Weighted distribution of the study variables.

Anaemia continues to be a burden especially in developing countries that not only affects the physical growth and cognitive development of children but also increases their risk to death. Over the past decade, the prevalence of anaemia among Ugandan children has been unacceptably high. Despite this, spatial variation and attributable risk factors of anaemia are not well explored at national level. The study utilized the 2016 Uganda Demographic and Health Survey (UDHS) data with a weighted sample of 3805 children aged 6–59 months. Spatial analysis was performed using ArcGIS version 10.7 and SaTScan version 9.6. This was followed by a multilevel mixed-effects generalized linear model for the analysis of the risk factors. Estimates for population attributable risks (PAR) and fractions (PAF) were also provided using STATA version 17. In the results, intra-cluster correlation coefficient (ICC) indicates that 18% of the total variability of anaemia was due to communities within the different regions. Moran’s index further confirmed this clustering (Global Moran’s index = 0.17; p-value.001). The main hot spot areas of anaemia were Acholi, Teso, Busoga, West Nile, Lango and Karamoja sub-regions. Anaemia prevalence was highest among boy-child, the poor, mothers with no education as well as children who had fever. Results also showed that if all children were born to mothers with higher education or were staying in rich household, the prevalence would be reduced by 14% and 8% respectively. Also having no fever reduces anaemia by 8%. In conclusion, anaemia among young children is significantly clustered in the country with disparities noted across communities within different sub-regions. Policies targeting poverty alleviation, climate change or environment adaptation, food security as well interventions on malaria prevention will help to bridge a gap in the sub regional inequalities of anaemia prevalence.

贫血仍是一项突出的公共卫生负担，尤其在发展中国家：它不仅会损害儿童的体格发育与认知发展，还会提升其死亡风险。过去十年间，乌干达儿童的贫血患病率高得令人无法接受。尽管如此，该国范围内贫血的空间分布差异及其归因危险因素尚未得到充分探索。本研究采用2016年乌干达人口与健康调查（Uganda Demographic and Health Survey, UDHS）的数据，其加权样本包含3805名6至59月龄的儿童。研究使用ArcGIS 10.7版本与SaTScan 9.6版本开展空间分析，随后采用多水平混合效应广义线性模型对危险因素进行探究，并通过STATA 17版本计算了人群归因危险度（Population Attributable Risk, PAR）与人群归因分值（Population Attributable Fraction, PAF）的估计值。结果显示，组内相关系数（Intra-cluster Correlation Coefficient, ICC）表明，贫血总变异中有18%来源于不同区域内的社区群体。全局莫兰指数进一步证实了该聚集性特征（全局莫兰指数=0.17，P值<0.001）。贫血的主要热点区域为阿乔利、特索、布索加、西尼罗河、兰戈与卡拉莫贾次区域。贫血患病率在男性儿童、贫困群体、未受教育母亲所育儿童以及曾发热儿童中最高。研究还发现，若所有儿童均由受过高等教育的母亲所生，或均居住在富裕家庭中，贫血患病率将分别降低14%与8%；此外，无发热史可使贫血患病率降低8%。综上，乌干达幼儿贫血现象存在显著的空间聚集性，不同次区域内的社区间亦存在患病差异。针对扶贫、气候变化与环境适应、粮食安全以及疟疾防控的干预政策，将有助于缩小不同次区域间贫血患病率的不平等差距。