dL. Of those with this condition, 107 (10.6%) were anemic and 898 (89.4%) were not. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows a summary of the participants\u0026rsquo; characteristics.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the study population (N\u0026thinsp;=\u0026thinsp;1,005)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory/Unit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.4\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e416 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e491 (48.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98 (9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e508 (50.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e497 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHemoglobin (g/dL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnemia status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e898 (89.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eHow common is anemia by sex?\u003c/h2\u003e \u003cp\u003eOf the 497 males, 63 (12.7%) were anemic. Of the 508 females, 44 (8.7%) were anemic (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2.1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis difference was statistically significant (χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;3.84, p\u0026thinsp;=\u0026thinsp;0.0499) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2.2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no significant difference in mean Hb values between sexes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2.1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnemia Prevalence by sex in children 6 to 59 months old\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnemic n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-anemic n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (12.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e434 (87.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e464 (91.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e898 (89.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2.2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-square test to see if there is a causal association between sex and anemia status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.0499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAnemia Prevalence by Age Group\u003c/h2\u003e \u003cp\u003eThere were three age groups for the children: 6 to 11 months (n\u0026thinsp;=\u0026thinsp;416), 12 to 23 months (n\u0026thinsp;=\u0026thinsp;491), and 24 to 59 months (n\u0026thinsp;=\u0026thinsp;98). The rates of anemia were 10.6%, 10.6%, and 11.2%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3.1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere was no statistically significant connection between age group and anemia status (χ\u0026sup2;(2)\u0026thinsp;=\u0026thinsp;0.04, p\u0026thinsp;=\u0026thinsp;0.981) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3.2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3.1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnemia prevalence by age group in children aged 6\u0026ndash;59 months.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge group (months)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnemic n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-anemic n (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e372 (89.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e439 (89.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87 (88.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e107 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e898 (89.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3.2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChi-square test to find a link between age group and anemia status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAnemia Predictors\u003c/h2\u003e \u003cp\u003eWe did a binary logistic regression with anemia (yes/no) as the dependent variable and age (in months) and sex (male vs. female) as the independent variables.\u003c/p\u003e \u003cp\u003eBeing male was strongly linked to an increased likelihood of having anemia (OR\u0026thinsp;=\u0026thinsp;1.53, 95% CI\u003c/p\u003e \u003cp\u003e[1.02\u0026ndash;2.29], p\u0026thinsp;=\u0026thinsp;0.041), but age was not a strong predictor (OR\u0026thinsp;=\u0026thinsp;0.99, 95% CI [0.97\u0026ndash;1.01], p\u0026thinsp;=\u0026thinsp;0.456).\u003c/p\u003e \u003cp\u003eThe model also explained a minimal fraction of the variance (Nagelkerke R\u0026sup2; = 0.010) (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression analysis of anemia predictors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI (lower)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI (upper)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male vs Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0413\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4557\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eA summary of the results\u003c/h2\u003e \u003cp\u003eThe overall prevalence of anemia in this population was 10.6%, significantly lower than the 33.1% reported nationally for Jordanian children under five years (Department of Statistics Jordan, 2023) ( 14 ).