Prevalence and factors related to anaemia in children aged 6–59 months attending a quaternary health facility in Maputo, Mozambique

Figures & data

Figure 1. Flowchart of the study population.

Table 1. Socio-demographic characteristics of children aged 6–59 months at Maputo Central Hospital, PAMC, August 2020-August 2022.

Variables (n = 637)	Categories	N	%
Gender of child	Male	354	55.6
	Female	279	43.8
	No information	4	0.6
Age of child (in months)	6 months–11 months	117	18.4
	12 months–23 months	142	22.3
	24 months–59 months	288	45.2
	No information	90	14.1
Residence Area	Rural	370	58.1
	Urban	244	38.3
	No information	23	3.6
Province	Maputo Province	270	42.4
	Maputo City	312	49.0
	Other provinces:
	Cabo Delgado	1	0.2
	Gaza	19	3.0
	Inhambane	18	2.8
	Manica	1	0.2
	Nampula	2	0.3
	Sofala	2	0.3
	Tete	3	0.5
	Zambezia	2	0.3
	No information	7	1.1
Level of Education of the Caregiver/Child’s companion	No scholarization	151	23.7
	Primary	93	14.6
	Secondary	296	46.5
	Technical	16	2.5
	University	77	12.1
	No information	4	0.6

Table 2. Nutritional and health characteristics of children aged 6–59 months at Maputo Central Hospital, PAMC, August 2020-August 2022.

Variables (n = 637)		Categories	n	%
Nutritional characteristics	Breastfeeding	Yes	334	52.4
		No	242	38.0
		No information	61	9.6
	Complementary feeding	Yes	302	47.4
		No	264	41.4
		No information	71	11.1
	Type of breastfeeding	Only breastfeeding	92	14.4
		Breastfeeding combined with complementary feeding	230	36.1
		Only complementary feeding	70	11.0
		No breastfeeding nor complementary feeding	169	26.5
		No information	76	11.9
	Porridge intake	Yes	310	48.7
		No	75	11.8
		No information	252	39.6
	Family meals intake (*)	Yes (**)	348	54.6
		No	98	15.4
		No information	191	30.0
	Eating practices (***)	1–3 food groups	117	18.4
		4 or more food groups	47	7.4
		Not specified/No information	473	74.3
Anthropometric characteristics	MUAC classification	Severe Acute Malnutrition (SAM)/ MUAC less than 11.0 cm	9	1.4
		Moderate Acute Malnutrition (MAM)/ MUAC between 11.0 cm and 12.5cm	18	2.8
		At risk for acute malnutrition/ MUAC between 12.5 cm and 13.5cm	33	5.2
		Well nourished/ MUAC over 13.5cm	334	52.4
		No information	243	38.1
Child anaemia	Anaemia	Has anaemia (Hb < 11.0 g/dL)	396	62.2
		Without anaemia (Hb ≥ 11.0 g/dL)	236	37.0
		No information	5	0.8
	Classification of anaemia based on hemoglobin (Hb) levels	Severe anaemia (Hb < 7.0 g/dL)	47	7.4
		Moderate anaemia (7 g/dL ≤ Hb ≤ 9.9 g/dL)	197	30.9
		Mild anaemia (10 g/dL ≤ Hb ≤ 10.9 g/dL)	152	23.9
		Without anaemia (Hb ≥ 11.0 g/dL)	236	37.0
		No information	5	0.8
	Classification of anaemia based on size of red blood cell (RCB) measured by the mean corpuscular volume (MCV)	Microcytic (<80 fL)	486	76.3
		Normocytic (80-100 fL)	120	18.8
		Macrocytic (>100 fL)	3	0.5
		No information	28	4.4
Health characteristics	Vomiting	Yes (more than 1 episode/postprandial/unrelated to food/after coughing/not characterized)	121	19.0
		No	455	71.4
		No information	61	9.6
	Malaria	Positive	68	10.7
		Negative	517	81.2
		No information/Not performed/Not requested	52	8.2
	HIV	Positive	25	3.9
		Negative	529	83.0
		No information/Not performed/Not requested/Pending	83	13.0
	COVID-19	Positive	15	2.4
		Negative	400	62.8
		No information/Not performed/Not requested/Pending	222	34.9
	Urine testing	Positive	25	3.9
		Negative (Normal)	123	19.3
		No information/ Not performed	489	76.8
	Glucose	Hypoglycemia (Blood Glucose Level <100 mg/dL)	291	45.7
		Normal (100 mg/dL ≤ BGL ≤ 180 mg/dL)	122	19.2
		Hyperglycemia (BGL > 180 mg/dL)	27	4.2
		No information	197	30.9
	Cough	Yes (Dry cough/productive, nocturnal/with difficulty breathing/with chest pain/not characterized)	149	23.4
		No	425	66.7
		No information	63	9.9
	Pale conjuctiva	Yes	61	9.6
		No	495	77.7
		No information	81	12.7
	Size of liver	Yes (2 cm or more below the costal margin)	24	3.8
		No	552	86.7
		No information	61	9.6

