The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis

Background/Objectives: Anemia and undernutrition are severe public health concerns in Ethiopia. These are the two most common nutritional disorders in pregnant women and frequently coexist. However, to our knowledge, there is little evidence of the coexistence of anemia and undernutrition among preg...

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Authors: Yoseph, Amanuel, Mussie, Lakew, Belayneh, Mehretu, Aguinaga Ontoso, Inés, Guillén Grima, Francisco, Mutwiri, George Kiremu
Format: article
Status:Published version
Publication Date:2025
Country:España
Institution:Universidad Pública de Navarra
Repository:Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
OAI Identifier:oai:academica-e.unavarra.es:2454/55406
Online Access:https://hdl.handle.net/2454/55406
Access Level:Open access
Keyword:Coexisting anemia and undernutrition
Pregnant women
Prevalence
Determinants
Modified poisson regression
Multi-level analysis
Dietary diversity
Food insecurity
Sidama region
Ethiopia
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spelling The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysisYoseph, AmanuelMussie, LakewBelayneh, MehretuAguinaga Ontoso, InésGuillén Grima, FranciscoMutwiri, George KiremuCoexisting anemia and undernutritionPregnant womenPrevalenceDeterminantsModified poisson regressionMulti-level analysisDietary diversityFood insecuritySidama regionEthiopiaBackground/Objectives: Anemia and undernutrition are severe public health concerns in Ethiopia. These are the two most common nutritional disorders in pregnant women and frequently coexist. However, to our knowledge, there is little evidence of the coexistence of anemia and undernutrition among pregnant women. Therefore, this study aimed to examine the prevalence of coexisting anemia and undernutrition (CAU) and associated factors among pregnant women. Methods: A community-based cross-sectional study was conducted from 1 to 25 June 2024, on 515 pregnant women in the Hawela Lida district of Sidama, Ethiopia. We utilized a multi-stage sampling method to choose eligible study participants. A pre-tested and structured questionnaire was used to collect data via the online Open Data Kit mobile tool. We controlled the effect of confounders and clustering by using a multi-level mixed-effect modified Poisson regression analysis model. Results: The prevalence of CAU among pregnant women was 25.4% (95% CI: 21.9–28.9). The prevalence of CAU was associated with household food insecurity (adjusted prevalence ratio [APR]: 2.17; 95% CI: 1.43–3.28), training on model family (APR: 0.66; 95% CI: 0.45–0.96), inadequate dietary diversity (APR: 1.51; 95% CI: 1.18–1.95), and having poor knowledge of nutrition (APR: 1.55; 95% CI: 1.06–2.26) at individual levels. Low community-level women’s autonomy (APR: 6.19; 95% CI: 3.42–11.22) and community-level road accessibility (APR: 0.65; 95% CI: 0.43–0.98) were the identified determinants of CAU at the community level. Conclusions: One in four pregnant women had CAU in the study area. Household food insecurity, inadequate dietary diversity, and poor nutrition knowledge were associated with an increased likelihood of CAU, while participation in model family training and improved road accessibility were associated with reduced CAU. We have also indicated that low community-level women’s autonomy significantly increased the risk of CAU. Therefore, inter-sectorial collaboration should be required to comprehensively address CAU’s determinants at different levels. Additionally, any CAU prevention and intervention programs should provide model family training explicitly targeting women with poor nutritional knowledge and low autonomy in healthcare decision-making.This research was funded by the Nestle Foundation with grant number NFHUC/0212/2024.MDPICiencias de la SaludOsasun Zientziak2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/ziphttps://hdl.handle.net/2454/55406reponame:Academica-e. Repositorio Institucional de la Universidad Pública de Navarrainstname:Universidad Pública de NavarraInglés© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:academica-e.unavarra.es:2454/554062026-06-17T12:41:47Z
dc.title.none.fl_str_mv The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
title The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
spellingShingle The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
Yoseph, Amanuel
Coexisting anemia and undernutrition
