Childhood Anemia and Maternal Media Exposure in Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis Across Ghana, Nigeria, and Tanzania
- 1University of Arizona
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.
DesignMulti-country cross-sectional analysis of nationally representative DHS data.
SettingCommunity-based household surveys in Ghana (2022), Nigeria (2023-24), and Tanzania (2022).
Participants42,944 children aged 6-59 months across 2,621 clusters.
Primary 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.
ResultsMedia 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.
ConclusionsMaternal 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.
Strengths 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
Related
- Maternal obesity, neonatal complications, and childhood wheezing in Dar es Salaam, Tanzania: a multicenter study
- The effect of childhood exposure to secondhand smoke on urinary cotinine and 8 hydroxy-2-deoxyguanosine levels: A cross-sectional study.
- Saharan dust exposure triggers or exacerbates existing respiratory morbidity in the Caribbean - an observational study.
- Bayesian spatio-temporal modeling of childhood anemia in Tanzania: spatial distribution, determinants, and causal impact of malaria
- Childhood burkitt lymphoma: treatment outcomes, survival, and mortality predictors at two tertiary hospitals in Tanzania
BibTeX
@misc{bonsu2026childhood,
title = {{Childhood Anemia and Maternal Media Exposure in Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis Across Ghana, Nigeria, and Tanzania}},
author = {E. Adu Bonsu and D. Ebo and D. Doku},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.08.26362530},
url = {https://www.medrxiv.org/content/10.64898/2026.09.08.26362530v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Childhood Anemia and Maternal Media Exposure in Sub-Saharan Africa: A Multi-Country Cross-Sectional Analysis Across Ghana, Nigeria, and Tanzania
AU - E. Adu Bonsu
AU - D. Ebo
AU - D. Doku
PY - 2026
DA - 2026/09/08
PB - medRxiv
DO - 10.64898/2026.09.08.26362530
UR - https://www.medrxiv.org/content/10.64898/2026.09.08.26362530v1
AB - 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. DesignMulti-country cross-sectional analysis of nationally representative DHS data. SettingCommunity-based household surveys in Ghana (2022), Nigeria (2023-24), and Tanzania (2022). Participants42,944 children aged 6-59 months across 2,621 clusters. Primary 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. ResultsMedia 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. ConclusionsMaternal 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. Strengths 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
ER -