Background In 2008, 78% of Ghanaian children under 5 years old were anemic versus 48% of children globally. In this study, we identified proximal and distal determinants of severe-moderate anemia and mild anemia related to socioeconomic status, nutrition, and health access. Methods Using data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys (GDHS), the odds of severemoderate anemia and mild anemia compared to no anemia, in relation to various hypothesized risk factors, were assessed using a multivariable, multinomial logistic regression, which accounted for survey design. Results From among 7739 households sampled, severe-moderate anemia was found in approximately 52%, 56%, and 40% of children during 2003, 2008, and 2014, respectively. The proportion of children diagnosed as not anemic was 26% in 2003, 22% in 2008, and 33% in 2014. There are large disparities in anemia prevalence among regions and between urban and rural areas. In 2014, children who were younger (aged 6-24 months), had a recent fever, were from poorer families, and whose mothers were less educated had greater odds of being severely-moderately anemic. These results remained significant when controlling for other risk factors. Predictors of anemia in Ghana remained relatively consistent among the three time periods when the GDHS was administered. Conclusions The prevalence of anemia in Ghana among children aged 6-59 months has remained unacceptably high. To reduce anemia in these children, the Ghanaian government should concentrate on educating women through both the traditional school system and antenatal care visits. Keywords Anemia disease risk • West Africa • Childhood health disparities • Demographic and health survey (DHS) • Maternal and child nutrition Significance What is Already Known on This Subject? Existing literature using GDHS data shows there are child, household, and sociocultural factors associated with anemia in Ghana. What This Study Adds? This is the first article, that we know of, to assess predictors of anemia in Ghana over three rounds of GDHS data. Younger child age, fever in the last 2 weeks, lower household wealth, less maternal education, and maternal anemia were significantly associated with severe-moderate anemia among children in 2014. The predictors remained relatively constant over time, with similar risk factors being seen in 2003 and 2008. These results can inform policy makers in Ghana.

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Objectives India has more unvaccinated children than any other country despite provision of free vaccines through the government's Universal Immunization Program. In this study, we calculated the proportion of children aged 12-48 months who were fully vaccinated, under-vaccinated, or who had not received any vaccines. Childhood, household, and sociocultural factors associated with under-vaccination and non-vaccination were evaluated. Methods Using data from India's 4th District-level Health and Facility Survey, 2012-2013 (DLHS-4) and the 2012-2013 Annual Health Survey (AHS), we calculated the proportion of children who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of diphtheria-pertussis-tetanus, and 1 dose of measles-containing vaccine. The odds of full vaccination compared to non-vaccination and under-vaccination relative to various factors was assessed using a multivariable, multinomial logistic regression which accounted for survey design. Results Of 1,929,580 children aged 12-48 months, 59% were fully vaccinated, 34% were under-vaccinated, and 7% were non-vaccinated. Compared to children born in government institutions, children delivered in non-institutional settings with a skilled birth attendant present had higher odds of non-vaccination (OR 1.66) and those without a skilled attendant present had still greater odds of non-vaccination (OR 2.39) and under-vaccination (OR 1.11). Conclusions for Practice India's vaccination rates among children aged 12-48 months remains unacceptably low. The Indian government should encourage institutional delivery or birthing with a skilled attendant to ensure women receive adequate health education through antenatal care that includes the importance of childhood vaccination.

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ObjectiveTo characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status.DesignScoping review.Data sourcesElectronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018.Study selectionAll English studies with vaccination status as the outcome and the use of DHS data.Data extractionStudies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted.ResultsA total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1–86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO’s Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child’s sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition.ConclusionsResearchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.