Population attributable fractions for risk factors for childhood anaemia: Findings from the 2017 Togo Malaria Indicator Survey

Abstract

Anaemia continues to be a major public health challenge in developing countries, particularly in Sub-Saharan Africa. This study estimated the proportion of anaemia cases that could be potentially prevented among children aged 6-59 months in Togo. Data from the 2017 national Malaria Indicator survey in Togo, the last one conducted to date, was used for this study. Maternal, child and household data were collected using a standard questionnaire administered face-to-face by trained interviewers. Haemoglobin tests were conducted for children and their mothers. A total of 2796 children were included in the analyses. The prevalence of anaemia was 75.0% (95% confidence interval, CI: 72.5-88.0). Factors associated with childhood anaemia were: age [(adjusted prevalence ratio, aPR=1.46 (CI: 1.37-1.56) for 6-23 months and aPR=1.23 (1.14-1.32) for 24-42 months, ref: 43-59 months], a later birth order (≥4^th position) [aPR=1.11 (1.03-1.19), ref: 1^st-2^nd position], malaria in children [aPR=1.30 (1.22-1.38)], maternal age ≤25 [aPR=1.17 (1.08-1.27), ref: ≥35 years], maternal anaemia [aPR=1.13 (1.07-1.19)], lack of maternal education [aPR=1.10 (1.02-1.18), ref: ≥secondary], number of children under 5 in household [aPR=1.07 (1.00-1.14) for ≥3, ref: 0-1], unimproved sanitation facilities [aPR=1.12 (1.02-1.22)] and low/middle household incomes [aPR=1.16 (1.04-1.30) and aPR=1.13 (1.01-1.26), respectively, ref: high]. The population-attributable fraction was estimated at 8.2% (6.3-10.1%) for child-related modifiable factors, 11.1% (5.7-16.3%) for maternal-related factors, 15.8% (8.6-22.5%) for household-related factors, and 30.9% (24.0-37.2%) for the combination of all modifiable factors. This study highlighted a high prevalence of childhood anaemia in Togo and showed that a high proportion of this could be prevented.