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Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data

Abstract

Background

Over one-third of women worldwide suffer from anaemia. The prevalence of anaemia is particularly pronounced among women of reproductive age (WRA) in developing countries, such as India. No prior study has ever exclusively studied the prevalence of anaemia across the Aspirational Districts of India. Therefore, the purpose of this study was to examine the prevalence of anaemia across Aspirational Districts of India and to identify the determinants of anaemia among WRA in these districts.

Methods

From the National Family Health Survey (NFHS)-4 (2015-16) and NFHS-5 (2019-21), data on 114,444 and 108,782 women aged 15–49 from Aspirational Districts were analyzed in our study, respectively. Bivariate statistics and multivariable binary logistic regression were used to identify the determinants of anaemia.

Results

The national prevalence of anaemia among WRA has increased from 53% in NFHS-4 to 57% in NFHS-5 whereas anaemia among WRA in Aspirational Districts has increased from 58.7% in NFHS-4 to 61.1% in NFHS-5. Between 2015 and 2021, over 60% of Aspirational Districts experienced an increase in the prevalence of anaemia and one-fourth, specifically 29 out of 112, observed a rise by at least 10 percentage points (pp). Notably, there are significant variations in anaemia prevalence among districts, with Simdega and Udalgiri having the highest anaemia prevalence in NFHS-4 and NFHS-5 at 78.2% and 81.5%, respectively. During this period, Barpeta followed by Udalgiri of Assam have witnessed the maximum increase with 29.4% and 26.7% respectively. Moreover, pooled regression results show women with three to four children [AOR: 1.13, 95% CI: 1.08–1.17], women who breastfeed [AOR: 1.17, 95% CI: 1.13–1.20], Scheduled Tribe women [AOR: 1.39, 95% CI: 1.35–1.44], poorest women [AOR: 1.27, 95% CI: 1.22–1.33] and women those who consume fish occasionally [AOR: 1.14, 95% CI: 1.12–1.17] were more likely to be anaemic.

Conclusion

The significant increase in anaemia among WRA in Aspirational Districts of India is a matter of concern. Given the rise in anaemia among WRA, determinants-based and district-specific measures must be designed and implemented to reduce the prevalence of anaemia among Aspirational Districts of India.

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Background

Anaemia is a condition where the count and size of red blood cells, or the concentration of hemoglobin, drop below a defined threshold [1]. According to World Health Organization (WHO), pregnant women are considered anaemic if their hemoglobin concentration is less than 11.0 g/dl, while non-pregnant women are considered anaemic if their hemoglobin concentration is below 12.0 g/dl [2]. Anaemia has three main causes: nutritional deficiencies, infectious diseases, and genetic disorders related to hemoglobin [3, 4]. Iron-deficiency anaemia stands out as the most prevalent type in developing nations [5, 6]. A global analysis indicates that anaemia affects 27% of the world’s population, with iron deficiency being the primary cause [7, 8]. Inadequate intake of essential nutrients such as iron, vitamin B12, and folic acid, coupled with excessive consumption of tea, coffee, and certain spices, can lead to nutritional deficiencies that often result in anaemia [3, 9, 10]. Similarly, genetic disorders, such as vitamin A, riboflavin, and folate deficiencies, sickle cell disease, glucose-6-phosphate dehydrogenase deficiency, as well as conditions like malaria, human immunodeficiency viruses (HIV), and tuberculosis, significantly contribute to the development of anaemia [3, 11]. It is a significant public health concern impacting approximately half a billion women aged 15–49 years [12]. In 2019, WHO estimates 30% (539 million) of non-pregnant women and 37% (32 million) of pregnant women aged 15–49 years were affected by anaemia [12].

Women of reproductive age (WRA) are one of the most vulnerable groups to this condition, caused by poor dietary intake of essential micronutrients, chronic diseases, heavy menstruation, infections, genetic disorders, and reproductive-related blood loss [1, 12,13,14,15]. Anaemia among WRA associated to several adverse health outcomes, such as poor pregnancy outcomes, preterm birth, stillbirth, increased susceptibility, low birth weight, loss of productivity, fatigue, breathlessness, dizziness, maternal morbidity, and mortality [16,17,18]. Moreover, anaemia can negatively impact infants’ and children’s cognitive and physical development [19,20,21,22].

Anaemia holds crucial importance in the context of achieving Sustainable Development Goals (SDGs), particularly SDG-2 (Zero Hunger) and SDG-3 (Good Health and well-being) [23, 24]. Around half a billion WRA are anemic globally, with anaemia being higher in low and middle-income countries (LMICs) like India [14, 25]. The most recent National Family Health Survey (NFHS) reveals a significant burden of anaemia, impacting 57% of WRA in India, while in the Aspirational Districts, the prevalence of anaemia among WRA is even higher at 61% [26]. Earlier research conducted in India identified that low socioeconomic status, limited educational attainment, increased childbearing, residing in rural areas, women belongs to lower social groups, and inadequate dietary intake were associated with anaemia among WRA [22, 27,28,29,30,31]. Furthermore, a study on urban India found that anaemia was associated with low serum ferritin levels indicating iron deficiency [32, 33]. It is noteworthy that these studies are primarily focused on broader population trends within the country. The significance of studying anaemia in Aspirational Districts is underscored by its correlation with low economic status, a prevalent characteristic among women in Aspirational Districts [34,35,36].

The “Aspirational Districts” program was launched by the government of India in 2018. These districts were characterized by poor development indicators, high rates of poverty, and limited access to healthcare facilities, making them vulnerable to health and nutrition-related issues like anaemia [34, 37]. These districts were selected based on their poor performance across various development indicators, including health, education, nutrition, and basic infrastructure [37, 38]. Earlier research conducted in the Aspirational Districts predominantly focused on socioeconomic status, maternal and child health and the effectiveness of education, with no research specifically addressing anaemia which is a critical health issue prevalent among WRA [39,40,41,42,43]. By examining the prevalence of anaemia in Aspirational Districts, the research aims to inform targeted interventions aimed at reducing anaemia rates and improving the well-being of WRA in these districts.

Our study has the following objectives. First, our study measures the prevalence of anaemia among WRA in Aspirational Districts in NFHS-4 and NFHS-5. Second, the study aims to examine the factors associated with anaemia among WRA in Aspirational Districts. The study results may aid policymakers, public health researchers, and health professionals in better comprehending the shifting nature of anaemia across Aspirational Districts.

