Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

Background Low haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin concentration. However, there is limited research on the prevalence and determinants of normal haemoglobin concentration among under-five children in sub-Saharan Africa.Objective To assess determinants of normal haemoglobin concentration among under-five children in SSA.Design Cross-sectional study design using a positive deviance approachSetting 33 SSA countries.Participants 129 408 children aged 6–59 monthsPrimary and secondary outcome measures A multilevel Poisson regression model with robust variance was fitted to identify determinants of normal haemoglobin concentration. An adjusted prevalence ratio with a 95% CI was reported to declare the statistical significance.Result The pooled prevalence of normal haemoglobin concentration among under-five children in SSA was 34.9% (95% CI: 34.6% to 35.1%). High maternal education, middle and rich household wealth, female child, frequent antenatal care visits, non-anaemic mothers, taking anthelmintic drugs and normal nutritional status were associated with increased odds of normal haemoglobin concentration. On the other hand, higher birth order, having fever and diarrhoea, rural residence were associated with lower odds of normal haemoglobin levels.Conclusion According to our finding, only four out of 10 under-five children in SSA had a normal haemoglobin level. This finding proved that anaemia among children in SSA remains a serious public health concern. Therefore, improving maternal education, provision of drugs for an intestinal parasite and early detection and treatment of maternal anaemia, febrile illness and diarrhoeal disease is important.