Prevalence and associated factors of severity levels of anemia among women of reproductive age in sub-Saharan Africa: a multilevel ordinal logistic regression analysis

Background Sub-Saharan Africa is the most anemia-prone region, with several of the sub-region's countries having a substantial prevalence of the anemia among women of reproductive age. Nonetheless, no adequate study has been conducted to illustrate severity levels and associated factors of anemia among women of reproductive age. Therefore, this study presents the most recent estimates on the prevalence and severity levels of anemia and its associated factors among women of reproductive age in 21 Sub-Saharan Africa countries.Methods This study used the most recent Demographic Health Survey (DHS) datasets, which were collected in 21 sub-Saharan African countries between 2015 and 2022. A total of 171,348 women of reproductive age were included in the analysis. Multilevel (three-level) ordinal logistic regression was done to identify factors associated with severity levels of anemia.Results The pooled prevalence of anemia was 41.74%. The pooled prevalence of mild, moderate and severe anemia was 23.45, 17.05 and 1.24, respectively. Women who were living at distance to a health facility (AOR = 1.07), women living in the poorest households (AOR = 1.49), women living in the households with unimproved toilet (AOR = 1.12) and in households that were using solid cooking fuel (AOR = 1.10), pregnant women (AOR = 1.72) and those who have given birth to more than one children within 3 years (AOR = 1.43) had greater odds of higher levels of anemia as compared to their counterparts. Women who were in the age groups of 20-24 (AOR = 0.81), 25-29 (AOR = 0.78), 30-34 (AOR = 0.79), 35-39 (AOR = 0.88), and 45-49 (AOR = 0.89), women who have attended primary school (AOR = 0.50), secondary (AOR = 0.57) and higher education (AOR = 0.76) and who were living in rural area (AOR = 1.07) had lower odds of higher levels of anemia as compared to their counterparts.Conclusion Considering individual, household and community contexts is necessary while formulating and implementing anemia prevention and control policies. Adolescent women, and women who did not attend education and at a distance to a health facility should get especial attention while implementing anemia prevention and control programs.