The stagnation of child anaemia (6–23 months) in Tanzania from 2004 to 2022: a missed opportunity during the ‘first 1000 days’

Abstract

Background: Child anaemia remains a major public health concern in low- and middle-income countries, particularly among children aged <2 years. Given Tanzania's slow progress towards addressing this challenge, despite the implementation of targeted national strategies, we aimed to examine the prevalence and associated factors of anaemia in children aged <2 years. Methods: This cross-sectional study was based on secondary data from the Tanzania Demographic and Health Surveys (2004-2005, 2010, 2015-2016, and 2022). We applied individual sampling weights to ensure national representativeness and used descriptive analyses to estimate the prevalence of child anaemia, both overall and in specific age group distributions (6-23 and 24-59 months), by severity. Then, employed geographic information system mapping to visualise the regional anaemia prevalence among children aged <2 years. Finally, we conducted a multivariable logistic regression analysis to identify risk factors related to child anaemia and sensitivity analyses to check the robustness of our findings. Results: We included 25 590 children aged <5 years with available haemoglobin data, of whom 10 166 were aged 6-23 months. In 2022, 59.9% of children aged <5 years and 73.1% of those aged 6-23 months were anaemic. Using spatial analysis, we found that 16 of 31 regions experienced increased prevalence of anaemia, while the remaining 15 saw slight to moderate declines since 2015. In the multivariable analysis, being male (adjusted odds ratio (aOR) = 1.380; 95% confidence interval (CI) = 1.133-1.681), having low birth weight (aOR = 1.713; 95% CI = 1.076-2.727), being underweight (aOR = 1.438; 95% CI = 1.032-2.005), and not having health insurance (aOR = 1.768; 95% CI = 1.247-2.508) were factors significantly associated with increased risk of anaemia. Conclusion: s Child anaemia in Tanzania has stagnated between 2015-2022, failing to meet national targets. The burden has remained disproportionately high among low birth weight children and those aged <2 years, with those residing in coastal regions and high food production areas being especially vulnerable. Targeted interventions during the first 1000 days of life should be prioritised to break the intergenerational cycle of anaemia.