{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:02:50Z","timestamp":1782270170893,"version":"3.54.5"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anemia affects over 30% of women of reproductive age globally, with the highest burden in low\u2011 and middle\u2011income countries, and it poses additional risks for women living with human immunodeficiency virus (HIV), including disease progression and reduced survival. Although previous studies report prevalence among HIV\u2011positive women ranging from 37.8% to 55.8%, most evidence comes from hospital\u2011based or high\u2011income settings, leaving a gap in population\u2011level data. Addressing this gap is critical, as women in low- and middle-income countries (LMICs) often face overlapping vulnerabilities such as nutritional deficiencies, limited healthcare access, and high HIV burden. Using nationally representative Demographic and Health Surveys, this study aims to estimate anemia prevalence and identify associated factors among HIV\u2011positive women to inform targeted interventions and integrated management strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross\u2011sectional study was conducted using Demographic and Health Survey data collected between 2022 and 2024 from nine countries in sub-Saharan Africa and Asia, including 1,446 HIV\u2011positive women aged 15\u201349 years. Hemoglobin concentration was used to classify anemia based on World Health Organization (WHO) thresholds. Individual and community\u2011level factors were examined, and weighted data were analyzed using multilevel logistic regression to account for clustering. Associations were reported as adjusted odds ratios with 95% confidence intervals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among HIV\u2011positive women in Africa and Asia, the prevalence of anemia was 50.62% (95% confidence interval (CI): 48.04\u201353.20%), with 19.29% classified as mild, 26.28% as moderate, and 5.05% as severe. Prevalence varied widely across countries, ranging from 71.43% in Mali to 12.00% in Tajikistan. Educational status [adjusted odds ration (AOR) = 0.43; 95% CI: 0.22\u20130.81], media exposure [AOR\u2009=\u20090.41; 95% CI: 0.19\u20130.87], contraceptive use [AOR\u2009=\u20092.37; 95% CI: 1.35\u20134.17], and iron supplementation during pregnancy [AOR\u2009=\u20092.17; 95% CI: 1.04\u20134.55] were significantly associated with anemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anemia remains a major public health concern among HIV\u2011positive women, driven by reproductive, nutritional, and socio\u2011behavioral factors. Strengthening antenatal and HIV care programs, integrating family planning services, and promoting adherence to iron supplementation are critical strategies to reduce anemia risk. Tailored health communication and nutritional interventions, alongside future longitudinal studies, are essential to establish causal pathways and inform targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0347752","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:30:01Z","timestamp":1777051801000},"page":"e0347752","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Anemia among HIV\u2011positive women in LMICs: Multilevel analysis of recent DHS survey"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9316-245X","authenticated-orcid":true,"given":"Enyew 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Horton","year":"2003","journal-title":"Food Policy"},{"issue":"7","key":"pone.0347752.ref004","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s10654-014-9929-9","article-title":"Anemia in the general population: prevalence, clinical correlates and prognostic impact","volume":"29","author":"A Martinsson","year":"2014","journal-title":"Eur J Epidemiol"},{"issue":"2","key":"pone.0347752.ref005","doi-asserted-by":"crossref","first-page":"146","DOI":"10.15537\/smj.2015.2.10289","article-title":"The impact of maternal iron deficiency and iron deficiency anemia on child\u2019s health","volume":"36","author":"NM Abu-Ouf","year":"2015","journal-title":"Saudi Med J"},{"issue":"2","key":"pone.0347752.ref006","first-page":"232","article-title":"Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania","volume":"26","author":"JA Kavle","year":"2008","journal-title":"J Health Popul Nutr"},{"issue":"12","key":"pone.0347752.ref007","doi-asserted-by":"crossref","first-page":"5915","DOI":"10.3390\/nu6125915","article-title":"The impact of anemia on child mortality: an updated review","volume":"6","author":"SP Scott","year":"2014","journal-title":"Nutrients"},{"issue":"11","key":"pone.0347752.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(17)30371-6","article-title":"Modifiers of the effect of maternal multiple micronutrient supplementation on stillbirth, birth outcomes, and infant mortality: a meta-analysis of individual patient data from 17 randomised trials in low-income and middle-income countries","volume":"5","author":"ER Smith","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"10","key":"pone.0347752.ref009","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1086\/383031","article-title":"Anemia in HIV infection: clinical impact and evidence-based management strategies","volume":"38","author":"PA Volberding","year":"2004","journal-title":"Clin Infect Dis"},{"key":"pone.0347752.ref010","doi-asserted-by":"crossref","first-page":"101283","DOI":"10.1016\/j.eclinm.2022.101283","article-title":"Prevalence of anemia among people living with HIV: A systematic review and meta-analysis","volume":"44","author":"G Cao","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"1","key":"pone.0347752.ref011","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12889-020-10033-8","article-title":"Intersection of HIV and Anemia in Women of Reproductive Age: A 10-Year Analysis of Three Zimbabwe Demographic Health Surveys, 2005\u20132015","volume":"21","author":"PN Gona","year":"2021","journal-title":"BMC Public Health"},{"issue":"12","key":"pone.0347752.