Abstract
Worldwide, anemia in under-five children is a serious public health problem that causes significant morbidity and mortality. It also negatively impacts children's physical growth, focus, memory, and academic performance. Despite this, there is a paucity of up-to-date information on the spatial distribution and determinants of under-five anemia in Mozambique. Therefore, this study aimed to assess the spatial variation and determinates of anemia among under-five children in Mozambique by using the most recent demographic and health survey data. A cross-sectional study was conducted using the most recent demographic and health survey data of Mozambique. A total weighted sample of 3127 under-five children was included in the study. Spatial SaTScan statistics were done using Kuldroff's SaTScan version 9.6 software. ArcGIS version 10.7 software is used to visualize the spatial distribution of under-five anemia. A multilevel mixed-effects logistic regression analysis was employed to identify the determinants of under-five anemia. The level of statistical significance was declared at a p-value of < 0.05. Overall, the prevalence of anemia among under-five children in Mozambique was 49.46% (95% CI 47.70-51.21). Under-five anemia was not evenly distributed across the country; a higher distribution was observed in Zambezia, Nampula, Safala, and the southern part of Gaza; fewer cold spots were observed in the western and southern parts of Niassa, the eastern part of Tete, the western part of Manica, and Maputo City. In spatial scan statistics, children in the most likely cluster were 1.58 times more likely to be anemic than those living outside the window (RR = 1.58, P-value < 0.001). Children with fathers with no formal education, children from anemic mothers, children whose mothers are underweight, children residing in the Zambzia region, children residing in the Nampula region, and children residing in the Niassa region were significantly associated with under-five anemia in Mozambique. The burden of under-five anemia in Mozambique is higher and distributed non-randomly across regions. Maternal anemia, underweighted mothers, husband education, and regions in Mozambique were found to be significant determinants of anemia in under-five children. Improving the nutritional status of mothers and interventions to address maternal anemia, with special attention to the Nampula and Zambzia regions, are recommended to reduce under-five anemia in Mozambique.