Background and Aims Hemoglobin (Hb) concentration is used clinically to determine the presence of anemia and other blood disorders. More than half of the under‐five children in South and Southeast Asia suffer from lower Hb concentration. The main goal of this study is to determine risk factors associated with lower Hb concentration among 6–59‐month‐old children of five selected South and Southeast Asian (SSEA) countries by developing a suitable multilevel model by accounting for cluster‐, region‐, and country‐level variations. Methods The study used Hb concentration data collected in the most recent Demographic and Health Surveys (DHS) conducted during 2011–2022 in five SSEA countries: Bangladesh, India (Seven Sister States), Nepal, Maldives, and Myanmar. The final analysis included 49,059 children between the ages of 6 and 59 months. Several multilevel models at SSEA and country levels have been developed considering the hierarchical geographical structure of the data to investigate the influence of risk factors on Hb concentration. Results The mean Hb concentration among the SSEA country’s children was 102.96 g/L (±0.11), with the highest mean Hb level in Nepal (111.84 ± 0.42 mg/dL) and the lowest in India (101.64 ± 0.42 g/L). A four‐level random intercept model considering children, cluster, region, and country as the consecutive hierarchical units was found as the best model based on the considered model selection criteria. The final model shows significant variations in the Hb concentration at children (166.60), cluster (26.96), region (9.02), and country (10.46) levels after accounting for children, mother, and household‐level associated risk factors such as the child’s age, morbidity, malnutrition, breastfeeding status, mother’s age, education status, current anemia, nutritional status, household wealth status, and toilet facilities. Country‐level analysis shows country‐specific risk factors, which are mostly common with some exceptions. Conclusions The results of this study suggest that various child‐, mother‐, and household‐level factors significantly influence the lower Hb concentration, and the variation in the Hb level is mainly at the individual level, followed by the cluster, region, and country level. The findings suggest that multidisciplinary interventions should be concentrated at least at the household and the community level to improve children’s and mothers’ health and nutrition status, mothers’ education status, and household socioeconomic status to improve children’s Hb concentration to combat childhood anemia.
Amin et al. (Thu,) studied this question.