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0116263","article-title":"HIV symptom burden and anemia among HIV-positive individuals: cross-sectional results of a community-based positive living with HIV (POLH) study in Nepal","volume":"9","author":"C Martin","year":"2014","journal-title":"PLoS One"},{"issue":"1","key":"pone.0347752.ref013","doi-asserted-by":"crossref","first-page":"2236","DOI":"10.1186\/s12889-024-19758-2","article-title":"Prevalence and factors associated with anemia among HIV-infected women in sub-saharan Africa: a multilevel analysis of 18 countries","volume":"24","author":"WM Tilahun","year":"2024","journal-title":"BMC Public Health"},{"key":"pone.0347752.ref014","article-title":"Biology of anemia, differential diagnosis, and treatment options in human immunodeficiency virus infection","author":"S Claster","year":"2002","journal-title":"J Infect Dis"},{"key":"pone.0347752.ref015","doi-asserted-by":"crossref","first-page":"40","DOI":"10.7196\/SAMJ.2019.v109i8b.13829","article-title":"HIV and haematopoiesis","volume":"109","author":"C Durandt","year":"2019","journal-title":"S Afr Med J"},{"issue":"2","key":"pone.0347752.ref016","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1093\/inthealth\/ihaa036","article-title":"Anemia and thrombocytopenia in people living with HIV\/AIDS: a narrative literature review","volume":"13","author":"A Marchionatti","year":"2021","journal-title":"Int Health"},{"issue":"1","key":"pone.0347752.ref017","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1054\/blre.2001.0188","article-title":"HIV-related thrombocytopenia","volume":"16","author":"A Scaradavou","year":"2002","journal-title":"Blood Rev"},{"issue":"1","key":"pone.0347752.ref018","first-page":"13","article-title":"Anaemia in persons with HIV infection: prognostic marker and contributor to morbidity","volume":"4","author":"G Moyle","year":"2002","journal-title":"AIDS Rev"},{"key":"pone.0347752.ref019","doi-asserted-by":"crossref","first-page":"1511795","DOI":"10.3389\/fmed.2025.1511795","article-title":"Prevalence and predictors of anemia among HIV-positive women in Ethiopia: findings from the Ethiopian demographic and health survey","volume":"12","author":"M Getie","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"pone.0347752.ref020","volume-title":"Demographic and Health Survey","author":"DB Manual","year":"2021"},{"issue":"6","key":"pone.0347752.ref021","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/ije\/dys184","article-title":"Demographic and health surveys: a profile","volume":"41","author":"DJ Corsi","year":"2012","journal-title":"International Journal of Epidemiology"},{"key":"pone.0347752.ref022","article-title":"Cluster optimal sample size for demographic and health surveys","volume-title":"7th International Conference on Teaching Statistics\u2013ICOTS","author":"ARR Aliaga","year":"2006"},{"key":"pone.0347752.ref023","volume-title":"Guide to DHS Statistics: DHS-7 (version 2)","author":"TMA Croft","year":"2020"},{"key":"pone.0347752.ref024","unstructured":"WHO. Glossary of health data, statistics and public health indicators. 2025."},{"key":"pone.0347752.ref025","unstructured":"de Pizay C, Villi\u00e9-Morgon F. WHO\/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP). 2010."},{"issue":"1","key":"pone.0347752.ref026","doi-asserted-by":"crossref","first-page":"229","DOI":"10.5334\/irsp.162","article-title":"Correction: Keep Calm and Learn Multilevel Logistic Modeling: A Simplified Three-Step Procedure Using Stata, R, Mplus, and SPSS","volume":"30","author":"N Sommet","year":"2017","journal-title":"International Review of Social Psychology"},{"issue":"1","key":"pone.0347752.ref027","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0226026","article-title":"Prevalence of anaemia and low intake of dietary nutrients in pregnant women living in rural and urban areas in the Ashanti region of Ghana","volume":"15","author":"J Ayensu","year":"2020","journal-title":"PLoS One"},{"issue":"1","key":"pone.0347752.ref028","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1186\/s12905-021-01461-8","article-title":"The urban-rural differential in the association between household wealth index and anemia among women in reproductive age in Ethiopia, 2016","volume":"21","author":"TW Abate","year":"2021","journal-title":"BMC Womens Health"},{"issue":"1","key":"pone.0347752.ref029","doi-asserted-by":"crossref","first-page":"11955","DOI":"10.1038\/s41598-021-91198-z","article-title":"The epidemiological landscape of anemia in women of reproductive age in sub-Saharan Africa","volume":"11","author":"E Correa-Agudelo","year":"2021","journal-title":"Sci Rep"},{"key":"pone.0347752.ref030","doi-asserted-by":"crossref","first-page":"1128214","DOI":"10.3389\/fpubh.2023.1128214","article-title":"Anaemia among women of reproductive age in selected sub-Saharan African countries: multivariate decomposition analyses of the demographic and health surveys data 2008-2018","volume":"11","author":"MG Salifu","year":"2024","journal-title":"Front Public Health"},{"issue":"9","key":"pone.0347752.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0275202","article-title":"Association between frequency of mass media exposure and maternal health care service utilization among women in sub-Saharan Africa: Implications for tailored health communication and education","volume":"17","author":"RG Aboagye","year":"2022","journal-title":"PLoS One"},{"issue":"12","key":"pone.0347752.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277654","article-title":"Maternal anemia and risk of adverse maternal health and birth outcomes in Bangladesh: A nationwide population-based survey","volume":"17","author":"MA Kabir","year":"2022","journal-title":"PLoS One"},{"key":"pone.0347752.ref033","doi-asserted-by":"crossref","first-page":"1497606","DOI":"10.3389\/fpubh.2025.1497606","article-title":"Unmet maternal health information needs and mass media exposure for maternal health among women in the Gedeo zone, South Ethiopia","volume":"13","author":"GA Tesfa","year":"2025","journal-title":"Front Public Health"},{"key":"pone.0347752.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/OAJC.S329045","article-title":"Modern Contraceptive Methods Predict Hemoglobin Levels Among Women of Childbearing Age from DHS 2016","volume":"13","author":"AA Teshome","year":"2022","journal-title":"Open Access J Contracept"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347752","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T17:30:08Z","timestamp":1777051808000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347752"}},"subtitle":[],"editor":[{"given":"Elisabetta","family":"Pilotti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0347752","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}