Methods

Data source

The study used the data from NFHS-4 and NFHS-5 conducted during 2015-16 and 2019-21, respectively. The NFHS aims to collect data on a diverse array of subjects, such as reproductive healthcare, fertility, infant and childhood mortality, HIVand acquired immune deficiency syndrome (AIDS), contraceptive awareness, family planning, maternal and infant nutrition, maternal and infant empowerment and more. Ministry of Health and Family Welfare, Government of India (MOHFW) conducted the study managed by the International Institute of Population Sciences (IIPS), Mumbai. Using a two-stage stratified random sampling method in each phase, NFHS-4 (2015–16) conducted interviews with 699,686 women aged 15–49 years across 572,000 households. In comparison, NFHS-5 interviewed 724,115 women aged 15–49 years from a total of 636,669 households with a response rate of 97% in both rounds [26, 44].

Study sample

The “Aspirational Districts” program was launched by the government of India in 2018 [36]. The program was a part of India’s broader development agenda, which aims to promote inclusive and sustainable development across the country [37, 45]. These districts were selected based on their poor performance across various development indicators, including health, education, nutrition, and basic infrastructure [45]. Health was an important component of this program, accounting for almost 30%, with a focus on indicators like anaemia among women. A total of 112 districts from 27 states were identified as “Aspirational Districts”. Among these districts, there were 19 from Jharkhand, 13 from Bihar, ten each from Chhattisgarh and Odisha, eight each in Uttar Pradesh and Madhya Pradesh, seven in Assam. Rajasthan and Maharashtra have five and four districts, respectively, while Andhra Pradesh and Telangana each have three. Additionally, Uttarakhand, Tamil Nadu, Punjab, Jammu and Kashmir, Gujarat, and Karnataka have two districts. On the other hand, Arunachal Pradesh, Haryana, Himachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, and Tripura each contribute one district to the program [34, 38, 45, 46].

For our study, we opted to include Visakhapatnam and Vizianagaram districts from Andhra Pradesh, even though Alluri Sitharamaraju and Parvathipuram Manyam districts are part of the Aspirational Districts program. This decision was based on the fact that the NFHS-4 and NFHS-5 surveys, conducted in 2015-16 and 2019-21, respectively, covered Visakhapatnam and Vizianagaram as survey districts. It’s worth noting that Alluri Sitharamaraju and Parvathipuram Manyam districts were formed in 2022 from Visakhapatnam and Vizianagaram, respectively. This choice was made to maintain consistency with the time frame of the survey data. The detailed list of Aspirational Districts used for this study is given in Supplementary Table 2.

For the present study, data was extracted from two consecutive rounds of NFHS. A total of 114,444 and 108,782 women aged between 15 and 49 years were chosen from NFHS-4 and NFHS-5, respectively. The detailed sample selection process is given in Fig. 1.

Fig. 1
figure 1

Process of sample selection for the study from NFHS-4 and NFHS-5

Hemoglobin testing

Health investigator took blood samples for anaemia testing from all women aged 15–49 who voluntarily consented to the testing. A drop of blood from a finger prick was used to collect blood samples in a microcuvette. In addition, on-site hemoglobin was tested using a battery-operated portable HemoCue Hb 201 + analyzer [26].

Conceptual framework

The framework illustrates various anaemia related variables which might affect the magnitude of anaemia in the Aspirational Districts of India. Three main domains of variables (biodemographic and socioeconomic, behavioural and health related variables) were selected for the study, which are described later in this section. The analysis for this study is based on this conceptual framework adapted from the existing literature on anaemia [47,48,49,50,51,52,53]. The conceptual framework is shown in Fig. 2.

Fig. 2
figure 2

Conceptual framework showing determinants of anaemia

Dependent variable

The variable representing the level of anaemia in both the NFHS-4 and NFHS-5 datasets is an ordinal variable having four categories: no anaemia, mild anaemia, moderate anaemia, and severe anaemia. The level of anaemia is designated as mild if hemoglobin level is between 11.0 g/dl to 11.9 g/dl for non-pregnant women and 10.0 g/dl to 10.9 g/dl for pregnant women, moderate if hemoglobin level is between 8.0 g/dl to 10.9 g/dl for non-pregnant women and 7.0 g/dl to 9.9 g/dl for pregnant women and severe if hemoglobin level is within < 8.0 g/dl for non-pregnant women and < 7.0 g/dl for pregnant women [26]. The dependent variable in this study was whether reproductive women were anaemic or not anaemic. The dependent variable is coded as a dichotomous variable, with ‘1’ indicating “anaemic” for women with mild, moderate, or severe anaemic conditions, and ‘0’ indicating “not anaemic” for women having no anaemia.

Independent variables

Based on prior research on anaemia, the independent variables were chosen for the study [32, 33, 47, 54,55,56,57]. These variables included age, marital status, parity, breastfeeding status, pregnancy status, level of education, social groups, religion, household wealth, type of residence, mass media exposure, frequency of eating eggs, frequency of eating fish, frequency of eating chicken, current contraceptive use, alcohol consumption, body mass index (BMI), currently having diabetes and currently amenorrhea. These variables were divided into three domains: (a) biodemographic and socioeconomic; (b) behavioural and (c) health related variables. Table 1 provides a detailed list of independent variables used in this study.

Table 1 Description of independent variables

Statistical analysis

The study analyzed the prevalence of anaemia among WRA in Aspirational Districts of India by their background characteristics. We additionally evaluated the temporal change in the prevalence of anaemia for each Aspirational District during the study period. This analysis allowed us to identify variations in anaemia prevalence at a more detailed level. The chi-square test was used to analyze the statistical significance of the association between outcome variable and each independent variable [59]. Furthermore, multivariable binary logistic regression was used to examine the association between dependent variable and independent variables [60]. The data from NFHS-4 and NFHS-5 were pooled for this analysis. By combining these datasets, we were also able to examine the independent effect of the survey year on the likelihood of anaemia [61].

Three models were constructed and a block-wise forward selection method was used to eliminate any variables that were statistically insignificant (p > 0.05). Variables were introduced in blocks, and only those with a p < 0.05 were included in the subsequent models. Model 1 included biodemographic and socioeconomic variables, including age, marital status, parity, breastfeeding status, pregnancy status, level of education, social groups, religion, household wealth, and type of place of residence. Model 2 included statistically significant variables from model 1 and behavioral variables including mass media exposure, frequency of eating egg, frequency of eating fish, frequency of eating chicken, current contraceptive use, alcohol consumption, and model 3 contained significant variables from model 2 and health-related variables including BMI, currently having diabetes, currently amenorrheic and year. Adjusted odds ratios (AOR), p-values (< 0.05), and 95% confidence intervals (CIs) were used to show the results of logistic regression models. In addition, variance inflation factors (VIFs) were calculated to determine the degree of multicollinearity [62] (see additional Table 1). The mean VIF value was under the threshold value of five in all the models, which indicated that multicollinearity was not a problem for the models.

