Prevalence and risk factors for anemia severity and type in Malawian men and women: urban and rural differences.
BACKGROUND
The global burden of anemia is large especially in sub-Saharan Africa, where HIV is common and lifestyles are changing rapidly with urbanization. The effects of these changes are unknown. Studies of anemia usually focus on pregnant women or children, among whom the burden is greatest. We describe prevalence and risk factors for anemia among rural and urban men and women of all ages in Malawi.


METHODS
We analyzed data from a population-wide cross-sectional survey of adults conducted in two sites, Karonga (rural) and Lilongwe (urban), commencing in May 2013. We used multinomial logistic regression models, stratified by sex to identify risk factors for mild and moderate-to-severe anemia.


RESULTS
Anemia prevalence was assessed among 8,926 men (age range 18-100 years) and 14,978 women (age range: 18-103 years). Weighted prevalence levels for all, mild, and moderate-to-severe anemia were 8.2, 6.7 and 1.2% in rural men; 19.4, 12.0 and 7.4% in rural women; 5.9, 5.1 and 0.8% in urban men; and 23.4, 13.6 and 10.1% in urban women. Among women, the odds of anemia were higher among urban residents and those with higher socioeconomic status. Increasing age was associated with higher anemia prevalence in men. Among both men and women, HIV infection was a consistent risk factor for severity of anemia, though its relative effect was stronger on moderate-to-severe anemia.


CONCLUSIONS
The drivers of anemia in this population are complex, include both socioeconomic and biological factors and are affecting men and women differently. The associations with urban lifestyle and HIV indicate opportunities for targeted intervention.
['Adamu|Aishatu L|AL|', 'Crampin|Amelia|A|', 'Kayuni|Ndoliwe|N|', 'Amberbir|Alemayehu|A|', 'Koole|Olivier|O|', 'Phiri|Amos|A|', 'Nyirenda|Moffat|M|', 'Fine|Paul|P|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000740:Anemia D003430:Cross-Sectional Studies D005260:Female D015658:HIV Infections D006801:Humans D016015:Logistic Models D008295:Malawi D008297:Male D008875:Middle Aged D015995:Prevalence D012307:Risk Factors D012424:Rural Population D012720:Severity of Illness Index D012737:Sex Factors D012959:Socioeconomic Factors D014505:Urban Population D055815:Young Adult
Risk factors Anemia severity Men Women Urban Rural Adult Anemia/epidemiology