Trends and determinants of anaemia in women of Nepal: a multilevel analysis

Abstract

In Nepal, the prevalence of anaemia decreased by 1% from 2006 to 2011 but increased by 6% from 2011 to 2016. In this study, we examined the changes in prevalence by possible factors from 2006 to 2016 along with the factors associated with anaemia among women of reproductive age (15–49 years) using the Nepal Demographic and Health Survey (NDHS) data from years 2006, 2011 and 2016. We used rate of change analysis to explore average annual rate of change (AARC) in anaemia prevalence and concentration curves and indices to assess unequal distribution of anaemia prevalence among socio‐economic quintiles. Multilevel regression was performed to examine the association of multilevel factors with anaemia. Our results showed higher AARC increase in anaemia prevalence from 2006 to 2016, among women aged 30–39 years, with secondary or higher education, who had two or fewer children, not working women, from higher wealth quintiles and who were overweight or obese. Shifting of concentration curve from ‘above the line of equality’ in 2006 and 2011 to ‘under the line of equality’ in 2016 was observed. Women aged 20–29 years, with more than four children, who underwent female sterilization, had experienced violence and from Provinces 1, 2 and 5 were at higher risk of anaemia. Overweight and obese women using hormonal contraception and from lowest wealth quintiles were at lower risk. The change in trends and the associated multilevel factors identified should be considered in designing multilevel interventions that particularly target women at risk for sustainable anaemia reduction.

Factors affecting anaemia among women of reproductive age in Nepal: a multilevel and spatial analysis

“…In this study, the prevalence of anaemia was found to be decreasing with increasing age. These findings are consistent with studies from Nepal, 36 Ethiopia, 39 Demographic Republic of Congo 73 and Benin. 60 The possible reason could be that the low fertility rates are high among older women.…”

“…Similar findings were reported by a previous study which was based on the analysis of the 2016 NDHS dataset. 36 The possible reason could be first, Nepal is an agrarian-based country and the staple diet may be similar for most of the households. 69 Second, it might be due to the nationwide open defecation free campaign initiated after 2011, which contributed to the reduction in hookworm infestation leading to decrease in anemia.…”

“…69 Second, it might be due to the nationwide open defecation free campaign initiated after 2011, which contributed to the reduction in hookworm infestation leading to decrease in anemia. 36 Third, there was various ongoing health and nutrition intervention programme targeted at poorer households. For instance, promoting consumption of iron-rich dark green leafy vegetables available from their kitchen garden, 70 consumption of animal source foods, and dietary iron consumption.…”

“… 39 Also, it might be due to young girls being under-represented in the public health programmes that aim to prevent anaemia in Nepalese context. 36 However, government of Nepal has started weekly iron folic acid supplementation to adolescent girls aged 10–19 years only after 2016. 74 In contrast, few studies from Nepal did not show any association of age with anaemia.…”

“…Only a few studies in the past have explored factors affecting anaemia among WRA using nationally representative Nepal Demographic and Health Survey (NDHS) data. [35][36][37] So far, no studies have used spatial data to explore the geographical hotspots (high prevalence) of anaemia among WRA using cluster sampling of the NDHS data. In addition, population in Nepal has diverse characteristics in terms of their culture, ethnicity and geographical locations.…”