Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Representative Cross-Sectional Survey, 2012-13

Jeetendra Yadav, BAOJ Hematol 2017 1: 11: 002

BAOJ Hematol, an open access journal Volume 1; Issue 1; 002

Jeetendra Yadav*

National Institute of Medical Statistics (ICMR) New Delhi, India

BAOJ Hematology

*Corresponding author: Jeetendra Yadav, National Institute of Medical Statistics (ICMR)New Delhi, India, E-mail: jeetu.nims@gmail.com

Sub Date: November 30, 2016, Acc Date: January 7, 2017, Pub Date: January 9, 2017.

Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Representa-tive Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

Copyright: © 2017 Jeetendra Yadav. This is an open-access article distributed under the terms of the Creative Commons Attribution Li-cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Research Article

Abstract Background

Anaemia is the common problem among Indian women, particular-ly during pregnancy. According to the reports of W.H.O, 2004, indi-cated that between one third to two thirds of pregnant women suffer from anaemia in developing countries and more than two thirds of Indian women were suffering from anaemia. NFHS-3 report high-lighted that every second Indian woman is anemic and one in ev-ery five maternal deaths is directly or indirectly related to anaemia.

Aim

The present study aimed to explore the prevalence of anaemia and factor associated with anaemia among pregnant women in India.

Methods

Using the nationally representative cross-sectional data from the fourth round of District Levels Household Survey (DLHS-4, 2012-13). The outcome variables included in the study was anaemia. Bivariate analyses including chi square tests to determine the prevalence of anaemia and logistical models to understand the determinants of anaemia were applied.

Findings

The findings of this study indicate that the prevalence of anaemia was high (62.6%) among pregnant women in India and the mean hemoglobin level was 10.3±2.3. Prevalence of anaemia was higher among younger women, uneducated women and women from the poorest wealth quintile. However, this study found that there is differential in anaemia across key selected individual, household and community characteristics of pregnant women in India. Finding of multivariate logistic regression analysis indicated that women’s age, women’s education, number of household members in the family, religion, caste, economic status, sanitation facility, type of cooking fuel and type of residence are the significant determinants of anaemia.

Conclusion

The prevalence of anaemia is very high among pregnant women in India. Women’s age and education, number of household members in the family, economic status, type of cooking fuel and type of residence are the major predictors of anaemia. Government should provide the counseling to empower adolescent girls and all women of child bearing age to prevent anaemia.

Keywords: Anaemia; Prevalence; Hemoglobin Level; Pregnant Women; Lactating Women and DLHS-4

Introduction Anaemia is the common problem among Indian women and it has serious health implications, particularly during pregnancy. WHO defines anaemia as a condition in which the Haemoglobin (Hb) content of blood is lower than normal as a result of deficiency of one or more essential nutrients, regardless of the cause of such deficiencies [1]. Most of the anaemias are due to inadequate supply of nutrients like iron, folic acid and vitamin B12, proteins, amino acids, vitamins A, C, and other vitamins of B-complex group i.e., niacin and pantothenic acid are also involved in the maintenance of haemoglobin level [2,3]. According to WHO, 2004, almost half of the women have any form of anaemia in developing countries and in India about two thirds of pregnant women suffer from anaemia (range: 33-89%) [4,9]. According to WHO, 2012 anaemia affects half a billion women of reproductive age worldwide. In 2011, 29% (496 million) of non-pregnant women and 38% (32.4 million) of pregnant women aged 15-49 years were anaemia. Further actions are required to reach the World Health Assembly target of a 50% reduction of anaemia in women of reproductive age by 2025 [10]. Maternal morbidity and mortality were higher if pregnant women suffering from severe anaemia [11,12]. Studies pointed out that the almost half of maternal deaths in India are associated with the anaemia while in South Asia as a whole more than two thirds are associated with anaemia [13]. It is established from some earlier studies that compared to other developing countries, the prevalence of anaemia in all the groups is higher in India [14,15]. As is everywhere else in all age groups without specific chronic blood loss morbidity, for instance compared to men in India [16].

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Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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In India maternal morbidity, maternal mortality and low birth weight are very much affected by anaemia [17].

Anaemia is linked with different causes, such as poor socioeconomic status, poor diet both in quantity and quality and a high rate of infectious diseases. In developing countries, like India, disadvantaged persons have often inadequate access to medical care, therefore they live at increased risk of anaemia and also increased maternal morbidity and maternal mortality [18,19].

