Background Even if many schoolchildren in Ethiopia are anemic and stunted, few have studied the co-existence of anemia and stunting among schoolchildren in Ethiopia. In addition, multilevel analysis to explore the variation in prevalence of concurrent anemia and stunting (CAS) across schools and classes is rarely applied. Thus, we aimed to assess the prevalence and risk factors of CAS at the individual, household, and school level among schoolchildren in southern Ethiopia. Methods We recruited 864 students aged 7–14 years from the Wonago district in southern Ethiopia using a three-stage random sampling, assigning four schools to level one, 24 classes to level two. We then randomly selected 36 children from each class, and recorded their weight, height, haemoglobin, intestinal helminthic infections, hygienic practices, dietary practices, household food insecurity, and socio-demographic information. A multivariate, multilevel logistic regression model was applied to detect potential risk factors for CAS. Results The prevalence of CAS was 10.5% (85/810) among schoolchildren, which increased with age in years (adjusted odds ratio [aOR] 1.39 [95% confidence interval 1.13, 1.71, P = 0.002]) and among children who always did not wash their hands with soap after use of latrine (aOR 4.30 [1.21, 15.3, P = 0.02]). Children who walked barefoot (aOR 10.4 [2.77, 39.1, P = 0.001]), were infected with Trichuris trichiura (aOR 1.74 [1.05, 2.88, P = 0.03]), or had head lice infestation (aOR 1.71 [1.01, 2.92, P = 0.04]) had higher CAS prevalence. Prevalence rates of CAS were low in those using treated drinking water (aOR 0.32 [95% CI 0.11, 0.97, P = 0.04]). Most of the risk factors for CAS were identified at the individual level. The clustering effect measured by the intra-cluster correlation coefficient was 6.8% at school level and 19% at class. Conclusion CAS prevalence is a moderate public health problem among schoolchildren in southern Ethiopia and varies across classes and schools. After controlling for clustering effects at the school and class levels, we found an association between CAS and increasing age, not always washing hands with soap after using latrine, walking barefoot, and T. trichiura infection. Using treated water for drinking was found to have a protective effect against CAS. Thus, educating children on personal hygiene and provision of safe drinking water could reduce the CAS burden in schoolchildren in rural areas of southern Ethiopia.

中文翻译：

---

埃塞俄比亚南部沃纳戈地区学童并发贫血和发育迟缓：横断面多层次分析


背景 即使埃塞俄比亚的许多学童患有贫血和发育迟缓，但很少有人研究埃塞俄比亚学童中贫血和发育迟缓的共存情况。此外，很少采用多层次分析来探讨不同学校和班级并发贫血和发育迟缓（CAS）患病率的变化。因此，我们的目的是评估埃塞俄比亚南部学童中 CAS 在个人、家庭和学校层面的患病率和风险因素。方法 我们采用三阶段随机抽样方法，从埃塞俄比亚南部沃纳戈地区招募了 864 名 7-14 岁的学生，将 4 所学校分配为一级，将 24 个班级分配为二级。然后，我们从每个班随机选择 36 名儿童，记录他们的体重、身高、血红蛋白、肠道蠕虫感染、卫生习惯、饮食习惯、家庭粮食不安全和社会人口统计信息。应用多变量、多水平逻辑回归模型来检测 CAS 的潜在危险因素。结果 学龄儿童中 CAS 的患病率为 10.5% (85/810)，随着年龄的增长而增加（调整后优势比 [aOR] 1.39 [95% 置信区间 1.13, 1.71，P = 0.002]）以及一直患有 CAS 的儿童使用厕所后不使用肥皂洗手（aOR 4.30 [1.21, 15.3, P = 0.02]）。赤脚行走的儿童 (aOR 10.4 [2.77, 39.1, P = 0.001])、感染毛虫 (aOR 1.74 [1.05, 2.88, P = 0.03]) 或患有头虱感染 (aOR 1.71 [1.01, 2.92, P = 0.04]）的 CAS 患病率较高。使用经过处理的饮用水的人群中 CAS 患病率较低（aOR 0.32 [95% CI 0.11, 0.97, P = 0.04]）。大多数 CAS 风险因素都是在个人层面上确定的。 通过聚类内相关系数衡量的聚类效应在学校层面为6.8%，在班级层面为19%。结论 CAS 患病率是埃塞俄比亚南部学童中的一个中等公共卫生问题，并且不同班级和学校之间存在差异。在控制学校和班级层面的聚类效应后，我们发现 CAS 与年龄增长、上厕所后不总是用肥皂洗手、赤脚走路以及毛毛虫感染之间存在关联。研究发现，饮用经过处理的水对 CAS 具有保护作用。因此，对儿童进行个人卫生教育和提供安全饮用水可以减轻埃塞俄比亚南部农村地区学童的 CAS 负担。