Furthermore, we applied Nagelkerke R square and Hosmer & Lemeshow tests to assess the goodness-of-fit of the models. Firstly, we conducted Nagelkerke R square, this helped us see how likely our model was to produce the observed data, and a lower log likelihood meant a better fit [63]. Additionally, we conducted the Hosmer-Lemeshow goodness-of-fit test. The Hosmer-Lemeshow test helped us assess how well our model’s predictions matched the actual outcomes, and if the result were not significant, it suggested a good fit [64]. In addition, we examined Akaike information criterion (AIC), Bayesian information criterion (BIC) and log likelihood. Higher log likelihood, and low AIC and BIC values indicated a better fit. [65].

Stata 16 was used for statistical analysis, and the ‘Svyset’ command was utilized to adjust for the complex survey design (sampling weights) of the NFHS-4 and NFHS-5 [66].

Results

Respondents’ characteristics

Table 2 presents the socio-demographic profile of WRA of Aspirational Districts. In both rounds of the NFHS, it was found that more than one-third of women were aged between 20 and 29, and around three-fourths of women were currently married. A minuscule percentage of women were pregnant and over 10% of women had five or more children. Furthermore, more than four-fifths women were identified as Hindu, and nearly half of the women belonged to OBC. Over one-third of women had not received any formal education and belonged to the lowest socioeconomic class. Contraceptive practices revealed that over 60% of women either used traditional methods or did not use any family planning method. In addition, across both rounds, over one-third of women reported that they occasionally ate egg, fish, and chicken. A small proportion of women in both rounds suffered from diabetes and amenorrhea.

Table 2 Background characteristics of WRA (15–49 years) in Aspirational Districts of India, NFHS-4 and NFHS-5.

Prevalence of anaemia among WRA by background characteristics

In NFHS-4, approximately 59% of WRA in Aspirational Districts were reported as anaemic. However, this percentage increased to 61% in NFHS-5. Table 3 presents the prevalence of anaemia among WRA from 2015 to 2021 in Aspirational Districts of India by background characteristics. In both rounds of the NFHS, the rates of anaemia remained nearly constant across all age groups, hovering around 60%. Furthermore, women with three to four children consistently exhibited the highest anaemia prevalence. However, the rate of anaemia increase was more pronounced among women with no children. Additionally, in both rounds of survey, the prevalence of anaemia was higher among women with no education, whereas those with higher education consistently had the lowest prevalence. In terms of household wealth, it was found that anaemia was higher among poorest category of women and lowest among the richest category.

Table 3 Prevalence of anaemia among WRA (15–49 years) by background characteristics in Aspirational Districts of India, NFHS-4 and NFHS-5.

The prevalence of anaemia also varied among different social groups. Specifically, the rates were relatively higher among ST women during both surveys. However, the rate of increase in anaemia prevalence was notable among women from other social groups, with a 6 percentage point (pp) rise. Furthermore, during both rounds, the prevalence of anaemia was also higher among women those who occasionally ate eggs, fish and chicken. Although, the rate of increase in anaemia prevalence was more pronounced among WRA those who never consumed any of abovementioned food, with a nearly 4 pp rise. Women utilizing modern contraceptive methods exhibited a lower prevalence of anaemia compared to those using traditional or no contraceptive methods. Additionally, in NFHS-5, over 70% of WRA who consumed alcohol were found to be anaemic. Across both survey rounds, underweight women consistently exhibited the highest prevalence of anaemia, whereas overweight women consistently had the lowest prevalence. Notably, the increase in anaemia prevalence was more notable among overweight women, showing an increase of over 4 pp between the two survey rounds. Furthermore, women with diabetes were less likely to experience anaemia. However, in the case of amenorrhea, the prevalence of anaemia was highest among women with amenorrhea and lowest among those without amenorrhea in both rounds of NFHS.

Distribution of anaemia among WRA in Aspirational Districts of India during NFHS-4 and NFHS-5

Figure 3 illustrates that in both rounds of the NFHS, the prevalence of anaemia among WRA in Aspirational Districts exceeded that of non-aspirational districts and the national average. Nationally, 53.2% and 57% of WRA in India were anemic in NFHS-4 and NFHS-5, respectively. In contrast, the prevalence in Aspirational Districts was 58.7% and 61.1% in NFHS-4 and NFHS-5, respectively.

Fig. 3
figure 3

Prevalence of anaemia in Aspirational and non-aspirational Districts in NFHS-4 and NFHS-5.

Between 2015 and 2021, more than 60% of all Aspirational Districts (72 out of 112) observed an increase in anaemia prevalence. On the other hand, 40 Aspirational Districts demonstrated a decline in anaemia prevalence during this period. There has been a notable increase in the number of Aspirational Districts where the prevalence of anaemia was 75% or higher. For instance, in NFHS-4, only two Aspirational Districts witnessed anaemia rates above 75%, but this number grew to nine in NFHS-5. Likewise, the number of Aspirational Districts with a prevalence of anaemia at 70% or higher increased from 13 in NFHS-4 to 21 in NFHS-5. In addition, 11 Aspirational Districts saw a rise of more than 20 pp, while 18 districts experienced a rise by at least ten pp. Additionally, there were Aspirational Districts where anaemia declined during the period from 2015 to 2021, with 8 Aspirational Districts experiencing a reduction by ten or more pp (see additional Table 2).

Aspirational Districts from Chhattisgarh witnessed a significant increase in anaemia, with 9 out of 10 districts experiencing a rise. Similarly, Bihar faced notable concerns, as 10 out of its 13 Aspirational Districts reported an increase in anaemia. Additionally, 6 out of 10 Aspirational Districts of Odisha observed an increase in anaemia. In contrast, states like Jharkhand, where 12 out of 19 Aspirational Districts experienced a decline in anaemia. Similarly, 7 out of 8 Aspirational Districts of Uttar Pradesh witnessed a decline in anaemia among WRA from 2015 to 2021 (see additional Table 2).

Additional Table 2 also shows, during both rounds, Chandel district of Manipur consistently experienced the highest anaemia among all Aspirational Districts, with 78% and 81%, respectively. On the other side, Simdega of Jharkhand in NFHS-4 and Udalguri of Assam in NFHS-5, witnessed the lowest anaemia prevalence, with at 23% and 27%, respectively. In addition, during both rounds, Barpeta followed by Udalgiri of Assam witnessed the maximum increase in anaemia with 29.4% pp and 26.7% pp, respectively. Conversely, Chitrakoot of Uttar Pradesh and Kalahandi of Odisha observed the maximum decline in anaemia with − 19.8% pp and − 21.1% pp, respectively.