Need for the StudyThe discussion above gives a brief idea about situation of women in the context of anaemia among pregnant women in Worldwide and India. It is evident that pregnant women in India have high risk of anaemia at almost holoendemic levels among women. In order to realise these objectives, the National Nutritional Anaemia Prophylaxis Programme (NNAPP) is launched in India in the year 1970 in which iron and folic acid tablets are distributed to pregnant women. In an evaluation study by in 1985–86 [7] has found that there is no positive impact on the prevalence of anaemia. Further, few revisions were made in the NNAPP to make it more effective and efficient [20,21]. Many of the studies point out the problem of anaemia among pregnant women but provide little guidance to help resolve this chronic condition; therefore, and, therefore, further exploration of the causes of such ineffectiveness should be undertaken in this respect. The DLHS-4 data from 2012-13 provide an opportunity to study the prevalence and factors associated with anaemia among pregnant women in India. The present study was carried out to examine the prevalence of anaemia and its correlates among pregnant women in India and will provide specific direction for future course of action to be taken based on evidence for pregnant women in India.

Objectives of the StudyThe objective of this study is to examine the prevalence of anemia, socioeconomic differential of anaemia and factors associated with anaemia among pregnant women in India.

Study Setting, Data, Method and EthicsData

The present study was based on the fourth round of District Levels Household Survey (DLHS-4) cross-sectional data conducted during 2012-13. The DLHS is a nationally representative and one of largest ever demographic surveys conducted in India. The basic aim of DLHS-4 is to provide reliable estimates of maternal and child health, family planning, other reproductive health indicators and clinical, anthropometric and biochemical (CAB) at district level (http://rchiips.org/).

Sampling Design and Sample Size

DLHS-4 adopted a multi-stage stratified systematic sampling design. Detailed information about sampling employed in this survey can be obtained from the report of DLHS-4 [22]. The present study pooled all states into a country data set. The survey interviewed 463440 ever-married women aged 15-49 years from rural (55%)

and from urban (45%) areas spanning 21 states and 528 districts of India. Out of these sample, a total of 9564 were pregnant and 1836 were pregnant and lactating, (total 11400 pregnant women) at the time of survey. This study extracted currently pregnant women and currently lactating pregnant women from the country data set. A total of 9899 currently pregnant women provided a blood sample for testing hemoglobin.

Outcome Measurements

The outcome variable in this study was anemia. All the pregnant women of the DLHS-4 were included in the anaemia test in. The present study used the HemoCue method for estimating hemoglobin level. The process of blood collection consists of obtaining blood droplets by pricking in the middle or ring finger with a retractable and non-reusable lancet. Before pricking, the finger was cleaned with a swab containing 70 percent is opropyl alcohol and allowed to dry [22]. Hemoglobin measurement by HemoCue is considered to be a standard method for field studies by the International Committee for Standardization in Hematology and World Health Organization [22,23,24]. The hemoglobin levels of >11 mg/dL were considered as normal, 10-11 mg/dL as mild anemia, 7–9.9 mg/dL as moderate anemia, and <7 mg/dL as severe anaemia [25,24].

Defining Predictor Variables

Important socioeconomic and demographic predictors such as age of women, education of women, work status of women, family size, household have a below poverty line card, religion, social group, wealth quintile, sanitation facilities, drinking water facilities, type of cooking fuel and type of residence were included as predictor variables in the present study. Further socioeconomic and demographic variables divided in three categories namely individual household and community characteristics.

Analytical Approach

To examine the prevalence and correlates of anemia, present study used both bivariate and multivariate analyses. Chi-square test is used to determine the difference in proportions of anaemia across selected individual, household and community background characteristics. Binary logistic regression is applied to understand factor associated with anemia. The whole analysis was performed using STATA version 13.0 to take into account the survey design (i.e. sampling weights with clustering and strata) and R.

Ethical Statement

The present study is based on data available in public domain; therefore, no ethical issue is involved.

Results Background Characteristics of the Pregnant Women

Table 1 represents the weighted percent distribution of pregnant women by selected individual, household and community characteristics. Among the pregnant women, 18.58% were aged less than 20 years of age at the time of pregnancy. Almost one fifth pregnant women had no formal education and majorities (85.4%)

BAOJ Hematol, an open access journal Volume 1; Issue 1; 002

Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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were not working. Almost two thirds were Hindus and 34.9% of pregnant women were from other backward classes (OBC). More than two fifths of pregnant women belonged to households which had up to 4 members. Almost two thirds belonged to rural areas,

and more than half (57.20%) of the households used unsafe cooking fuels. Among the households, almost two thirds were having safe sanitation facilities and the majorities (86.9%) were using safe drinking water.