Notes: Abbreviations: MUAC – mid-upper arm circunference; Hb – hemoglobin; RCB-red blood cell; MCV-mean corpuscular volume; HIV-Human immunodeficiency virus; COVID-19 – Coronavirus disease 2019; BGL – blood glucose level; CI-confidence interval.

(*) Children that have meals/eat food with their family members.

(**) It refers to whether the child eats or not family meals (if the child consumes meals with other family members, such as breakfast, lunch, afternoon snack, and dinner). Family meals include consuming food from the household´s usual diet (other family members, children older than five years, adolescents, and adults).

(***) Food groups include a. Cereals, tubers, and derivates; b. Meat, fish and eggs; c. Legumes; d. Vegetables; e. Dairy products; F. Fruits; g. Fats and oils.

Table 3. Analysis of factors associated with anaemia in children aged 6–59 months at Maputo Central Hospital, PAMC, August 2020-August 2022.

Variables (n = 637)	Categories	Has anaemia (Hb <11.0 g/dL) (N = 396)		Without anaemia (Hb ≥ 11.0 g/dL) (N = 236)		COR (CI 95%)		p*	Global p-value^a	AOR (CI 95%)**		p**	Global p-value^b
		n	%	n	%	COR	CI 95%			OR	CI 95%
Gender of child	Male	229	58	123	52.8	1.234	(0.891–1.709)	0.206	–	–	–	–	–
	Female	166	42	110	47.2	Ref	–	–		–	–	–	–
Age of child (in months)	6 months–11 months	87	25.5	30	14.8	2.335	(1.451–3.757)	<0.001	<0.001	2.388	(1.372–4.156)	0.002	0.006
	12 months–23 months	95	27.9	45	22.2	1.7	(1.112–2.598)	0.014		1.643	(0.974–2.771)	0.063
	24 months–59 months	159	46.6	128	63.1	Ref	–	–		Ref	–	–
Residence area	Rural	234	61.6	135	59	1.116	(0.799–1.560)	0.521	–	–	–	–	–
	Urban	146	38.4	94	41	Ref	–	–		–	–	–	–
Province	Maputo Province	167	42.6	102	43.6	1.003	(0.716–1.405)	0.986	0.597	–	–	–	–
	Maputo City	191	48.7	117	50	Ref	–	–		–	–	–	–
	Other provinces	34	8.7	15	6.4	1.388	(0.725–2.659)	0.322		–	–	–	–
Level of Education of the Caregiver/Child’s companion	No scholarization	101	25.7	47	20	2.579	(1.463–4.544)	0.001	0.009	3.073	(1.371–6.890)	0.006	0.049
	Primary	65	16.5	28	11.9	2.786	(1.483–5.233)	0.001		2.705	(1225–5.976)	0.014
	Secondary	182	46.3	112	47.7	1.950	(1.175–3.236)	0.01		1.963	(1.071–3.598)	0.029
	Technical	10	2.5	6	2.6	2	(0.661–6.051)	0.22		2.407	(0.626–9.254)	0.201
	University	35	8.9	42	17.9	Ref	–	–		Ref	–	–
Breastfeeding	Yes	216	60.7	115	53	1.368	(0.973–1.925)	0.071	–	–	–	–	–
	No	140	39.3	102	47	Ref	–	–		–	–	–	–
Complementary feeding	Yes	201	57.6	100	46.7	1.548	(1.099–2.180)	0.012	–	–	–	****	–
	No	148	42.4	114	53.3	Ref	–	–		Ref	–	–
Type of breastfeeding	Only breastfeeding	50	14.5	41	19.2	0.905	(0.542–1.512)	0.704	0.053	–	–	–	–
	Breastfeeding combined with complementary feeding	157	45.4	72	33.8	1.619	(1.071–2.447)	0.022		–	–	–	–
	Only complementary feeding	42	12.1	28	13.1	1.113	(0.631–1.963)	0.71		–	–	–	–
	No breastfeeding nor complementary feeding	97	28	72	33.8	Ref	–	–		–	–	–	–
Porridge intake	Yes	204	81.6	104	78.8	1.194	(0.706–2.020)	0.509	–	–	–	–	–