Determinants of anaemia among WRA in Aspirational Districts of India

Table 4 provides the AORs of anaemia among WRA in Aspirational Districts of India. We have found that, model 3 has lowest value of AIC and BIC and highest value of log likelihood and Hosmer-Lemeshow test, which indicate that model 3 is the best fit model among all the models.

Table 4 Adjusted odds ratios (with 95% CI) for anaemia among WRA (15–49 years) in Aspirational Districts of India, NFHS-4 and NFHS-5.

The final regression model (model 3) revealed that women in NFHS-5 had a 19% higher likelihood of having anaemia (AOR: 1.19, 95% CI: 1.17–1.21) compared to NFHS-4. Women with three to four children faced 13% higher odds of anaemia (AOR: 1.13, 95% CI: 1.08–1.18) compared to those without children. In addition, breastfeeding women had 17% higher (AOR: 1.17, 95% CI: 1.13–1.20) odds of being anaemic than non-breastfeeding women. Women with higher education had 13% lower odds of being anaemic (AOR: 0.87, 95% CI: 0.84–0.91), followed by those with primary education (AOR: 0.92, 95% CI: 0.90–0.95). Moreover, the odds of anaemia were higher among ST women (AOR: 1.39, 95% CI: 1.35–1.44) as compared to the women from other category. Christian women had a 40% lower likelihood of being anaemic (AOR: 0.60, 95% CI: 0.58–0.62) than Hindu women. Additionally, household wealth status showed a negative association with anaemia; women from the poorest quintile had 28% higher odds of anaemia (AOR: 1.28, 95% CI: 1.23–1.34) than the richest quintile. Furthermore, the odds of anaemia were 14% higher (AOR: 1.14, 95% CI: 1.12–1.17) among women who ate fish occasionally. Underweight women were 20% more likely to have anaemia (AOR: 1.20, 95% CI: 1.18–1.23) compared to those with normal weight. Additionally, women with amenorrhea had 13% higher odds of anaemia (AOR: 1.13, 95% CI: 1.08–1.17).

Discussion

This study examined the prevalence of anaemia among WRA in Aspirational Districts of India between 2015 and 2021. During NFHS-4 and NFHS-5, the prevalence of anaemia among WRA within Aspirational Districts was higher than the national prevalence of anaemia. Within the Aspirational Districts, 72 districts experienced an increase, while 40 districts witnessed a decline in anaemia among WRA. Anaemia prevalence varied across Aspirational Districts, a majority of Aspirational Districts from Chhattisgarh and Bihar experienced a major rise in anaemia. While Aspirational Districts from Jharkhand and Uttar Pradesh observed a considerable decline in anaemia among WRA from 2015 to 2021. In terms of specific districts, Chandel of Manipur consistently faced the highest anaemia prevalence in both rounds of NFHS. In contrast, Simdega of Jharkhand and Udalguri of Assam witnessed the lowest anaemia prevalence in NFHS-4 and NFHS-5, respectively. During both rounds of survey, Barpeta and Udalgiri of Assam witnessed the highest increase in anaemia while, Chitrakoot of Uttar Pradesh and Kalahandi of Odisha witnessed highest decline in anaemia respectively.

After controlling for a number of factors, the regression results revealed that, women education, their wealth status, breastfeeding status, mass media exposure, social groups, underweight women, frequency of eating fish, and amenorrhea were associated with anaemia among WRA of Aspirational Districts of India.

This study found that women with higher education were less prone to be anaemic, this is supported by previous studies which identified women with higher education levels are less likely to develop anaemia than those with lower education levels [32, 47, 53, 67]. A possible reason could be, education provides knowledge and awareness about nutrition, health, and hygiene, which are essential for preventing anaemia [61, 68]. In addition, women with higher education levels are also more likely to have better access to healthcare, including prenatal care during pregnancy, which might help in managing anaemia [47].

Our study also revealed that poorest women had higher odds of anaemia compared to richest women. Poorest women face insufficient access to food resources, struggled to afford well-balanced meals, often reduced meal sizes, and occasionally skipped meals, all of which could contribute to anaemia [69,70,71]. Furthermore, knowledge of different vitamin and mineral- containing foods is generally limited among the lower wealth status women, which could be another factor contributing to anaemia [69, 72]. Furthermore, women with lower wealth status generally have limited access to healthcare services making diagnosing and treating anaemia more difficult [73, 74]. On the contrary, women belonging from the highest and richest households are associated with better nutritional status and were less vulnerable to get anaemia [69, 75, 76]. Additionally, lower wealth levels also lack resources for basic hygiene, such as clean water and sanitation facilities, which might increase the risk of infectious diseases that associate with anaemia [61].

Similar to many previous studies, this study also identified a positive association between anaemia and breastfeeding [25, 53, 61]. A study conducted in Pakistan revealed that inadequate consumption of enough iron-rich foods in their diet might cause insufficient milk supply, resulting in a shorter breastfeeding and the return of menstruation [25]. This, in turn, can contribute to iron deficiency and the beginning of anaemia [25, 77]. Though the relationship between breastfeeding and anaemia among WRA is little complex, which requires additional research for the better understanding.

The findings of the study indicated that increased mass media exposure was associated with a lower prevalence of anaemia. One possible explanation might be women with greater mass media exposure have greater access to information regarding the significance of nutrition and healthy behavior, such as consuming iron-rich foods or taking iron supplements [78]. Additionally, women with a significant exposure to mass media may be more likely to know about healthcare services, such as regular check-ups such as blood tests, which can aid in the early identification and treatment of anemia [79,80,81].

Our study also revealed that ST women were more likely to be anaemic than women from other social groups. Some previous studies have also revealed that anaemia is a significant health problem among tribal women in India [32, 48, 82, 83]. The higher anaemia prevalence in tribal women may have been a result of limited access to nutritious foods, including iron, folate, and vitamin B12 [84]. Moreover, dietary habits, poor sanitation practices, cultural norms like early marriage, insufficient maternal care, and taboos may collectively contribute to the prevalence of anemia among women of reproductive age in tribal communities [83, 85].

The relationship between fish consumption and anaemia is a bit complex. Some previous studies have indicated that anaemia tends to increase with fish consumption, a finding consistent with our own study [86]. However, there are some studies where it is found that anaemia does not increase with the consumption of fish [87, 88]. A possible explanation for these results may be that non-vegetarians have a higher animal protein intake, which can increase the body’s need for iron [89]. However, the underlying reasons for this complex relationship remain somewhat unclear and warrant further investigation.