Table 1. Percent distribution of pregnant women by selected individual, household and community characteristics, DLHS-4 (2012-13), in India

Background characteristics Sample Weighted proportion 95% CI

Individuals characteristics

Age

Less than 20 years 1823 18.58 [17.62-19.58]

20-24 2725 27.40 [26.35-28.47]

25-30 3095 30.94 [29.99-31.91]

31 and above 2256 23.09 [21.55-24.70]

Education

Illiterate 1935 19.96 [18.62-21.38]

Literate but below middle 2128 21.63 [20.74-22.55]

Middle but below secondary 3319 33.43 [32.19-34.70]

Secondary and above 2517 24.97 [23.74-26.24]

Occupation

Not working 8438 85.41 [84.45-86.33]

working 1408 14.59 [13.67-15.55]

Household characteristics

Family members

Up to 4 members 4404 44.36 [43.13-45.60]

5-7 members 3005 30.65 [29.55-31.78]

More than 7 members 2490 24.99 [23.90-26.10]

Household have BPL card

No 6090 61.15 [59.53-62.75]

Yes 3798 38.85 [37.25-40.47]

Religion

Hindu 6384 64.95 [63.38-66.48]

Muslim 1013 10.44 [09.49-11.48]

Christian 1433 13.99 [12.60-15.50]

Others 1060 10.62 [09.90-11.40]

Caste

Scheduled tribes 1967 20.22 [18.43-22.13]

Scheduled castes 2498 27.11 [25.77-28.49]

Other backward classes 3310 34.86 [33.10-36.65]

Others 1687 17.81 [16.72-18.97]

Wealth quintile -

Poorest 1980 20.11 [18.96-21.31]

Poorer 1980 20.04 [19.16-20.95]

Middle 1980 20.19 [19.40-21.00]

Richer 1980 19.77 [18.70-20.89]

Richest 1979 19.89 [18.75-21.08]

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Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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Prevalence and Differentials in Anaemia Among Pregnant Women

To identify the factors associated with the anaemia the bivariate differential by the selected individuals, household and community characteristics were examined. Table 2 shows the weighted percentage of pregnant women who suffered from anaemia by selected individual, household and community characteristics. The overall prevalence of anaemia was 62.6%. Mild, moderate, and severe anaemia was found in 16.9%, 38.4%, and 7.2% of the sample. The prevalence of anaemia was 67.6% among women aged less than 20 years at the time of pregnancy and significantly lower (57%) for those women aged 31 and above at the time of pregnancy (χ2=51.746 p<0.01). Similarly, the prevalence of anaemia was higher among illiterate women (66.7%) compared with women with secondary and above education (56.2%). A significant association between anaemia and education was observed, and it showed statistical significance (χ38.830=2, p<0.01, χ16.601=2, p<0.01 and χ66.543=2 p<0.01, moderate anemia, severe anaemia and any anaemia, respectively). However, there was no significant association between mild anaemia and education. There were not many differentials found in anaemia among working and not working women. More than half (59.7%) of pregnant women

from other religions were having any form of anemia, while the corresponding figures for Hindu, Muslim and Christian were 62.8%, 62.5% and 63.9%, respectively. The prevalence of anaemia (59.7%), was lower among others backward class women as compared to women from scheduled tribes (65.3%). Almost two third (66.8%) women from poorest wealth quintile were suffering from any form of anemia. Sanitation facilities and cooking facilities were also lined with anaemia among pregnant women. Results indicated that almost two third (66.8%) women suffering from anaemia whose household were using unsafe sanitation facilities as compared to women whose household were using safe sanitation facilities (60.7%). Similarity, the prevalence of anaemia were higher (65.0%) among pregnant women whose household were using unsafe cooking fuel as compared to women whose household were using safe cooking fuel (59.5%) and it was found statistically significant (χ2=31.265, p=<=0.01). A significant association found between type of residence (rural-urban) and anaemia and its showed statistical significance (χ2=6.839, p=<=0.05, χ2=32.308, p=<=0.01, χ2=4.5239, p=<=0.10 and χ21.974=2, p=<=0.01, mild anemia, moderate anemia, severe anaemia and any anaemia respectively).