\u003c/p\u003e \u003cp\u003eAnemia was considerably more prevalent in males, demonstrating no variation with age.\u003c/p\u003e \u003cp\u003eRegression analysis validated that only sex persisted as an independent predictor.\u003c/p\u003e \u003cp\u003eMost of the anemic children had moderate anemia, which shows just how essential it is to maintain screening and provide nutritional help.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study presents a secondary analysis of data collected from a quality improvement (QI) project at a comprehensive health-care center in Aqaba, Jordan, that mainly aimed at investigating the prevalence and predictors of anemia among children aged 9\u0026ndash;59 months in the southern part of Jordan, specifically, Aqaba, Jordan.\u003c/p\u003e \u003cp\u003e As well, the study sought to generate and update locally relevant data to complement existing national data with the goal of supporting future health planning, informing evidence-based decision-making, and ensuring appropriate healthcare is provided for anemic children through screening programs and guidelines-based treatment plans.\u003c/p\u003e \u003cp\u003eThe main results showed that 10.6% of the children in this facility-based population, which included 1,005 kids, had anemia. This is a lot less than the previous national rate of 33.1% for kids under five years old in Aqaba from the 2023 Jordan Population and Family Health Survey (JPFHS) (Department of Statistics). [\u003ca class=\"FNLink\" href=\"#Fn10\" id=\"#FNLinkFn10\"\u003e\u003c/a\u003e]\u003c/p\u003e \u003cp\u003eNotably, the odds for male children to be anemic were significantly higher than for females, identifying sex as a statistically significant predictor.\u003c/p\u003e \u003cp\u003eAlthough the study utilized a facility-based sample rather than a randomly selected community sample, the center serves a diverse range of urban neighborhoods, allowing valuable insight into anemia patterns among children who access routine health services in this catchment area.\u003c/p\u003e \u003cp\u003eIn contrast, this study found no statistically significant association between age and anemia status, challenging earlier research in Jordan by Al-suhiemat et al. [5], which suggests older preschool children are more likely to be anemic compared to their younger counterparts.\u003c/p\u003e \u003cp\u003eThe notable sex-related difference could be explained by the biological determinants, including greater iron requirements during male infants\u0026rsquo; rapid growth; another key role may be behavioral factors, such as feeding practices, which may also play a role (Ruiz-Canela et al., 2017) [\u003ca class=\"FNLink\" href=\"#Fn11\" id=\"#FNLinkFn11\"\u003e\u003c/a\u003e].\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eKey results in context\u003c/h2\u003e \u003cp\u003eThe study objective was to compare anemia prevalence to national figures and explore demographic factors. The results showed a considerably lower prevalence level, suggesting heterogeneity within regions of Jordan and possibly within the city of Aqaba itself. The observed difference in prevalence between different sexes showed that boys experience a higher prevalence of anemia, which was a key finding.\u003c/p\u003e \u003cp\u003eIn contrast, the fact that no association was found between age and anemia challenges previous Jordanian data, which had reported older preschool children being more affected by anemia than younger children. This could reflect recent improvements in health interventions, including an integrated anemia screening program during vaccination visits and broader micronutrient supplementation programs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eComparison with other studies\u003c/h2\u003e \u003cp\u003eThe 10.6% prevalence reported here is not only below the national estimate but also well below global estimates, which place anemia prevalence at around 39% in children under five (WHO 2021) [\u003ca class=\"FNLink\" href=\"#Fn12\" id=\"#FNLinkFn12\"\u003e\u003c/a\u003e]. For regional comparison, studies from Egypt (47%) (Al Ghwass et al., 2015) [\u003ca class=\"FNLink\" href=\"#Fn13\" id=\"#FNLinkFn13\"\u003e\u003c/a\u003e], Saudi Arabia (25\u0026ndash;30%) (AlQuaiz et al., 2013) [\u003ca class=\"FNLink\" href=\"#Fn14\" id=\"#FNLinkFn14\"\u003e\u003c/a\u003e], and Morocco (31%) (El Ati et al., 2012) [\u003ca class=\"FNLink\" href=\"#Fn15\" id=\"#FNLinkFn15\"\u003e\u003c/a\u003e], Show that the prevalence in Aqaba is much lower.