Malaria is a leading cause of morbidity in Ethiopia. However, its transmission varies in both space and time, and large areas of the country are hypoendemic and epidemic-prone. The Ethiopia National Malaria Indicator Survey 2007 is a cross-sectional, nationally-representative household survey. The objective of the analyses presented here were to use the surveys data to identify factors associated with anemia presence in children under 6 years of age (U6); specifically, investigate the association between malaria and anemia; and discuss using anemia as a malaria proxy biomarker in the Ethiopian hypo-endemic transmission setting. The survey sampled 4185 households in 347 enumeration areas 2500 m above sea level. Primary outcome was increasing anemia severity in sampled children: no anemia (Hb: 11g/dl); mild anemia (Hb: 8g/dl and 11g/dl); and moderatesevere anemia (Hb: 8g/dl). Secondary outcomes were positive malaria rapid diagnostic test (RDT) or blood slide microscopy. The analysis included 6054 (92.0) children U6 in 3962 households. The proportion of children with no anemia, mild anemia, and moderate-severe anemia was 63.6, 31.3, and 5.1, respectively. The overall prevalence of anemia (Hb 11g/dl) was 36.4 (95 CI 34.438.4). Factors independently associated with reduced relative odds of anemia categories were age (OR0.7, 95 CI 0.70.7) and female sex (OR0.9, 95 CI 0.81.0); malaria RDT positivity was associated with increased relative odds of a more severe anemia category (OR5.8, 95 CI 3.79.2). We conclude that at altitudes 2500 m malaria appears to be a significant risk factor for anemia; potentially anemia could be used as a useful proxy biomarker for malaria and its control in Ethiopia