Additionally, our study uncovered an association between underweight women and the prevalence of anemia. Previous studies have similarly shown that underweight women are associated with an elevated risk of anaemia [47, 67, 90, 91]. The potential cause for this could be insufficient intake of essential nutrients, such as iron and folate, and an inadequate diet, which are the predominant immediate causes of anaemia among WRA [67, 91]. Underweight individuals may also be more susceptible to chronic illnesses and inflammation which can interfere with the body’s inability to produce red blood cells, leading to anaemia [92, 93].

This study also identified an association between increased prevalence of anaemia and women who had experienced amenorrhea, consistent with earlier studies conducted in India [61]. This could be attributed to inadequate iron levels in the body, which typically result from improper and insufficient diet [25]. When the diet is inadequate, the body cannot produce an adequate amount of iron, leading to amenorrhea and subsequently resulting in anaemia among WRA [25, 77].

The Indian government has implemented a series of programs and policies aimed at preventing and eliminating anaemia among women. This began with the National Nutritional Anaemia Control Program (NNACP) in 1970, followed by the National Nutritional Policy in 1993. Additionally, Iron and Folic Acid Supplementation (WIFS) program, initiated in 2012, focused on providing iron and folic acid supplements to school-going and adolescent girls, aiming to prevent anaemia [94,95,96]. The National Iron + Initiative, launched in 2013, aimed to improve the quality and accessibility of iron and folic acid supplements in the public health system [97]. The Anaemia Mukt Bharat program (2018) aimed to increase awareness about anaemia, provide iron and folic acid supplements to vulnerable groups, and strengthen the health system for effective anaemia prevention and treatment [98]. Moreover, there are some states like Chhattisgarh and Uttar Pradesh where initiatives were adopted in order to eradicate NCDs including anaemia from Aspirational Districts [99, 100]. However, in addition to these initiatives, it is essential for more states to bring effective measures in Aspirational Districts to improve the condition of anaemia among WRA.

The major strength of this study is that this is the first national-level study to assess the prevalence of anaemia among WRA in Aspirational Districts using NFHS-4 and NFHS-5 datasets. Additionally, the study concentrated on assessing district-level anaemia prevalence and its temporal changes, aiming to inform the development of district-specific interventions to mitigate anaemia among women of reproductive age (WRA). Furthermore, the study studied the determinants of anaemia among WRA, which might help policy makers adopt specific measures to reduce anaemia among WRA in Aspirational Districts. One of the key limitations of this research arises from its cross-sectional survey design, which restricts causal inferences and instead permits only the establishment of associations between dependent and independent variables. An additional limitation is the exclusion of some key variables, such as folate, vitamin B12, vitamin A intake, access to healthcare services, and cultural beliefs and practices, which could influence anaemia prevalence but were not included due to their unavailability in the dataset. Furthermore, the reason of anaemia within WRA in Aspirational Districts is unknown because most Aspirational Districts research focuses on socioeconomic status, mother and child health, and education efficacy etc. Therefore, future research should incorporate more variables to provide a more comprehensive and accurate picture of the prevalence of anaemia among WRA of Aspirational Districts of India.

Conclusion

Anaemia among WRA in Aspirational Districts was found higher than the national prevalence. Our study revealed that women with secondary education, ST women, poorest women, women who consume fish occasionally, underweight women and those with amenorrhea were associated with anaemia among WRA. The Government of India has taken several steps to reduce the prevalence of anaemia among women at national level, however there is a need to adopt some specific measures for Aspirational Districts too. More concerted efforts are needed to eradicate anaemia from Aspirational Districts. Focus towards healthy food consumption, better economic condition and higher education for women must be given importance. At the same time knowledge and awareness towards anaemia must be promoted among women. Implementing targeted public health programs in Aspirational Districts with higher prevalence of anaemia may reduce the issue at the grass-root level.

Data availability

All National Family Health Survey datasets used in this study are available at the official website of Demographic and Health Surveys (DHS): https://dhsprogram.com/data/availabledatasets.cfm. Additionally, this data can be obtained by registering as a DHS data user and requesting access for legitimate research purposes: https://dhsprogram.com/data/Access-Instructions.cfm.

References

  1. World Health Organisation. Global Nutrition Target 2025: Anaemia Policy Brief. 2014.

  2. World Health Organization. Anaemia. 2008. https://www.who.int/data/nutrition/nlis/info/anaemia.

  3. Sunuwar DR, Singh DR, Pradhan PMS, Shrestha V, Rai P, Shah SK, et al. Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis. BMC Public Health. 2023;23:1–17.

    Article  Google Scholar 

  4. World Health Organization. Iron deficiency anaemia: Assessment, Prevention, and Control A guide for programme managers. 2001.

  5. Mog M, Neogi D, Bharadwaz MP, Panda BK, Sil A. Prevalence and factors associated with anaemia in Married Women of Reproductive age group: evidence from North East India. J Biosoc Sci. 2022;2005:425–37.

    Google Scholar 

  6. Bekele A, Tilahun M, Mekuria A. Prevalence of Anemia and Its Associated Factors among Pregnant Women Attending Antenatal Care in Health Institutions of Arba Minch Town, Gamo Gofa Zone, Ethiopia: A Cross-Sectional Study. Hindawi Publ Corp. 2016;2016.

  7. Kassebaum NJ, Fleming TD, Flaxman A, Phillips DE, Steiner C, Barber RM, et al. The Global Burden of Anemia. Hematol Oncol Clin North Am. 2016;30:247–308.

    Article  PubMed  Google Scholar 

  8. Takeshima T, Ha C, Iwasaki K. Estimation of the utilities of attributes of intravenous iron infusion treatment for patients with iron-deficiency anemia: a conjoint analysis in Japan. J Med Econ. 2023;26:84–94.

    Article  PubMed  Google Scholar 

  9. Wieringa FT, Dahl M, Chamnan C, Poirot E, Kuong K, Sophonneary P et al. The high prevalence of anemia in Cambodian children and women cannot be satisfactorily explained by nutritional deficiencies or hemoglobin disorders. Nutrients. 2016;8.

  10. Metz J. A high prevalence of biochemical evidence of vitamin B12 or folate deficiency does not translate into a comparable prevalence of anemia. Food Nutr Bull. 2008;29(2 SUPPL):74–85.

    Article  Google Scholar 

  11. Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann N Y Acad Sci. 2019;1450:15–31.

    Article  PubMed  PubMed Central  Google Scholar 

  12. World Health Organization. Anaemia. 2023. https://www.who.int/news-room/fact-sheets/detail/anaemia.

  13. Dalmiya N, Kupka R, Tyler V. Aguayo. V. Maternal nutrition: Prevention of malnutrition in women before and during pregnancy and while breastfeeding. 2022.