\u003c/p\u003e \u003cp\u003eThis suggests that Aqaba may represent a relatively advantaged group, possibly due to better healthcare coverage represented by around 43 healthcare centers across the district in addition to 5 hospitals, governmental and private, dietary diversity fostered by urbanization, and successful local supplementation programs.\u003c/p\u003e \u003cp\u003eIn contrast with Al-Suhiemat et al. (2020) [5], who reported that older preschoolers (36\u0026ndash;59 months) were at increased risk of having anemia, our study did not show an effect of age on the children's anemia status. This could be the result of recent national and local health interventions to combat childhood anemia. Jordan\u0026rsquo;s Ministry of Health has strengthened micronutrient supplementation programs and linked anemia screening with child vaccination visits, which may have reduced age-related disparities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations in this study should be noted. The cross-sectional nature of the study provides the prevalence of anemia at one point in time, limiting the ability to infer causal relationships between anemia and its predictors. Additionally, the use of fingertip blood samples to measure hemoglobin could introduce measurement errors. However, venous sampling confirmation of fingertip hemoglobin values improved measurement accuracy by reducing misclassification bias. Moreover, as this was a retrospective analysis of routinely collected data, the study did not account for potential confounders such as parental level of education, diet, and socioeconomic status, which could affect anemia prevalence and severity.\u003c/p\u003e \u003cp\u003eThe findings suggest that Aqaba achieved meaningful progress in reducing childhood anemia compared with national averages. This improvement could reflect strong health system coverage, effective dietary supplementation, and the integration of anemia screening within routine pediatric and vaccination services. Despite this progress, anemia remains a significant public health issue due to its well-established effects on child growth, immune function, and neurocognitive development (Beard, 2003; Pala et al., 2010) [\u003ca class=\"FNLink\" href=\"#Fn16\" id=\"#FNLinkFn16\"\u003e\u003c/a\u003e].\u003c/p\u003e \u003cp\u003eThe comparatively low prevalence observed in this study should be interpreted cautiously. Socioeconomic and dietary factors were not examined, and children from the extremes of socioeconomic status may have been underrepresented, which could have contributed to a lower overall estimate. However, measurement accuracy was strengthened by confirming fingertip hemoglobin values with venous sampling, thereby minimizing misclassification bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eInterpretation\u003c/h2\u003e \u003cp\u003eThe results suggest that Aqaba has achieved meaningful progress in reducing childhood anemia compared with national averages. This could reflect improved health coverage, dietary supplementation, and integration of screening into routine pediatric and vaccination services. However, anemia remains a concern as it can impair growth, immunity, and neurocognitive development (Beard, 2003; Pala et al 2010) [16]. The higher prevalence among boys emphasizes the need for targeted monitoring and intervention for male children.\u003c/p\u003e \u003cp\u003eThe lower prevalence compared with other governorates should be interpreted cautiously. Socioeconomic status and dietary confounders were not assessed in this study, and children from the extremes of socioeconomic status may have been underrepresented. Nevertheless, the results of this study are directly applicable to the population of Aqaba due to the enormous diversity of the population this comprehensive center serves. Measurement reliability was enhanced by confirming fingertip hemoglobin values with venous sampling, which reduces misclassification bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eGeneralizability \u0026amp; Implications:\u003c/h2\u003e \u003cp\u003eThe findings of this study are directly applicable to Aqaba and potentially to other urban communities with similar health infrastructure. They are less generalizable to rural Jordanian communities, where limited healthcare access and different dietary practices may result in different prevalence rates.\u003c/p\u003e \u003cp\u003eThe relatively low prevalence of childhood anemia in Aqaba suggests local public health initiatives were effective and should be maintained. However, the high prevalence in boys emphasizes the importance of targeted interventions like nutritional counseling for families with male infants. Future research efforts should assess the effect of education, socioeconomic status, and dietary factors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study found a 10.6% prevalence of anemia among children aged 9–59 months in Aqaba, which is substantially lower than the most recent national estimate for Jordan. The findings suggest that improved health coverage, dietary fortification, and integration of anemia screening within routine vaccination programs may have contributed to this decline.