Risk factors of anemia among women of reproductive age in Rwanda: a secondary data analysis of Rwanda demographic and health survey (RDHS) 2014/2015

Abstract

BACKGROUND Anemia among Women of Reproductive Age (WRA) continues to be among the public health problems in Rwanda and has long-term consequences to health, social and economic development if not addressed. Its increases portray challenges in existing approaches to alleviate its burden; new approaches, based on scientifically identified risk factors to which interventions should be targeted are needed. However, those evidences are scarce. This study was conducted to assess the variations of anemia among WRA in Rwanda and identify its risk factors, in order to inform the policy makers, the appropriate interventions to address it in Rwanda. METHODS This is a quantitative, cross-sectional study using secondary data analysis of Rwanda Demographic and Health Survey (RHDHS) 2014-2015. The outcome for this study was anaemia status and 6680 WRA who had haemoglobin results and anemia status were included in this study. Logistic regression was used for bivariate and multivariate to test the association between anemia and exposures. Multivariable analysis used backward stepwise multiple logistic regression. Significant variables were assessed using odds ratio (OR), their 95% confidence interval (CI) and p-value <0.05. Adjusted Wald test was used to assess the significance of each variable in the model. Stata v.13 was used for analysis and sampling weights were applied in all steps of the analysis. RESULTS The prevalence of anemia among WRA was 19.2%; 15.7 had mild anemia, 3.4% had a moderate anemia and 0.2% had severe anemia. The risk factors for anemia among WRA are province of residence : Southern province (OR: 1.52 with 95% CI: 1.19 - 1.95 and p value of <0.001) and Eastern provinces (OR: 1.49 with 95% CI: 1.15 - 1.92 and p value of 0.002), economic status (wealth index level) where the risk decreases with the improvement of the economic status among poorer (OR: 0.78 with 95% CI: 0.64 - 0.95 and p value of 0.013), among middle (OR: 0.73 with 95% CI: 0. 0.59 - 0.90 and p value of 0.003), among richer (OR: 0.61 with 95% CI: 0.49 - 0.76 iii and p value of <0.001), the richest (OR: 0.72 with 95% CI: 0.57 - 0.90 and p value of 0.003) compared to the poorest. Moreover, the risk of anemia is increased among separated/widowed (OR: 1.35 with 95% CI: 1.08 - 1.68 and p value of 0.008). Furthermore, having history of malaria is anemia risk factor (OR: 1.77 with 95% CI: 1.31 - 2.38 and p value of <0.001) and sleeping under mosquito offer a protective effect (OR: 0.86 with 95% CI: 0.74 - 0.99 and p value of 0.038). Additionally, women with normal BMI has a reduced risk (OR: 0.73 with 95% CI: 0.57 - 0.94 and p value of 0.013), as well as for those with obesity (OR: 0.45 with 95% CI: 0.28 - 0.71 and p value of <0.001) compared to underweight. Use of hormonal contraceptives reduce anemia risk (OR: 0.60 with 95% CI: 0.50 - 0.73 and p value of <0.001) while the use of Intra Uterus Device increases the risk (OR: 1.94 with 95% CI: 1.03 - 3.67 and p value of 0.041). CONCLUSION Anemia is increasing in Rwanda; innovative interventions to address it are necessary including improving the distribution and access to mosquito nets by the community members, use of Community Health Workers to offer iron supplementation, and emphasis to programs aiming to improve nutrition and economic status of WRA.