Household wealth and childhood anaemia in resource-constrained settings: a Bayesian multilevel analysis

Anaemia remains one of the most prevalent childhood conditions in Africa. Despite its multifactorial nature, most studies have focused on individual-level determinants while overlooking broader contextual influences. Using Ghana as a case study, this research examines the effect of household wealth on childhood anaemia outcomes within a dynamic political landscape. The cross-sectional design used nationally representative data from the 2022 Ghana Demographic and Health Survey (n = 3,882). Data were summarized using both unweighted and weighted estimates. The effects of household wealth on childhood anaemia across regions were evaluated using a Bayesian adjacent-category logit multilevel models. Anaemia prevalence was 49% nationally, with modest regional variation. Children in the Northern Region, for instance, had more than twice the odds of being anaemic (OR = 2.26) compared to those in the regional capital (OR = 0.58). Overall, regions dominated by the poorest household quintiles exhibited the highest prevalence of anaemia. Results further revealed significant regional variation in the effect of household wealth on childhood anaemia across Ghana’s sixteen regions. The protective effect of household wealth was particularly strong (posterior probability > 0.99) in more developed regions such as Greater Accra, Ashanti, Central and Eastern regions. However, this protective effect was not linear across levels of anaemia severity. Children who had a recent illness and those whose mothers were anaemic had higher odds of anaemia. In contrast, children from wealthier households, those of older age, and female children had lower odds of anaemia. Interventions to reduce childhood anaemia should focus on socioeconomically disadvantaged regions, particularly those with persistently low household wealth yet a high anaemia burden. The findings suggest that while wealth mitigates the risk of anaemia onset, structural and non-nutritional factors may underlie its progression.