Sanitation facility

Unsafe 3072 31.66 [29.90-33.47]

Safe 6827 68.34 [66.53-70.10]

Drinking water

Unsafe 1332 13.06 [11.92-14.30]

Safe 8567 86.94 [85.70-88.08]

Cooking fuel

Unsafe 5579 57.20 [54.67-59.69]

Safe 4320 42.80 [40.31-45.33]

Community characteristics

Type of locality

Rural 6415 66.51 [61.04-71.56]

Urban 3484 33.49 [28.44-38.96]

Region

Northeast 1959 19.41 [17.06-22.00]

South 4350 43.91 [41.76-46.09]

North 2418 24.42 [22.79-26.13]

Others 1172 12.26 [11.41-13.17]

India 9899 100.0

Note: All ‘n’ are unweighted. Total may not be equal due to some missing cases.

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Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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Table 2. Percentage of pregnant women classified as having anaemia by degree of anaemia and by selected Individuals, household and community characteristics of pregnant women in India, DLHS-4 (2012-13)

Background characteristics

Anaemia status by hemoglobin level n

Mild anemia Moderate anemia Severe anemia Any anemia

(10.0-10.9 g/dl) (7.0-9-9 g/dl) (< 7g/dl) <11.0 g/dl

Individuals characteristics

Age χ2=3.047 χ2=34.634*** χ2=10.002** χ2=51.746***Less than 20 years 18.1 42.6 6.9 67.6 1823

20-24 16.9 39.9 6.9 63.8 2725

25-30 16.3 37.9 8.4 62.7 3095

31 and above 16.5 34.1 6.3 57.0 2256

Education χ2=1.256 χ2=38.830*** χ2=16.601*** χ2=66.543***

Illiterate 17.4 40.7 8.6 66.7 1935

Literate but below middle 16.8 41.2 7.7 65.9 2128

Middle but below secondary 16.3 39.1 7.3 62.8 3319

Secondary and above 17.2 33.3 5.6 56.2 2517

Occupation χ2=0.008 χ2=0.605 χ2=0.470 χ2=0.197

Not working 16.9 38.6 7.1 62.7 8438

working 16.9 37.5 7.6 62.1 1408

Household characteristics

Family members χ2=2.350 χ2=34.649*** χ2=2.503 χ2=39.188***

Up to 4 members 16.8 35.4 7.0 59.3 4404

5-7 members 17.6 39.8 6.9 64.3 3005

More than 7 members 16.1 42.2 7.9 66.3 2490

Household have BPL card χ2=0.093 χ2=5.097** χ2=13.269*** χ2=13.269***

No 17.0 37.6 6.4 61.1 6090

Yes 16.7 39.8 8.4 65.0 3798

Religion χ2=2.255 χ2=5.2978 χ2=3.994 χ2=4.892

Hindu 16.7 38.9 7.0 62.8 6384

Muslim 16.6 39.6 6.3 62.5 1013

Christian 18.2 37.4 8.2 63.9 1433

Others 16.2 35.6 7.7 59.7 1060

Caste χ2=6.385 χ2=18.645*** χ2=10.439*** χ2=21.656***

Scheduled tribes 17.5 39.5 8.3 65.3 1967

Scheduled castes 15.4 40.9 8.1 64.4 2498

Other backward classes 17.7 35.6 6.3 59.7 3310

Others 16.6 38.9 6.8 62.4 1687

Wealth quintile χ2=6.609 χ2=46.1717*** χ2=18.805*** χ2=58.924***

Poorest 15.6 42.8 8.4 66.8 1980

Poorer 17.6 39.2 8.8 65.7 1980

Middle 17.7 39.5 6.6 63.9 1980

Richer 15.8 38.1 5.9 59.9 1980

Richest 17.6 32.5 6.4 56.8 1979

Sanitation facility χ2=0.608 χ2=34.113*** χ2=1.620 χ2=34.401***

Unsafe 16.4 42.6 7.7 66.8 3072

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Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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Safe 17.1 36.5 7.0 60.7 6827

