The changing importance of key factors associated with anaemia in 6- to 59-month-old children in a sub-Saharan African setting where malaria is on the decline: Analysis of the Rwanda Demographic and Health Survey 2010

Objective: To estimate the relative contribution of malaria and other potential determinants to current anaemia prevalence in Rwanda. Methods: The database for this study was the Rwanda Demographic and Health Survey 2010. Haemoglobin and malaria test results, and additional exposures ascertained through mothers' interviews, were analysed for all eligible children age 6-59 months (n = 4068), in addition to diet data available for the youngest under 5-year-old per household. We examined anaemia-exposure associations through forward logistic regression, first for the overall population (n = 3685), and second, for the subpopulation with diet data (n = 1934). Results: In the overall study population, malaria was strongly associated with anaemia (OR = 6.83, 95% CI: 2.90-16.05), but population impact was modest (population-attributable fraction = 2.5%). Factors associated with lower odds of anaemia were recent de-worming medication (six months; OR = 0.60, 95% CI: 0.49-0.74), female sex (OR = 0.76, 95% CI: 0.66-0.87), increasing age, residence in North Province and educated mother. Being underweight and recent fever (two weeks) were associated with higher odds. In the subpopulation with diet data, odds were lower with consumption of vitamin A-rich foods (OR = 0.66, 95% CI: 0.50-0.88); and higher in households with many young children. Conclusions: Malaria remains a strong determinant of anaemia for the individual child: transmission control efforts must be maintained. At population level, to further reduce anaemia prevalence, promoting regular vitamin A intake from natural sources and reducing intestinal helminths burden appear the most promising strategies to explore; exploring potential hitherto unidentified sex-linked factors is warranted.