\u003c/p\u003e\n\u003cp\u003eMale sex was identified as an independent predictor of anemia, highlighting the need for targeted preventive and nutritional interventions among boys during early childhood. While the results are encouraging, ongoing monitoring remains essential to sustain these gains and ensure equity across regions.\u003c/p\u003e\n\u003cp\u003eFuture research should investigate socioeconomic, dietary, and environmental determinants of anemia to better understand the regional variations observed and to guide evidence-based national strategies for reducing childhood anemia in Jordan.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePALA: psychomotor development during childhood,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQI: Quality Improvement.\u003c/p\u003e\n\u003cp\u003eUSAID: U.S. Agency for International Development.\u003c/p\u003e\n\u003cp\u003eHSQA: Health Services Quality Accelerator Activity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments and declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a secondary analysis of data gathered for the Ministry of Health and USAID Health Services Quality Accelerator (HSQA) project, which the University Research Co., LLC (URC) is carrying out. The authors thank the HSQA team and the staff of the Aqaba Comprehensive Health Center for their contributions to data collection and quality improvement activities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis analysis received no specific funding beyond the USAID-supported HSQA project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTSMA and YHMK conceptualized the study and developed the overall methodology. YHMK conducted the original data collection as part of the quality improvement project and managed access to facilities and resources. YHMK and MHMK curated and validated the dataset. TSMA and THA performed the formal statistical analyses and interpreted the results. MHMK and THA prepared the tables and figures. TSMA supervised the study and provided overall guidance throughout the research process. THA and TSMA drafted the initial manuscript, and THA and MHMK critically revised and edited the final version.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGallagher P. G. (2022). Anemia in the pediatric patient. \u003cem\u003eBlood\u003c/em\u003e, \u003cem\u003e140\u003c/em\u003e(6), 571\u0026ndash;593. https://doi.org/10.1182/blood.2020006479\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2024). \u003cem\u003ePrevalence of anaemia in children under 5 years (%)\u003c/em\u003e. Global Health Observatory (GHO) data. Retrieved October 16, 2025, from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-children-under-5-years-(-)\u003c/li\u003e\n\u003cli\u003eBeard J. Iron deficiency alters brain development and functioning. J Nutr. 2003 May;133(5 Suppl 1):1468S-72S. doi: 10.1093/jn/133.5.1468S. PMID: 12730445. \u003c/li\u003e\n\u003cli\u003eStatistics (DoS). [Jordan D of, Program TD. Jordan Population and Family Health Survey 2023 - final report. 2024 Aug 15 [cited 2024 Dec 29]; Available from: https://dhsprogram.com/publications/publication-FR388-DHS-Final-Reports.cfm\u003c/li\u003e\n\u003cli\u003eAl-Suhiemat, A. A., Shudifat, R. M., \u0026amp; Obeidat, H. (2020). Maternal Level of Education and Nutritional Practices Regarding Iron Deficiency Anemia Among Preschoolers in Jordan. \u003cem\u003eJournal of pediatric nursing\u003c/em\u003e, \u003cem\u003e55\u003c/em\u003e, e313\u0026ndash;e319. https://doi.org/10.1016/j.pedn.2020.08.019\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2011). \u003cem\u003eHaemoglobin concentrations for the diagnosis of anaemia and assessment of severity.\u003c/em\u003e Geneva: WHO. (WHO/NMH/NHD/MNM/11.1).\u003cbr\u003eAvailable at: https://www.who.int/vmnis/indicators/haemoglobin.pdf \u003c/li\u003e\n\u003cli\u003eThe jamovi project (2025). \u003cem\u003ejamovi\u003c/em\u003e. (Version 2.7) [Computer Software]. Retrieved from https://www.jamovi.org.\u003c/li\u003e\n\u003cli\u003eR Core Team (2025). \u003cem\u003eR: A Language and environment for statistical computing\u003c/em\u003e. (Version 4.5) [Computer software]. Retrieved from https://cran.r-project.org. (R packages retrieved from CRAN snapshot 2025-05-25).\u003c/li\u003e\n\u003cli\u003eSerdar Balci (2022). \u003cem\u003eClinicoPath jamovi Module doi:10.5281/zenodo.3997188\u003c/em\u003e. [R package]. Retrieved from https://github.com/sbalci/ClinicoPathJamoviModule. link.