Pregnant women
Prevalence
Determinants
Modified poisson regression
Multi-level analysis
Dietary diversity
Food insecurity
Sidama region
Ethiopia
title_short The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
title_full The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
title_fullStr The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
title_full_unstemmed The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
title_sort The determinants of coexisting anemia and undernutrition among pregnant women in Southern Ethiopia: a multi-level analysis
dc.creator.none.fl_str_mv Yoseph, Amanuel
Mussie, Lakew
Belayneh, Mehretu
Aguinaga Ontoso, Inés
Guillén Grima, Francisco
Mutwiri, George Kiremu
author Yoseph, Amanuel
author_facet Yoseph, Amanuel
Mussie, Lakew
Belayneh, Mehretu
Aguinaga Ontoso, Inés
Guillén Grima, Francisco
Mutwiri, George Kiremu
author_role author
author2 Mussie, Lakew
Belayneh, Mehretu
Aguinaga Ontoso, Inés
Guillén Grima, Francisco
Mutwiri, George Kiremu
author2_role author
author
author
author
author
dc.contributor.none.fl_str_mv Ciencias de la Salud
Osasun Zientziak
dc.subject.none.fl_str_mv Coexisting anemia and undernutrition
Pregnant women
Prevalence
Determinants
Modified poisson regression
Multi-level analysis
Dietary diversity
Food insecurity
Sidama region
Ethiopia
topic Coexisting anemia and undernutrition
Pregnant women
Prevalence
Determinants
Modified poisson regression
Multi-level analysis
Dietary diversity
Food insecurity
Sidama region
Ethiopia
description Background/Objectives: Anemia and undernutrition are severe public health concerns in Ethiopia. These are the two most common nutritional disorders in pregnant women and frequently coexist. However, to our knowledge, there is little evidence of the coexistence of anemia and undernutrition among pregnant women. Therefore, this study aimed to examine the prevalence of coexisting anemia and undernutrition (CAU) and associated factors among pregnant women. Methods: A community-based cross-sectional study was conducted from 1 to 25 June 2024, on 515 pregnant women in the Hawela Lida district of Sidama, Ethiopia. We utilized a multi-stage sampling method to choose eligible study participants. A pre-tested and structured questionnaire was used to collect data via the online Open Data Kit mobile tool. We controlled the effect of confounders and clustering by using a multi-level mixed-effect modified Poisson regression analysis model. Results: The prevalence of CAU among pregnant women was 25.4% (95% CI: 21.9–28.9). The prevalence of CAU was associated with household food insecurity (adjusted prevalence ratio [APR]: 2.17; 95% CI: 1.43–3.28), training on model family (APR: 0.66; 95% CI: 0.45–0.96), inadequate dietary diversity (APR: 1.51; 95% CI: 1.18–1.95), and having poor knowledge of nutrition (APR: 1.55; 95% CI: 1.06–2.26) at individual levels. Low community-level women’s autonomy (APR: 6.19; 95% CI: 3.42–11.22) and community-level road accessibility (APR: 0.65; 95% CI: 0.43–0.98) were the identified determinants of CAU at the community level. Conclusions: One in four pregnant women had CAU in the study area. Household food insecurity, inadequate dietary diversity, and poor nutrition knowledge were associated with an increased likelihood of CAU, while participation in model family training and improved road accessibility were associated with reduced CAU. We have also indicated that low community-level women’s autonomy significantly increased the risk of CAU. Therefore, inter-sectorial collaboration should be required to comprehensively address CAU’s determinants at different levels. Additionally, any CAU prevention and intervention programs should provide model family training explicitly targeting women with poor nutritional knowledge and low autonomy in healthcare decision-making.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2454/55406
url https://hdl.handle.net/2454/55406
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv https://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/zip
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv reponame:Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
instname:Universidad Pública de Navarra
instname_str Universidad Pública de Navarra
reponame_str Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
collection Academica-e. Repositorio Institucional de la Universidad Pública de Navarra
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