Spatiotemporal patterns of anemia among lactating mothers in Ethiopia using data from Ethiopian Demographic and Health Surveys (2005, 2011 and 2016)

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 were neither pregnant nor breastfeeding. To date, there is limited evidence on spatiotemporal patterns of anemia among lactating mothers in the country. Exploring the spatial patterns of maternal anemia is vital to design and monitor effective intervention programs. Therefore this study aimed to explore spatiotemporal patterns of anemia among lactating mothers in Ethiopia over the past one and half-decades.

Methods: A total of 11,989 lactating mothers were included from the three consecutive Ethiopian Demographic and Health Surveys(2005, 2011, and 2016). The trend of anemia over the three surveys was showed. Furthermore, spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographically risk areas of anemia among lactating mothers in Ethiopia. Finally, the most anemia risk areas were detected consistently by different spatial analytic methods in each survey.

Results: Anemia during lactation had an increasing trend from 2011 to 2016 in all regions of Ethiopia. It was also spatially clustered over three survey periods (Moran's I: 0.102-0.256, P<0.01).The hotspot areas were detected in Afar, Somali, Gambela, Dire Dawa, and Oromia regions during the last fifteen years. In 2005 and 2011, a total of 100 most likely clusters (Loglikelihood Ratio(LLR) = 8.8, P<0.05, and LLR = 45.94, P<0.001, respectively) were identified in the Afar region. However, in the 2016 survey period, primary clusters were shifted to the Somali region where 57 clusters (LLR = 72.73, P<0.001) were detected in the entire region. Besides, the risk prediction map showed that the eastern part of the country was at a higher risk of anemia during lactation.

Conclusion: Anemia during lactation was spatially clustered in Ethiopia. High-risk areas were detected in the eastern part of Ethiopia prominently in the Afar and Somali regions. Therefore, public health intervention activities designed in a targeted approach to impact high-risk populations in those hot spot areas wound be helpful to reduce anemia in Ethiopia.

Fig 1. Map of Ethiopia where the three surveys were undertaken with nine regions and two administrative cities (Source: Shapefile from Central Statistical Agency, Ethiopia, 2013).

Fig 2. Trends of anemia among lactating mothers in Ethiopia overtime across regions 2005, 2011, and 2016.

Fig 3

a-c: Spatial distribution of anemia among lactating mothers in Ethiopia 2005 (a), 2011 (b), 2016 (c) EDHS (Source: Shapefile from Central Statistical Agency, Ethiopia, 2013).

Fig 4

a-c: Spatial autocorrelation of anemia among lactating mothers in Ethiopia, 2005 (a), 2011 (b), 2016 (c) (Source: Shapefile from Central Statistical Agency, Ethiopia, 2013).

Fig 5

a-c: Cluster outlier identification ofanemia among lactating mothers in Ethiopia, 2005 (a), 2011 (b), 2016 (c) EDHS (Source: Shapefile from Central Statistical Agency, Ethiopia, 2013).

Fig 6

a-c: Hot spot identification of anemia among lactating mothers in Ethiopia 2005 (a), 2011 (b), 2016 (c) EDHS (Source: Shapefile from Central Statistical Agency, Ethiopia, 2013).

Fig 7

a-c: Spatiotemporal interpolation of anemia among lactating mothers in Ethiopia 2005 (a), 2011 (b), 2016 (c) (Source: Shapefile from Central Statistical Agency, Ethiopia, 2013).

Fig 8

a-c. spatiotemporal patterns of primary clusters of anemia among lactating mothers in Ethiopia 2005 (a), 2011 (b), and 2016 (c) (Source: Shape file from Central Statistical Agency, Ethiopia, 2013).