\u003c/li\u003e\n\u003cli\u003eDepartment of Statistics (Jordan). (2023). Jordan Population and Family Health Survey 2023. Amman: DOS., https://dhsprogram.com/publications/publication-FR388-DHS-Final-Reports.cfm. \u003c/li\u003e\n\u003cli\u003eRuiz-Canela, M., Babio, N., Mart\u0026iacute;nez, J. A., Donat-Vargas, C., Mic\u0026oacute;, V., San Cristobal, R., Mart\u0026iacute;nez-Gonz\u0026aacute;lez, M. \u0026Aacute;., Salas-Salvad\u0026oacute;, J., Corella, D., Fit\u0026oacute;, M., Alonso, \u0026Aacute;. M., W\u0026auml;rnberg, J., Vioque, J., Romaguera, D., L\u0026oacute;pez-Miranda, J., Estruch, R., Damas-Fuentes, M., Lapetra, J., Serra-Majem, L., \u0026hellip; Ros, E. (2023). \u003cem\u003eDietary iron, anemia markers, cognition, and quality of life in older community-dwelling subjects at high cardiovascular risk.\u003c/em\u003e Nutrients, 15(20), 4440. https://doi.org/10.3390/nu15204440\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Global anaemia estimates, 2021 edition. Geneva: WHO. https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children\u003c/li\u003e\n\u003cli\u003eAl Ghwass, M. M., Halawa, E. F., Sabry, S. M., \u0026amp; Ahmed, D. (2015). Iron deficiency anemia in an Egyptian pediatric population: a cross-sectional study. \u003cem\u003eAnn Afr Med, 14\u003c/em\u003e(1), 25\u0026ndash;31. https://doi.org/10.4103/1596-3519.148725\u003c/li\u003e\n\u003cli\u003eAlQuaiz, A. M., et al. (2013). Iron deficiency anemia and risk factors in preschool children in Riyadh, Saudi Arabia. \u003cem\u003eJ Trop Pediatr, 59\u003c/em\u003e(6), 460\u0026ndash;466. https://doi.org/10.1093/tropej/fmt044\u003c/li\u003e\n\u003cli\u003eEl Ati, J., et al. (2012). Prevalence of anaemia and iron deficiency in North Africa. \u003cem\u003ePublic Health Nutr, 15\u003c/em\u003e(10), 1825\u0026ndash;1833. https://doi.org/10.1017/S1368980011002881\u003c/li\u003e\n\u003cli\u003ePala, E., Erguven, M., Guven, S., Erdogan, M., \u0026amp; Balta, T. (2010). Psychomotor development in children with iron deficiency and iron-deficiency anemia. \u003cem\u003eFood and nutrition bulletin\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(3), 431\u0026ndash;435. https://doi.org/10.1177/156482651003100305\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anemia, Childhood, Jordan, prevalence, hemoglobin","lastPublishedDoi":"10.21203/rs.3.rs-8069642/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8069642/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnemia is a global public health problem. Childhood anemia is associated with detrimental effects on growth and development and increased morbidity and mortality. This study aims to estimate the prevalence and assess factors associated with anemia among children aged 9-59 months in Aqaba, Jordan, and compare findings with national data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis facility-based cross-sectional study retrospectively analyzed de-identified secondary data in the Hakeem electronic health record and the center’s quality-improvement database at a comprehensive center in Aqaba, Jordan, between May 2024 and January 2025. During this period, a quality improvement project aimed to monitor and improve anemia screening, ultimately enhancing child health aged 9 months to 59 months.\u003c/p\u003e\n\u003cp\u003eHemoglobin results and demographic variables were extracted from existing records of the quality improvement project. Classification of anemia was according to the World Health Organization (WHO) thresholds. We used Descriptive statistics to summarize demographic data, and CHI-square tests and binary logistic regression to assess associations between anemia status, age, and sex. A p-value \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of the total of 1005 children included in the study, 497 (49.5%) were males, and 508 (50.5%) were females. Of the 497 males, 63 (12.7%) were anemic. Of the 508 females, 44 (8.7%) were anemic. The average age was 16.4 ± 9.2 months, and the average hemoglobin (Hb) level was 12.0 ± 0.9 g/dL.\u003c/p\u003e\n\u003cp\u003eMale sex independently predicted anemia (OR = 1.53, 95% CI 1.02–2.29, p = 0.041).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of anemia among children below the age of 5 years is notably lower than national estimates, suggesting potential benefits from improved health coverage, dietary fortification, and integrated supplemental programs. However, the higher risk among male children warrants targeted preventive strategies. Continued surveillance and prompt intervention remain essential to sustain and further reduce childhood anemia in Jordan.\u003c/p\u003e","manuscriptTitle":"Prevalence and Predictors of Anemia Among Preschool Children in Aqaba, Jordan: Evidence from a Comprehensive Health Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-26 05:27:50","doi":"10.21203/rs.3.rs-8069642/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be8a471a-aede-4558-b232-322181d821e5","owner":[],"postedDate":"December 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T04:39:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-26 05:27:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8069642","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8069642","identity":"rs-8069642","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}