Drinking water χ2=0.136 χ2=0.044 χ2=1.071 χ2=0.007***

Unsafe 17.2 38.7 6.5 62.5 1332

Safe 16.8 38.4 7.3 62.6 8567

Cooking fuel χ2=7.234*** χ2=49.454*** χ2=1.433 χ2=31.265***

Unsafe 16.0 41.4 7.5 65.0 5579

Safe 18.0 34.5 6.9 59.5 4320

Community characteristics

Type of locality χ2=6.839** χ2=32.308*** χ2=4.529* χ2=21.974***

Rural 16.2 40.4 7.6 64.2 6415

Urban 18.3 34.5 6.4 59.4 3484

Region χ2=11.468** χ2=54.608*** χ2=37.483*** χ2=17.608***

Northeast 17.6 40.2 8.1 66.0 1959

South 17.8 36.9 6.9 61.5 4350

North 16.1 35.5 9.0 60.8 2418

Others 14.0 47.1 3.6 64.8 1172

India 16.9 38.4 7.2 62.6 9899

Levels of significance: *p<0.10; **p<0.05; ***p<0.01.

Predictors of Anaemia among Pregnant Women

Table 3 and 4 illustrates the results of the binary logistic regression analysis of anaemia among pregnant women by their background characteristics. Results of the logistic regression analysis reiterate that women’s age women’s education, number of household member in the family, religion, caste, economic status, sanitation facility, type of cooking fuel and type of residence are the significant determinants of anemia. The result shows that women from the middle but below secondary education were less likely to suffer from anaemia compared with women from the less than 20 years age. The likelihood of having anaemia was lower among women

with secondary and higher education as compared with uneducated women. Women from household who having more member in the family were suffering more from anaemia than women from household having less number in the family. The odds of having anaemia decreasing significantly with improved household economic status. Women from the richest wealth quintile were less likely to have a anaemia than with women from the poorest wealth quintile. The likelihood of having anaemia was lower among those women living in houses with safe sanitation facility and those using safe cooking fuel, compared with women using unsafe sanitation facility and unsafe cooking fuel, respectively.

Table 3. Estimated effects (odds ratio and confidence intervals) of selected individual, household and community predictors on anaemia prevalence among pregnant women on maternal anaemia in India, DLHS-4 (2012-13)

Background characteristics Mild anaemia Moderate anaemia

Individuals characteristics Odds Ratio 95% C.I Odds Ratio 95% C.I

Age

Less than 20 years ® 1.00 1.00

20-24 0.920 [0.798-1.061] 0.993 [0.861-1.146]

25-30 0.798** [0.687-0.927] 0.954 [0.828-1.098]

31 and above 0.835* [0.686-1.017] 0.744*** [0.636-0.871]

Education

Illiterate ® 1.00 1.00

Literate but below middle 0.928 [0.759-1.134] 0.949 [0.804-1.121]

Middle but below secondary 0.848* [0.708-1.014] 0.887 [0.765-1.029]

Secondary and above 0.863 [0.702-1.060] 0.789*** [0.674-0.924]

Occupation

Not working ® 1.00 1.00

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Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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working 0.998 [0.833-1.195] 0.938 [0.832-1.057]

Household characteristics

Family members

Up to 4 members ® 1.00 1.00

5-7 members 1.097 [0.954-1.262] 1.187*** [1.061-1.327]

More than 7 members 0.976 [0.841-1.132] 1.311*** [1.159-1.483]

Household have BPL card

No ® 1.00 1.00

Yes 0.972 [0.838-1.128] 1.007 [0.917-1.104]

Religion

Hindu ® 1.00 1.00

Muslim 0.878 [0.715-1.078] 0.974 [0.828-1.146]

Christian 1.210 [0.919-1.593] 0.836** [0.699-0.999]

Others 1.061 [0.862-1.305] 0.815*** [0.699-0.951]

Caste

Scheduled tribes ® 1.00 1.00

Scheduled castes 0.871 [0.679-1.118] 1.157* [0.938-1.427]

Other backward classes 1.035 [0.802-1.338] 0.965 [0.786-1.186]

Others 0.991 [0.767-1.280] 1.173** [0.922-1.492]

Wealth quintile

Poorest ® 1.00 1.00

Poorer 1.183 [0.961-1.456] 0.874 [0.747-1.023]

Middle 1.173 [0.925-1.486] 0.908 [0.777-1.061]

Richer 1.021 [0.805-1.296] 0.948 [0.761-1.183]

Richest 1.159 [0.898-1.497] 0.798 [0.649-0.982]

Sanitation facility

Unsafe ® 1.00 1.00

Safe 0.995 [0.845-1.172] 0.909 [0.807-1.024]

