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Association between increasing ITN use and reductions in moderate-to-severe anemia in children 6-23 months of age: A multi-country decomposition analysis
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Association between increasing ITN use and reductions in moderate-to-severe anemia in children 6-23 months of age: A multi-country decomposition analysis

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Presented at the November 2013 ASTMH Conference.

Presented at the November 2013 ASTMH Conference.

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Association between increasing ITN use and reductions in moderate-to-severe anemia in children 6-23 months of age: A multi-country decomposition analysis Association between increasing ITN use and reductions in moderate-to-severe anemia in children 6-23 months of age: A multi-country decomposition analysis Document Transcript

  • Association between increasing ITN use and reductions in moderate-to-severe anemia in children 6-23 months of age: A multi-country decomposition analysis Lia S. Florey¹; Cameron Taylor¹; Yazoume Ye2; Fred Arnold¹ ¹ICF International, MEASURE DHS; 2ICF International, MEASURE Evaluation Background Methods Interpretation Acknowledgments Assessing the success of malaria control interventions is difficult due to the challenge of measuring malaria-specific outcomes. In contrast, hemoglobin levels are relatively simple to measure, and although not highly specific to malaria, moderate-to-severe anemia (hemoglobin < 8 g/dL) is a common symptom of the disease. Approximately 15% of anemia in pre-school-age children is attributable to malaria. This analysis was done to describe distributions and trends in nationally representative estimates of ITN use and moderate-to-severe anemia over periods of ITN scale-up and to assess the impact of ITN use on prevalence of moderate-to-severe anemia in children age 6-23 months. • Data from 11 countries with two or more DHS surveys between 2001 and 2011 containing information on insecticide-treated net (ITN) use and hemoglobin levels in children 6-23 months of age. Data sources • Multivariable logistic regression models on pooled data comparing baseline and endline were used to identify differential effects of ITN use on anemia between the two periods. • Multivariate Oaxaca-Blinder decomposition for nonlinear response models with deviation contrast normalization for categorical variables were used to estimate the proportion of the decline in anemia prevalence over time due to increases in ITN use. In most countries the prevalence of moderate-to-severe anemia in children 6-23 months of age has decreased over a period in which ITN use has increased dramatically. The changes in ITN use explained the greatest proportion of the total change in anemia between baseline and endline as compared to other covariates. Results suggest that scale-up of malaria control interventions are likely to have measurable impact on moderate-to-severe anemia and consequently that anemia may be a useful impact measure. Analysis Funding for this research was provided by the United States Agency for International Development (USAID) through the MEASURE DHS project, implemented by ICF International in Calverton, Maryland, USA. Views expressed are those of the authors and do not necessarily reflect the views of USAID or the United States Government. Results Figure 1: Change in anemia between baseline and endline surveys 863 Table 1: Pooled, multivariable model of anemia 0 5 10 15 20 25 30 35 40 45 baseline endline 0 10 20 30 40 50 60 70 80 90 baseline endline Figure 2: Change in ITN use between baseline and endline surveys Table 2: Adjusted odds ratio of anemia by ITN use (Y/N) Table 3: Decomposition model results * <0.05; ** < 0.01; *** <0.001 OR 95% CI p-value ITN Use No Ref. Yes 0.81 0.70 0.94 0.005 Residence Urban Ref. Rural 1.22 1.02 1.47 0.034 Wealth Quintile Lowest Ref. Second 0.92 0.80 1.07 0.291 Middle 0.83 0.70 0.97 0.022 Fourth 0.73 0.61 0.87 0.001 Highest 0.53 0.41 0.67 <0.001 Multiple Birth Status Singleton Ref. Twin or more 2.19 1.56 3.06 <0.001 Mother's Education No education Ref. Primary 0.92 0.81 1.05 0.222 Secondary+ 0.83 0.68 1.02 0.075 Child's Sex Male Ref. Female 0.83 0.75 0.93 0.001 Child's Age 6-11 months Ref. 12-17 months 0.99 0.87 1.12 0.863 18-23 months 0.77 0.67 0.88 Recent Fever No Ref. Yes 1.82 1.62 2.05 <0.001 Total N 22,802 Endowments Coefficient Household-level ITN Use 1.102 * 0.69 Rural Residence -0.054 ** 7.2 * Lowest Wealth Quintile 0.027 * -0.36 Second Wealth Quintile -0.01 * -0.27 Middle Wealth Quintile 0.002 -0.25 Fourth Wealth Quintile 0.001 0.28 Highest Wealth Quintile 0.051 * 0.41 Mother-level No Education 0.059 ** 0.1 Primary 0.002 0.87 Secondary or More 0.039 -0.39 Child-level Multiple Birth -0.023 *** -0.01 Female 0.011 2.14 6-11 Months 0.001 -0.4 12-17 Months -0.001 * 0.16 18-23 Months 0.002 ** 0.22 Recent Fever 0.247 *** -0.03 Constant -5.98 Total 1.46 ** 4.4 *** Percent 24.9 75.1 Anemia difference (%) -5.8 *** *Adjusted for urban-rural residence, wealth quintile, multiple births, mother's education, sex, age, mother's age, and recent fever. Baseline pooled I2 test for heterogeneity = 33.8% (p=0.138). Endline pooled I2 test for heterogeneity = 0.0% (p=0.661). Overall pooled I2 test for heterogeneity = 10.9% (p=0.319). © Bonnie Gillespie, courtesy of Photoshare