	No	46	18.4	28	21.2	Ref	–	–		–	–	–	–
Family meals intake	Yes	216	75.5	132	83	0.631	(0.385–1.034)	0.068	–	–	–	–	–
	No	70	24.5	27	17	Ref	–	–		–	–	–	–
Eating practices	1–3 food groups	81	76.4	36	62.1	1.98	(0.989–3.966)	0.054	–	–	–	–	–
	4 or more food groups	25	23.6	22	37.9	Ref	–	–		–	–	–	–
MUAC classification	Severe Acute Malnutrition (SAM)/ MUAC less than 11.0 cm	5	2	4	2.7	0.821	(0.216–3.113)	0.772	0.071	–	–	–	–
	Moderate Acute Malnutrition (MAM)/ MUAC between 11.0 cm and 12.5cm	15	6.1	3	2.1	3.284	(0.932–11.563)	0.064		–	–	–	–
	At risk for acute malnutrition/ MUAC between 12.5 cm and 13.5cm	25	10.2	7	4.8	2.345	(0.986–5578)	0.054		–	–	–	–
	Well nourished/ MUAC over 13.5cm	201	81.7	132	90.4	Ref	–	–		–	–	–	–
Vomiting	Yes	67	18.8	54	25.1	0.689	(0.459–1.035)	0.073	–	–	–	–	–
	No	290	81.2	161	74.9	Ref	–	–		–	–	–	–
Malaria	Positive	57	15.5	11	5.1	3.427	(1.755–6.691)	<0.001		3.555	(1.628–7.766)	0.001	–
	Negative	310	84.5	205	94.9	Ref	–			Ref	–	–	–
HIV	Positive	20	5.7	4	2	3.049	(1.027–9.048)	0.045		–	–	****	–
	Negative	328	94.3	200	98	Ref	–			Ref	–		–
COVID-19	Positive	10	3.9	4	2.6	1.538	(0.474–4.992)	0.473		–	–	–	–
	Negative	247	96.1	152	97.4	Ref	–			–	–	–	–
Glucose	Hypoglycemia (Blood Glucose Level <100 mg/dL)	197	67.5	91	63.2	1.221	(0.782–1.906)	0.379	0.669	–	–	–	–
	Hyperglycemia (BGL > 180 mg/dL)	17	5.8	9	6.3	1.066	(0.438–2.591)	0.889		–	–	–	–
	Normal (100 mg/dL ≤ BGL ≤ 180 mg/dL)	78	26.7	44	30.6	Ref	–	–
Urine testing	Positive	21	19.1	4	10.5	2.006	(0.641–6.271)	0.231		–	–	–	–
	Negative (Normal)	89	80.9	34	89.5	Ref	–	–
Cough	Yes	83	23.3	66	30.8	0.682	(0.466–0.997)	0.048	–	–	–	****	–
	No	273	76.7	148	69.2	Ref	–			Ref	–		–
Pale conjuctiva	Yes	60	17.6	0	0	–	–	***	–	–	–	–	–
	No	281	82.4	211	100	–				–	–	–	–
Size of the Liver	Yes (2 cm or more below the costal margin)	21	5.9	3	1.4	4.383	(1.291–14.873)	0.018	–	10.569	(1.363–81.952)	0.024	–
	No	337	94.1	211	98.6	Ref	–	–		Ref	–	–	–

Notes: Bivariate analysis: (*) Crude Odds Ratio (COR) and p values; (***) COR and p-value were not performed for variable pale conjunctiva for presenting no values for ‘Without anaemia'/‘Yes category'; (^a) global p value, for categories with more than 2 levels.

Multivariate analysis: included 403 participants. (**) AOR and p values for variables of multivariate analysis; (^b) global p value, for categories with more than 2 levels. Only variables with a p-value less than 0.05 (5% of significance level) were included in the adjusted multiple logistic regression model; (****)According to the multivariate regression model (backward stepwise likelihood method), the variables complementary feeding, HIV, and cough are no longer significant (p > 0.05), being automatically excluded from the model. Thus, odds ratios are not presented for these variables.

Abbreviations: MUAC – mid-upper arm circunference; HIV-Human immunodeficiency virus; COVID-19 – Coronavirus disease 2019; Hb – hemoglobin; BGL – blood glucose level; CI – confidence interval.