Sex-based differences in the prevalence and determinants of anaemia among children living with HIV Southern Province of Zambia

Background: anaemia remains a major comorbidity among children living with HIV (CLHIV) in sub-Saharan Africa, yet sex-specific risk factors are poorly characterized. This study investigated the prevalence and sex-based determinants of anaemia among CLHIV in the Southern Province, Zambia. Methods: A retrospective cohort study was conducted using medical records from 321 CLHIV aged 0-14 years. Data on demographic, clinical, and anthropometric variables were analysed. Sex-stratified multivariable logistic regression identified factors associated with anaemia. Results: Overall anaemia prevalence was 47.0% (151/321), with a higher, though not statistically significant, burden in males (52.6%) than females (41.9%). Younger age was a strong, independent risk factor across both sexes. Distinct sex-specific determinants were identified. In males, cotrimoxazole (CTX) use during treatment was associated with increased odds of anaemia (Adjusted Odds Ratio, AOR=3.04; 95% CI: 0.95-9.74). Conversely, among females, the type of caregiver was a significant factor; care provided by an aunt was associated with 90% lower odds of anaemia compared to other arrangements (AOR=0.10; 95% CI: 0.01-0.90). Poor anthropometric indices (height and weight) were significantly associated with anaemia in both sexes. Conclusions: The study findings reveal a high prevalence of anaemia among CLHIV in Zambia, with nuanced sex-based differences in its determinants. The findings advocate for differentiated, gender-sensitive intervention strategies. For boys, careful review of CTX prophylaxis is warranted, while for girls, enhancing supportive caregiving environments may be protective. Integrating these sex-specific approaches into paediatric HIV programs is crucial for reducing the anaemia burden and improving clinical outcomes.