DETERMINANTS OF ANAEMIA IN CHILDREN AGED 6–59 MONTHS IN RWANDA: A MULTILEVEL MIXED-EFFECTS ANALYSIS, 2019-20 RWANDA DEMOGRAPHIC AND HEALTH SURVEY

Abstract

Background: Anaemia remains a critical public health issue in low- and
middle-income countries, particularly affecting children by causing
cognitive difficulties, stunted growth, and increased infection risk.
Despite its importance, knowledge about the factors influencing anaemia
prevalence in young Rwandan children is limited. This study investigated
individual and community determinants of anaemia among children aged
6-59 months in Rwanda.
Methods: We analysed data from the 2019–2020 Rwanda Demographic and Health Survey (RDHS), focusing on a weighted sample of 3,699 children aged 6-59 months. A stratified two-stage cluster sampling design was used, and data were weighted to adjust for survey design effects. Multilevel mixed-effects logistic regression was performed to assess associations between anaemia and individual/community factors, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported.
Results: Children aged 24-42 months (AOR 0.4, 95% CI: 0.34-0.47) and 43-
59 months (AOR 0.2, 95% CI: 0.20-0.29) were less likely to be anaemic
compared to those aged 6-23 months. The likelihood of anaemia was
higher among children who tested positive for malaria (AOR 8.3, 95% CI:3.32-20.63), were underweight (AOR 1.3, 95% CI: 1.01-1.78), or those using unimproved toilet facilities (AOR 1.9, 95% CI: 1.22-3.02). Children from lower wealth categories had higher odds of anaemia (AOR 1.3, 95% CI:1.04-1.52), while those in the Southern (AOR 0.6, 95% CI: 0.45-0.80) and
Eastern (AOR 0.7, 95% CI: 0.54-0.94) regions were less likely to be anaemic
compared to those in the Northern region.
Conclusion: Age, underweight, malaria, sanitation, wealth, and regional
factors significantly influence anaemia in young children. Further
strengthening of the existing interventions such as malaria prevention
strategies and treatment, child nutrition programmes, access to improved
sanitation and delivery of equitable health and social services can help to
further reduce anaemia and improve child health outcomes in Rwanda.