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Figure 2. Structural Equation Model for Severe Anemia, Iron Deficiency, and Malaria.

In this exploratory model of the factors associated with severe anemia,²⁵ the sizes of the associations are indicated by the standardized regression coefficients (range, –1.0 to +1.0). Inverse (protective) associations are indicated by red lines. This model was created containing all possible associations between the displayed variables, after which all nonsignificant arrows (P0.05) were removed. The model also contained all other variables entered in the multivariate model (omitted for clarity). The displayed variables were all adjusted for age; in addition, malaria was adjusted for previous use of antimalarial agents, and iron deficiency was adjusted for a history of transfusions (before the previous 4 weeks) or use of hematinic agents (within the previous 8 weeks) (both omitted for clarity). Replacement of severe anemia by continuous hemoglobin levels and iron deficiency (ratio of soluble transferrin receptor to log ferritin, >5.6)¹⁰ resulted in a virtually identical model. The overall model fit was valid (root mean square area of approximation, 0.043; 95% confidence interval, 0.039 to 0.048).