Prevalence of anemia and its associated factors among children aged 6–23 months, in Ethiopia: a systematic review and meta analysis
Authors: Azmeraw Molla , Kassaw Amare , Habtegiorgis Samuel Derbie , Tigabu Agimasie , Amare Abraham Tsedalu , Mekuria Kindie , Temesgen Dessie , Zemariam Alemu Birara , Kerebeh Gashaw , Bantie Berihun , Alemnew Dessie , Abate Biruk Beletew 
Published: December 2023

Abstract
Introduction
Despite several strategies exist for anemia prevention and control, it has been the major public health important problem in the world. Numerous immediate and long-term health issues were reported in children who have history of anemia including decreased work productivity in adult hood period. Although analyzing data on burden and risk factors of anemia are the recommended action areas of World Health Organization framework for accelerating anemia reduction, the aggregated national burden and contributors of anemia in Ethiopia has not been determined so far. There for, this systematic and meta-analysis study is aimed to assess the pooled prevalence and associated factors of anemia among children aged 6–23 months in Ethiopia.

Methods
The electronic databases including PubMed, Scopus, EMBASE, Web of Science, Science Direct, Google scholar and institutional repositories were searched using search terms. The studies that reported the prevalence and/or risk factors of anemia in children 6–23 months of age were included. The JBI quality assessment tool was used to evaluate the quality of each study. The data was extracted with Microsoft Excel, 2019 and analyzed with STATA 17.0 statistical software. A random effect model was used to estimate the pooled prevalence of anemia and its associated factors. The Cochrane Q-test statistics and I2 test were used to measure heterogeneity between the included studies. Furthermore, publication bias was examined using the funnel plot graph and statistical tests (Egger’s and begg tests). Outliers also visualized using Galbraith plot. When necessary, sensitivity analysis was also employed to detect small study effect.

Result
Ten studies with a total population of 14, 733 were included for analysis. The pooled prevalence of anemia among children aged 6–23 months of age in Ethiopia was found to be 57.76% (95%CI; 51.61–63.91; I2 = 97.192%; p < 0.001). Having history of diarrhea AOR = 2.44 (95%CI: 1.03–3.85), being stunted AOR = 2.00 (95%CI: 1.38–2.61), living in food insecure house hold AOR = 2.08 (95%CI: 1.10–3.07), consuming less diversified food AOR = 2.73 (95%CI: 2.06–3.39) and being 6–11 months of age AOR = 1.59 (95%CI: 1.23–1.95) were associated with anemia.

Conclusion and recommendation
The prevalence of anemia is in the range of severe public health problem among children aged 6–23 months in Ethiopia. Diarrhea, stunting, house hold food insecurity, dietary diversity, and age were the predictors of anemia. Further, prospective cohort and random controlled trial studies are recommended. Further, random controlled trial especially effectiveness of nutritional education interventions trial is important. To reduce prevalence of anemia, strengthening diarrhea reduction program, securing household food insecurity, preventing stunting, giving special attention for infants age 6–11 months and encouraging food diversification are important.