  14. World Health Organisation. The Global prevalence of Anaemia in 2011. 2015.

  15. Shastri L, Mishra PE, Dwarkanath P, Thomas T, Duggan C, Bosch R, et al. Association of oral iron supplementation with birth outcomes in non-anaemic south Indian pregnant women. Eur J Clin Nutr. 2014;69:1–5.

    Google Scholar 

  16. Daru J, Zamora J, Fernández-Félix BM, Vogel J, Oladapo OT, Morisaki N, et al. Risk of maternal mortality in women with severe anaemia during pregnancy and post partum: a multilevel analysis. Lancet Glob Heal. 2018;6:e548–54.

    Article  Google Scholar 

  17. Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2012;26:3–24.

    Article  PubMed  Google Scholar 

  18. Armah-Ansah EK. Determinants of anemia among women of childbearing age: analysis of the 2018 Mali demographic and health survey. Arch Public Heal. 2023;81:1–13.

    Google Scholar 

  19. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–60.

    Article  PubMed  Google Scholar 

  20. Pivina L, Semenova Y, Doşa MD, Dauletyarova M, Bjørklund G. Iron Deficiency, cognitive functions, and Neurobehavioral disorders in Children. J Mol Neurosci. 2019;68:1–10.

    Article  CAS  PubMed  Google Scholar 

  21. Moschovis PP, Wiens MO, Arlington L, Antsygina O, Hayden D, Dzik W, et al. Individual, maternal and household risk factors for anaemia among young children in sub-saharan Africa: a cross-sectional study. BMJ Open. 2018;8:1–14.

    Article  Google Scholar 

  22. Heesemann E, Mähler C, Subramanyam MA, Vollmer S. Pregnancy anaemia, child health and development: a cohort study in rural India. BMJ Open. 2021;11:1–10.

    Article  Google Scholar 

  23. Halle S, Kellogg M, Sawas A, Owren C, Meijer S, Gilligan S et al. M,. Gender, Climate & Security - Sustaining inclusive peace on the frontlines of climate change. 2020.

  24. United Nations Development Program. The 2030 agenda for sustainable development by United Nations. 2016.

  25. Ali SA, Abbasi Z, Shahid B, Moin G, Hambidge KM, Krebs NF, et al. Prevalence and determinants of anemia among women of reproductive age in Thatta Pakistan: findings from a cross-sectional study. PLoS ONE. 2020;15(9 September):1–16.

    Google Scholar 

  26. International Institute for Population. Sciences (IIPS) and ICF. National Family Health Survey (NFHS-5), India. 2019.

  27. Barzegari S, Afshari M, Movahednia M, Moosazadeh M. Prevalence of anemia among patients with tuberculosis: a systematic review and meta-analysis. Indian J Tuberc. 2019;66:299–307.

    Article  PubMed  Google Scholar 

  28. Malik VS, Singh M, Pradhan P, Singal K, Agarwal A, Chauhan A, et al. Role of environmental lead in the occurrence of anemia in Indian children: a systematic review and meta-analysis. Environ Sci Pollut Res. 2022;29:37556–64.

    Article  CAS  Google Scholar 

  29. Venkatesh U, Sharma A, Ananthan VA, Subbiah P, Durga R. Micronutrient’s deficiency in India: a systematic review and meta-analysis. J Nutr Sci. 2021;10:1–11.

    Article  Google Scholar 

  30. Rao S, Joshi S, Bhide P, Puranik B, Asawari K. Dietary diversification for prevention of anaemia among women of childbearing age from rural India. Public Health Nutr. 2013;17:939–47.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sharif N, Das B, Alam A. Prevalence of anemia among reproductive women in different social group in India: cross-sectional study using nationally representative data. PLoS ONE. 2023;18(2 February):1–22.

    Google Scholar 

  32. Bentley ME, Griffiths PL. The burden of anemia among women in India. Eur J Clin Nutr. 2003;57:52–60.

    Article  CAS  PubMed  Google Scholar 

  33. Mistry R, Jones AD, Pednekar MS, Dhumal G, Dasika A, Kulkarni U, et al. Antenatal tobacco use and iron deficiency anemia: integrating tobacco control into antenatal care in urban India. Reprod Health. 2018;15:1–8.

    Article  Google Scholar 

  34. NITI Aayog. Deep dive insights from champions of Change the aspirational districts dashboard. Mycol Res. 2002;106:1323–30.

    Google Scholar 

  35. United Nations Development Program. Aspirational Districts Programme: An appraisal. 2020.

  36. Porter ME, Stern S, Green M, Dr Kapoor A. An assessment of aspirational districts programme. 2018.

  37. NITI Aayog. Transformation of Aspirational District A New India by 2022. 2018.

  38. Ministry of Communication and Information Technology. Transformation of aspirational districts - Baseline ranking and real time monitoring dashboard. 2018.

  39. Dominic DM, Meena HR, Niranjan DA. Effectiveness of an Educational Module on Diet and Nutrition: A Farm Women Perspective from Aspirational districts. Indian J Ext Educ. 2023;59:28–31.

    Article  Google Scholar 

  40. Prasad UV, Vastrad P, Chandan N, Barvaliya MJ, Kirte R, Sabarinath R et al. A community-based study of dental fluorosis in rural children (6–12 years) from an aspirational district in Karnataka, India. Front Public Heal. 2023;11.

  41. Singh A, Palaniyandi S, Palaniyandi A, Gupta V, Kumar PR, Mahore Rkumar, et al. A cross–sectional study to assess the utilization pattern of maternal health services and associated factors in aspirational district of Haryana, India. J Fam Med Prim Care. 2021;10:2879–85.

    Article  Google Scholar 

  42. Katekar VP, Deshmukh SS. Assessment of Socioeconomic Development of the Aspirational District in Central India: a methodological comparison. J Asian Afr Stud. 2022;:1–29.

  43. Kumar A, Jeeva JC, Saranga DN, Panda AK, Srivastava SK. Analysis of Socio-economic status of people in aspirational districts of Odisha for inclusive growth. J AgriSearch. 2020;7:158–62.

    Article  CAS  Google Scholar 

  44. International Institute for Population Sciences (IIPS). and ICF. National Family Health Survey (NFHS-4) 2015-16, India. 2015.

  45. Centre for Social and Behaviour, Change AU. Stories of Change: From India’s Aspirational Districts. 2022.

  46. NITI Aayog. List of 112 Aspirational Districts: NITI Aayog. 2018.

  47. Jana A, Chattopadhyay A, Saha UR. Identifying risk factors in explaining women’s anaemia in limited resource areas: evidence from West Bengal of India and Bangladesh. BMC Public Health. 2022;22:1–16.

