{
  "abstract": "ObjectivesTo examine the association between maternal media exposure and childhood anemia in three sub-Saharan African countries, and to develop a two-stage multiple imputation approach for substantial hemoglobin outcome missingness in Demographic and Health Survey (DHS) data.\n\nDesignMulti-country cross-sectional analysis of nationally representative DHS data.\n\nSettingCommunity-based household surveys in Ghana (2022), Nigeria (2023-24), and Tanzania (2022).\n\nParticipants42,944 children aged 6-59 months across 2,621 clusters.\n\nPrimary and secondary outcome measuresThe primary outcome was anemia (altitude-adjusted hemoglobin <11.0 g/dL, WHO criteria); the primary exposure was a composite maternal media score (0-4 channels). Given 61.5% hemoglobin missingness, we imputed altitude-adjusted hemoglobin using multilevel Gaussian models and derived anemia deterministically, then estimated associations using population-averaged generalized estimating equations (pre-specified primary analysis), with six sensitivity analyses and exploratory mediation analysis.\n\nResultsMedia exposure was significantly associated with reduced anemia odds (OR 0.946, 95% CI 0.917 to 0.976, p<0.001; FMI 32.5%), a 5.4% reduction per additional weekly channel. Estimates were consistent across six sensitivity analyses (OR range 0.914-0.961), with no heterogeneity by country (I{superscript 2}=0%, p=0.482). Media exposure predicted antenatal care attendance and iron supplementation (both p<0.001), but neither mediated the anemia association.\n\nConclusionsMaternal media exposure was consistently associated with reduced childhood anemia across three sub-Saharan African settings. A two-stage multiple imputation approach addressed substantial (61.5%) outcome missingness while maintaining stable estimates, offering a transferable framework for DHS-based analyses. Prospective and intervention studies are needed before media-based communication can be recommended as a complementary anemia-control strategy.\n\nStrengths and Limitations of This StudyO_LIThis is among the first multi-country analyses to directly examine maternal media exposure and childhood anemia using nationally representative biomarker data from three sub-Saharan African countries. C_LIO_LIA validated two-stage multiple imputation approach addressed substantial (61.5%) hemoglobin missingness, with robustness confirmed across six pre-specified sensitivity analyses. C_LIO_LIThe cross-sectional design precludes establishing temporality and cannot rule out reverse causation or residual confounding from unmeasured household factors. C_LIO_LIMaternal media exposure was measured as frequency of channel use only, without capturing content, quality, or health-specific programming. C_LIO_LIMediation analysis relied on a single imputed dataset with non-clustered models, limiting direct comparability with the primary GEE-based estimate. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "University of Arizona"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. Adu Bonsu"
    },
    {
      "name": "D. Ebo"
    },
    {
      "name": "D. Doku"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5sv8kzpk09axf.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.08.26362530",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362530v1.full",
  "id": "5sv8kzpk09axf",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362530v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "epidemiology"
    ],
    [
      "openalex",
      "2916|Child Nutrition and Water Access"
    ]
  ],
  "openalex": "W7204972268",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362530v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-08",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5sv8kzpk09axf.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:18Z",
      "native_id": "10.64898/2026.09.08.26362530",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.08.26362530v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:epidemiology",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Childhood Anemia and Maternal Media Exposure in Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis Across Ghana, Nigeria, and Tanzania",
  "title_text": "Childhood Anemia and Maternal Media Exposure in Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis Across Ghana, Nigeria, and Tanzania",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:18Z",
  "url": "https://research.draconitic.com/paper/5sv8kzpk09axf",
  "venue": "medRxiv",
  "versions": []
}