Tehran University of Medical Sciences Journal of Biostatistics and Epidemiology 2383-4196 11 4 2026 10 07 415 435 EN Denekew Bitew Belay Bahir Dar University Nigussie Adam Birhan Injibara University Tilahun Yemanu Birhan University of Gondar Yegnanew A. Shiferaw University of Johansberg Ding-Geng Chen University of Pretoria 2024 10 03 2026 01 04 Background: Anemia is a condition characterized by a deficiency of hemoglobin in the blood and is a significant risk factor for poor health and nutrition in children. The main aim of this study was to assess the prevalence and contributing factors of anemia in children under five in Eastern Africa. Method: The research was conducted between 2010 and 2023 across ten East African countries. To identify potential factors associated with anemia, a multilevel logistic regression model was utilized, with adjusted odds ratios at a 95% confidence interval. Results:  The prevalence of anemia in Eastern Africa was 54.26%, with the highest in Tanzania (70.32%) and the lowest in Rwanda (36.64%). A multilevel multivariable logistic regression model revealed that; months age, female, stunted, underweight, number of under-five children, birth order, having fever, having diarrhea, vitamin A supplementation, primary educated mother, anemic mother, toilet facility, middle wealth index, a mother had occupation and high community poverty were significantly associated with anemia in Eastern Africa. Conclusions: The prevalence of anemia was still high in the region. The stakeholder should design and scale up comprehensive nutrition interventions, which may represent a potential consideration to reduce the burden of anemia. Moreover, interventions like improving household wealth index and nutritional education activities are important to decrease the prevalence of anemia. https://jbe.tums.ac.ir/index.php/jbe/article/view/1515