    Article  Google Scholar 

  48. Balarajan YS, Fawzi WW, Subramanian SV. Changing patterns of social inequalities in anaemia among women in India: cross-sectional study using nationally representative data. BMJ Open. 2013;3:1–11.

    Article  Google Scholar 

  49. Nankinga O, Aguta D. Determinants of Anemia among women in Uganda: further analysis of the Uganda demographic and health surveys. BMC Public Health. 2019;19:1–9.

    Article  Google Scholar 

  50. Loy SL, Lim LM, Chan S-Y, Tan PT, Chee YL, Quah PL, et al. Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study. BMC Public Health. 2019;19:397.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Jamnok J, Sanchaisuriya K, Sanchaisuriya P, Fucharoen G, Fucharoen S, Ahmed F. Factors associated with anaemia and iron deficiency among women of reproductive age in Northeast Thailand: a cross-sectional study. BMC Public Health. 2020;20:1–8.

    Article  Google Scholar 

  52. Al-farsi YM, Brooks DR, Werler MM, Cabral HJ, Al-shafei MA. Effect of high parity on occurrence of anemia in pregnancy: a cohort study. BMC Pregnancy Childbirth. 2011;11:1471–2393.

    Article  Google Scholar 

  53. Gautam S, Min H, Kim H, Jeong H. Determining factors for the prevalence of anemia in women of reproductive age in Nepal: evidence from recent national survey data. PLoS ONE. 2019;:1–17.

  54. Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, De Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;382:427–51.

    Article  PubMed  Google Scholar 

  55. Williams PA, Poehlman J, Moran K, Siddiqui M, Kataria I, Rego AM, et al. Strategies to address anaemia among pregnant and lactating women in India: a formative research study. Public Health Nutr. 2020;23:795–805.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Guddattu BSP. Understanding the change in the prevalence and factors influencing the Childhood Stunting using District-Level Data from NFHS-4 and NFHS-5 in India. Inq J Heal Care Organ Provision Financ. 2022;59:1–10.

    Google Scholar 

  57. Singh A, Let S, Tiwari S, Chakrabarty M. Spatiotemporal variations and determinants of overweight/obesity among women of reproductive age in urban India during 2005–2021. BMC Public Health. 2023;23:1–19.

    Article  Google Scholar 

  58. World Health Organization. A healthy lifestyle - WHO recommendations. 2010. https://www.who.int/europe/news-room/fact-sheets/item/a-healthy-lifestyle---who-recommendations. Accessed 12 Apr 2023.

  59. Chen Y-T, Chen MC. Using Chi Square statistics to measure similarities for text categorization. Expert Syst Appl. 2011;38:3085–90.

    Article  Google Scholar 

  60. Mertler CA, Vannatta RA, LaVenia KN. Binary logistic regression. Advanced and Multivariate Statistical methods. New York: Routledge; 2015. pp. 219–74.

    Google Scholar 

  61. Chakrabarty M, Singh A, Singh S, Chowdhury S. Is the burden of anaemia among Indian adolescent women increasing? Evidence from Indian demographic and health surveys (2015–21). PLOS Glob Public Heal. 2023;3:e0002117.

    Article  Google Scholar 

  62. Midi H, Sarkar SK, Rana S. Collinearity diagnostics of binary logistic regression model. J Interdiscip Math. 2010;13:253–67.

    Article  Google Scholar 

  63. Hemmert GAJ, Schons LM, Wieseke J, Schimmelpfennig H. Log-likelihood-based Pseudo-R2 in logistic regression: deriving sample-sensitive benchmarks. Sociol Methods Res. 2018;47:507–31.

    Article  MathSciNet  Google Scholar 

  64. Hosmer DW, Lemesbow S. Goodness of fit tests for the multiple logistic regression model, Communications in Statistics - Theory and Methods. 2007. p. 1043–69.

  65. Multiple Regression Analysis - an overview. Nutrition in the Prevention and Treatment of Disease. https://www.sciencedirect.com/topics/economics-econometrics-and-finance/multiple-regression-analysis. Accessed 15 Dec 2023.

  66. StataCorp LLC. Stata Release 17: Statistical Software. StataCorp; 2021.

  67. Bharati S, Pal M, Sen S, Bharati P. Malnutrition and anaemia among adult women in India. J Biosoc Sci. 2019;51:1–11.

    Article  Google Scholar 

  68. Abu-Baker NN, Eyadat AM, Khamaiseh AM. The impact of nutrition education on knowledge, attitude, and practice regarding iron deficiency anemia among female adolescent students in Jordan. Heliyon. 2021;7:e06348.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Abate TW, Getahun B, Birhan MM, Aknaw GM, Belay SA, Demeke D, et al. The urban–rural differential in the association between household wealth index and anemia among women in reproductive age in Ethiopia, 2016. BMC Womens Health. 2021;21:1–8.

    Article  Google Scholar 

  70. Desta M, Akibu M, Tadese M, Tesfaye M. Dietary diversity and Associated Factors among pregnant women attending Antenatal Clinic in Shashemane, Oromia, Central Ethiopia: a cross-sectional study. J Nutr Metab. 2019;2019:7–10.

    Article  Google Scholar 

  71. Dean WR, Sharkey JR. Rural and urban differences in the associations between characteristics of the community food environment and fruit and vegetable intake. J Nutr Educ Behav. 2011;43:426–33.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Hossain M, Islam Z, Sultana S, Rahman AS, Hotz C, Haque A, et al. Effectiveness of Workplace Nutrition Programs on Anemia Status among female readymade. Nutrients. 2019;11:1–23.

    Article  CAS  Google Scholar 

  73. Awoleye AF, Alawode OA, Chima V, Okunlola DA, Obiesie S. Rural-urban differentials in the relationship between household wealth index and maternal anaemia status in Nigeria. Health Care Women Int. 2022;:1–17.

  74. Liou L, Kim R, Subramanian SV. Identifying geospatial patterns in wealth disparity in child malnutrition across 640 districts in India. SSM - Popul Heal. 2020;10:1–10.

    Google Scholar 

  75. Sharma H, Singh SK, Srivastava S. Socio-economic inequality and spatial heterogeneity in anaemia among children in India: evidence from NFHS-4 (2015–16). Clin Epidemiol Glob Heal. 2020;8:1158–71.

    Article  Google Scholar 

  76. Sharma H, Singh SK, Srivastava S. Major Correlates of Anemia among women (Age 15–49) in India and spatial variation, evidence from National Family Health Survey-4. J Women’s Heal Care. 2018;07:1–13.

    Google Scholar 

  77. Dewey KG, Cohen RJ, Brown KH, Rivera LL. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. J Nutr. 2001;131:262–7.