Drinking water

Unsafe ® 1.00 1.00

Safe 1.000 [0.849-1.178] 1.050 [0.895-1.231]

Cooking fuel

Unsafe ® 1.00 1.00

Safe 1.106 [0.953-1.285] 0.934 [0.829-1.051]

Community characteristics

Type of locality

Rural ® 1.00 1.00

Urban 1.128 [0.967-1.316] 0.899* [0.796-1.015]

Region

Northeast ® 1.00

South 1.116 [0.820-1.518] 0.755*** [0.607-0.939]

North 1.016 [0.755-1.367] 0.715*** [0.554-0.921]

Others 0.853 [0.601-1.212] 1.012 [0.790-1.295]

Levels of significance: *p<0.10; **p<0.05; ***p<0.01. OR= Odds ratio. ®= reference category

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Table 4. Estimated effects and significance levels of selected individual, household and community predictors of anaemia among pregnant women on maternal anaemia in India, DLHS-4 (2012-13)

Background characteristics Severe anaemia Any anaemia

Individuals characteristics Odds Ratio 95% C.I Odds Ratio 95% C.I

Age

Less than 20 years ® 1.00 1.00

20-24 0.954 [0.760-1.198] 0.926 [0.800-1.071]

25-30 1.220* [0.956-1.558] 0.880* [0.759-1.021]

31 and above 0.811 [0.574-1.145] 0.635*** [0.548-0.736]

Education

Illiterate ® 1.00 1.00

Literate but below middle 0.961 [0.714-1.294] 0.900 [0.768-1.055]

Middle but below secondary 0.979 [0.736-1.301] 0.791*** [0.666-0.939]

Secondary and above 0.777* [0.574-1.051] 0.672*** [0.569-0.794]

Occupation

Not working ® 1.00 1.00

working 1.027 [0.810-1.301] 0.947 [0.823-1.090]

Household characteristics

Family members

Up to 4 members ® 1.00 1.00

5-7 members 0.961 [0.801-1.152] 1.245*** [1.116-1.390]

More than 7 members 1.144 [0.915-1.430] 1.367*** [1.200-1.558]

Household have BPL card

No ® 1.00 1.00

Yes 1.473*** [1.203-1.803] 1.104** [0.992-1.229]

Religion

Hindu ® 1.00 1.00

Muslim 1.233 [0.904-1.683] 0.945 [0.787-1.134]

Christian 1.009 [0.707-1.438] 0.925 [0.759-1.128]

Others 0.861 [0.651-1.139] 0.802*** [0.682-0.942]

Caste

Scheduled tribes ® 1.00 1.00

Scheduled castes 0.980 [0.706-1.360] 1.070 [0.875-1.309]

Other backward classes 0.830 [0.595-1.158] 0.941 [0.747-1.184]

Others 0.945 [0.641-1.391] 1.144 [0.905-1.446]

Wealth quintile

Poorest ® 1.00 1.00

Poorer 1.034 [0.816-1.312] 0.971 [0.839-1.124]

Middle 0.786* [0.594-1.041] 0.924 [0.821-1.041]

Richer 0.648*** [0.480-0.875] 0.836*** [0.721-0.970]

Richest 0.616*** [0.433-0.878] 0.749*** [0.643-0.871]

Sanitation facility

Unsafe ® 1.00 1.00

Safe 1.016 [0.831-1.243] 0.908 [0.803-1.027]

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Citation: Jeetendra Yadav (2017) Prevalence and Factor Associated with Maternal Anaemia in India: Analysis of A Nationally Repre-sentative Cross-Sectional Survey, 2012-13. BAOJ Hematol 1: 002.

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Drinking water

Unsafe ® 1.00 1.00

Safe 1.304 [0.940-1.809] 1.122 [0.951-1.322]

Cooking fuel

Unsafe ® 1.00 1.00

Safe 1.238** [1.016-1.507] 1.050 [0.929-1.186]

Community characteristics

Type of locality

Rural ® 1.00 1.00

Urban 0.875 [0.693-1.105] 0.943 [0.825-1.077]

Region

Northeast ® 1.00 1.00

South 0.736 [0.503-1.078] 0.760** [0.599-0.965]

North 1.370 [0.905-2.074] 0.795* [0.621-1.018]

Others 0.392*** [0.246-0.623] 0.761** [0.586-0.990]

