(P12-20-26) Anemia and Iron Deficiency Anemia Among Ethiopian Children Varied by Agricultural Seasons: Evidence From a Longitudinal Panel Survey

Objectives: To assess seasonal variation in anemia and iron deficiency anemia (IDA) and identify nutritional, inflammatory, and morbidity-related determinants among Ethiopian children aged 6–59 months.

Methods: In this longitudinal panel study, 590 Ethiopian children were assessed during the 2022 harvest and lean seasons. Hemoglobin was measured using HemoCue 301, and serum ferritin was adjusted for inflammation using C-Reactive Protein (CRP) and α-1-Acid Glycoprotein (AGP) per the BRINDA method. Anemia was defined by the 2024 WHO guidelines after adjusting for altitude ( < 10.5 g/dL for children 6–23 months; < 11.0 g/dL for 24–59 months), iron deficiency as ferritin < 12µg/L, and IDA as both conditions. Adjusted Poisson regression estimated Incidence Risk Ratios (IRR) for anemia, and Population Attributable Fractions (PAF) quantified the contribution of modifiable risk factors using Stata 19.

Results: Mean hemoglobin concentrations did not differ significantly between harvest and lean seasons (11.5 vs. 11.4 g/dL; p = 0.086). However, the prevalence of anemia was higher in the lean season than in the harvest season (29.4% vs. 23.4%; p < 0.05), and IDA was also more prevalent during the lean season (7.7% vs. 5.0%; p < 0.05). In adjusted Poisson regression models, iron deficiency was associated with a twofold increase in anemia risk (IRR 2.05; 95% CI: 1.58–2.65), and the PAF analysis estimated that 12.3% of anemia cases were attributable to iron deficiency. Inflammation during the incubation (IRR 1.84; CI: 1.04–3.26) and late convalescence stages (IRR 1.61; CI: 1.18–2.20) accounted for approximately 12% of anemia cases. Household food insecurity increased anemia risk (IRR 1.31; CI: 1.02–1.67), contributing 16% to the burden, while vitamin A deficiency (IRR 1.28; CI: 1.02–1.61) accounted for 8%, and malaria infection (IRR 2.45; CI: 1.59–3.78) for 2% of cases. After adjusting for these determinants, seasonal differences in anemia prevalence were no longer statistically significant.

Conclusions: Childhood anemia in Ethiopia is multifactorial and more prevalent in the lean season, with substantial contributions from iron deficiency, inflammation, household food insecurity, vitamin A deficiency, and malaria. These results highlight the need for season-based nutrition interventions combined with infection-control programs.

Funding Sources: No external funding