    Article  CAS  PubMed  Google Scholar 

  78. Chauhan S, Kumar P, Marbaniang SP, Srivastava S, Patel R. Prevalence and predictors of anaemia among adolescents in Bihar and Uttar Pradesh, India. Sci Rep. 2022;12:1–9.

    Article  Google Scholar 

  79. Perumal V. Reproductive risk factors assessment for anaemia among pregnant women in India using a multinomial logistic regression model. Trop Med Int Health. 2014;19:841–51.

    Article  PubMed  Google Scholar 

  80. Teshale AB, Tesema GA, Worku MG, Yeshaw Y, Tessema ZT. Anemia and its associated factors among women of reproductive age in eastern Africa: a multilevel mixed-effects generalized linear model. PLoS ONE. 2020;15(9 September):1–16.

    Google Scholar 

  81. Liyew AM, Teshale AB. Individual and community level factors associated with anemia among lactating mothers in Ethiopia using data from Ethiopian demographic and health survey, 2016; a multilevel analysis. BMC Public Health. 2020;20:1–11.

    Article  Google Scholar 

  82. Kamath R, Majeed J, Chandrasekaran V, Pattanshetty S. Prevalence of anemia among tribal women of reproductive age in Udupi Taluk, Karnataka. J Fam Med Prim Care. 2013;2:345.

    Article  Google Scholar 

  83. Rohisha IK, Jose TT, Chakrabarty J. Prevalence of anemia among tribal women. J Fam Med Prim Care. 2019;6:145–7.

    Article  Google Scholar 

  84. Vart P, Jaglan A, Shafique K. Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005–2006 Chronic Disease epidemiology. BMC Public Health. 2015;15:1–8.

    Article  Google Scholar 

  85. De M, Halder A, Podder S, Sen R, Chakrabarty S, Sengupta B, et al. Anemia and hemoglobinopathies in tribal population of Eastern and North-eastern India. Hematology. 2006;11:371–3.

    Article  CAS  PubMed  Google Scholar 

  86. Tong TYN, Key TJ, Gaitskell K, Green TJ, Guo W, Sanders TA, et al. Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank. Am J Clin Nutr. 2019;110:461–72.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Imai E, Nakade M. Fish and meat intakes and prevalence of anemia among the Japanese elderly. Asia Pac J Clin Nutr. 2019.

  88. Rammohan A, Awofeso N, Robitaille M-C. Addressing Female Iron-Deficiency Anaemia in India: is Vegetarianism the Major obstacle? ISRN Public Health. 2012;2012:1–8.

    Article  Google Scholar 

  89. Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18:288–93.

    Article  PubMed  Google Scholar 

  90. Bharati P, Som S, Chakrabarty S, Bharti S, Pal M. Prevalence of Anemia and its determinants among nonpregnant and pregnant women in India. Asia-Pacific J Public Heal. 2008;20:347–59.

    Article  Google Scholar 

  91. Win HH, Ko MK. Geographical disparities and determinants of anaemia among women of reproductive age in Myanmar: analysis of the 2015–2016 Myanmar demographic and Health Survey. WHO South-East Asia J Public Heal. 2018;7:107–13.

    Article  Google Scholar 

  92. Varghese JS, Stein AD. Malnutrition among women and children in India: limited evidence of clustering of underweight, anemia, overweight, and stunting within individuals and households at both state and district levels. Am J Clin Nutr. 2019;109:1207–15.

    Article  PubMed  Google Scholar 

  93. Rahman MS, Mushfiquee M, Masud MS, Howlader T. Association between malnutrition and anemia in under-five children and women of reproductive age: evidence from Bangladesh demographic and Health Survey 2011. PLoS ONE. 2019;14:1–18.

    Article  CAS  Google Scholar 

  94. Ministry of women and child development. Natl Nutr Policy. 1993.

  95. Kapil U, Kapil R, Gupta A. National Iron Plus Initiative: current status & future strategy. Indian J Med Res. 2019;150:239–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. Weekly Iron Folic Acid Supplementation(WIFS): National Health Mission.388. Accessed 7 Mar 2023.

  97. Ms Gupta A, Dr Kumar R, Dr Singh Salhotra V, Ms Mohan A, Dr Rahi S. Guidelines for Control of Iron Deficiency Anaemia. 2013.

  98. Ahmad K, Singh J, Singh RA, Saxena A, Varghese M, Ghosh S, et al. Public health supply chain for iron and folic acid supplementation in India: Status, bottlenecks and an agenda for corrective action under Anemia Mukt Bharat strategy. PLoS ONE. 2023;18(2 February):1–18.

    Google Scholar 

  99. Sharda S. In war against anaemia, UP’s aspirational districts Shravasti raises iron supplement coverage by 10 times in 10 months. The Times of India. 2023. https://timesofindia.indiatimes.com/city/lucknow/in-war-against-anaemia-ups-aspirational-district-shravasti-raises-iron-supplement-coverage-by-10-times-in-10-month/articleshow/99248734.cms. Accessed 6 Dec 2023.

  100. Mishra R. Chhattisgarh government to launch campaign to eradicate malnutrition and anaemia. Hindustan Times, Raipur. 2019. https://www.hindustantimes.com/india-news/chhattisgarh-government-to-launch-campaign-to-eradicate-malnutrition-and-anaemia/story-nNAtYD7HcVkUgbdfF7VIbP.html. Accessed 6 Dec 2023.

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Acknowledgements

Subhojit Let (Ref. No: 200510160983) and Mahashweta Chakrabarty (Ref. No: 200510082749) acknowledge the support of Junior Research Fellowship provided by University Grants Commission, India. Dr. Aditya Singh acknowledges the support of Institute of Eminence Seed Grant (R/Dev/D/IoE/Equipment/Seed Grant-II/2022-23/48726) provided by Banaras Hindu University.

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Subhojit Let: Data curation; Formal analysis; Investigation; Methodology; Validation; Visualization; Writing– original draft; Writing– review & editing. Seema Tiwari: Investigation; Validation; Supervision; Project administration, Visualization. Aditya Singh: Conceptualization; Investigation; Project administration; Formal analysis; Supervision; Validation; Visualization; Writing– review & editing. Mahashweta Chakrabarty: Formal analysis; Methodology; Software; Project administration; Writing– original draft; Writing– review & editing.

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Correspondence to Aditya Singh or Mahashweta Chakrabarty.

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Let, S., Tiwari, S., Singh, A. et al. Prevalence and determinants of anaemia among women of reproductive age in Aspirational Districts of India: an analysis of NFHS 4 and NFHS 5 data. BMC Public Health 24, 437 (2024). https://doi.org/10.1186/s12889-024-17789-3

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