Levels of significance: *p<0.10; **p<0.05; ***p<0.01. OR= Odds ratio.®= reference category

DiscussionThe present study has comprehensively demonstrated the prevalence of anaemia and the significance of several predictive factors among pregnant women in India. The problem of anaemia among pregnant women in India has widely attracted the attention of the public, policy-makers and researchers because anaemia in pregnancy is an important preventable cause of maternal morbidity, maternal mortality and low birth weight. The prevalence of anaemia is observed near about two thirds among pregnant women in India. The WHO recommends that if prevalence of anaemia is > 40%, it becomes a severe public health problem. [30]. Overall prevalence of mild anemia, moderate anemia, severe anaemia and any anaemia was 16.9%, 38.4%, 7.2% and 62.6%, respectively, which is consistent with findings in several earlier studies [31,32]. The mean hemoglobin level was 10.3±2.3, which almost similar observation was made in a earlier studies conducted among pregnant women [25,33-35]. In this study, women’s age women’s education, number of household member in the family, religion, caste, economic status, sanitation facility, type of cooking fuel and type of residence, contributed significantly to the higher prevalence and determinants of anaemia during pregnancy time of women and apart from this reasons the women health status in India not only reflects gender discrimination from birth but also their social and biological vulnerability both within the household and society [36]. Study finds that the prevalence of anaemia was high among younger age group of pregnant women (67.6%) i.e., below 20 years as compared to older age group of pregnant women (57.0%) i.e., age 31 years and above. This indicates that the nutritional status of young girl is poor. Similar finding observed in the earlier study done by [37]. A significant correlation found between education of pregnant women and anaemia in the present study. Prevalence of anaemia were higher among illiterate women (66.7%) compared with women with secondary and above (56.2%) which showed in

several earlier studies that low educated pregnant women were suffering more from anaemia than high educated pregnant women [38,37]. Results from this study indicated that almost two third women from poorest wealth quintile were suffering from any form of anemia. Several earlier studies [34,39] and this study showed that the proportion of pregnant women suffering from anaemia was decreased as increased with wealth quintile (economic status) of the household.

Conclusion and Policy ImplicationsNotwithstanding the national scope of the iron and folic acid supplementation program for pregnant women (100 tablets per pregnancy), anaemia continues to be a severe public health problem among pregnant women in India. This study concludes that prevalence of anaemia was very high among pregnant women in India which requires concerted efforts by all the stakeholders, policy maker, planners involved in National Health Policy. Long term multispectral efforts are to be made to prevent and timely diagnose anemia and its underlying determinants and biologic causes, better sanitation and hygienic conditions at home and also appropriate education measures based on the population’s awareness of the importance of preventive measures must be taken up. Not with standing the national scope of the iron and folic acid supplementation program for pregnant women (100 tablets per pregnancy), anaemia continues to be a severe public health problem among pregnant women in India. Provision of providing 100+IFA tablets to every pregnant woman is being ensured at policy level. The key intervention to deal with anaemia at programme level and other important intervention to decrease anemia are also in place. The main causes of causes of anemia being iron deficiency, malaria and helminth infections. However. other factors such as awareness among women and motivation of local health provider may determine the utilization as well, particularly among remote areas and population belonged to lower social and economic

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AcknowledgmentAn earlier version of this paper was presented in the 14th Annual Conference of Indian Association for Social Science and Health (IASSH) on “Health, Gender and Development: Emerging Issues and Challenges” during 23-25 September, 2016, at Centre for the Study of Social Exclusion and Inclusive Policy Gokhale Institute of Politics and Economics, Pune Maharashtra, India. Author is grateful to session chairpersons and participants for comments and constructive suggestions facilitating improvement in the paper. The author thanks Dr. Jitenkumar Singh and Dr. Lucky Singh, Scientist ‘C’, National Institute of Medical Statistics, (ICMR) Delhi for their useful comments and suggestions. The author is thankful to the editor and anonymous reviewers for their comments and feedbacks of this paper.

Limitations of the Study While this study explores several unfold dimensions of maternal anaemia but this study has some potential limitations too. This study used the fourth round of District Levels Household Survey (DLHS-4) which conducted survey in 21 states of India. The data was not available for EAG states constitute 45% of the total population of India. The present study could not include food intake and dietary habits of pregnant women due to unavailable of data that are thought to have directly associated with the anaemia among pregnant women.

Additional information and declarationsCompeting Interests

The author declare that he has no competing interests.

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