Association of women empowerment with anaemia and haemoglobin concentration in children in sub-Saharan Africa: a multilevel analysis

BackgroundChildhood anaemia is an intractable public health problem, particularly in low- and middle-income countries. Womens empowerment may improve child nutrition, but information on the relationship between different dimensions of womens empowerment and childhood anaemia in sub-Saharan Africa (SSA) is limited. We assessed the associations between womens empowerment and anaemia and haemoglobin (Hb) concentration among children in SSA. MethodsWe included 72 032 women and their singleton children aged 6-59 months from the most recent Demographic and Health Surveys conducted between 2006 and 2019 in 31 SSA countries. We constructed a four-dimensional womens empowerment index using principal components analysis and used multilevel regression to assess the associations of these dimensions with child anaemia and Hb concentration. ResultsOf the included children, 65.8% were anaemic and the mean Hb concentration was 102.3 g/dl (SD 16.1). The odds of anaemia reduced with increasing empowerment in the dimensions of attitude towards violence [quintile (Q1) vs. Q5, OR 0.80; 95% CI 0.71-0.89, Ptrend <0.001], decision making (Q1 vs. Q5, OR 0.68; 95% CI 0.59-0.79, Ptrend <0.001), education (Q1 vs. Q5, OR 0.80; 95% CI 0.72-0.89, Ptrend <0.001), and social independence (Q1 vs. Q5, OR 0.89; 95% CI 0.79-1.00, Ptrend <0.015). Similarly, the mean Hb concentration increased with increasing womens empowerment in the dimensions of attitude towards violence (Q1 vs. Q5, mean difference (MD) 0.96 g/dl; 95% CI 0.17-1.74, Ptrend = 0.009), decision making (Q1 vs. Q5, MD 0.73 g/dl; 95% CI 0.03-1.43, Ptrend <0.001), social independence (Q1 vs. Q5, MD 1.65 g/dl; 95% CI 0.99-2.31, Ptrend <0.001) and education (Q1 vs. Q5, MD 1.01 g/dl; 95% CI 0.50-1.52, Ptrend <0.002). ConclusionWomen empowerment was associated with reduced odds of anaemia and higher Hb concentration in children. Promotion of women empowerment may reduce the burden of childhood anaemia in SSA. Key questionsO_ST_ABSWhat is already known?C_ST_ABSO_LIWomen empowerment may reduce maternal and child undernutrition, specifically wasting, stunting and Vitamin A deficiency. C_LIO_LIWomen empowerment is a multidimensional concept and is often measured in an unstandardized way making it difficult to compare and interpret findings across studies. C_LIO_LIA survey-based womens empowerment index (the SWPER index) was developed to measure women empowerment in a standardised manner across sub-Saharan African countries. C_LI What are the new findings?O_LIChildren of women who were empowered in the attitude towards domestic violence, decision making, education, and social independence domains had higher haemoglobin concentrations and were less likely to be anaemic than those of less empowered women. C_LIO_LIEmpowerment in decision making seemed to have the strongest association with anaemia. C_LI What do the new findings imply?O_LIPromotion of women empowerment in attitude towards violence, decision making, social independence and education domains may contribute towards reducing the burden of anaemia among sub-Saharan African children. C_LI