The rise in anaemia among adolescent women in India: a comprehensive study on prevalence trends

By Pooja Toshniwal PahariaSep 7 2023Reviewed by Sophia Coveney

In a recent study published in PLOS Global Public Health, researchers analyzed the change in the prevalence of anemia among adolescent women in India from 2015 to 2021. They identified the factors associated with anemia in this population.

Anemia is a major health concern in India, particularly among women, as it affects the number of erythrocytes and hemoglobin concentrations, leading to decreased oxygen-carrying capacity of blood.

Women are particularly susceptible to low hemoglobin concentrations due to their unique physiological needs, including menstrual blood loss and pregnancy. However, data on the anemia burden among Indian adolescent females is limited, making it a significant concern for females in India.

About the study

In the present cross-sectional study, researchers investigated whether the prevalence rates of anemia among adolescent Indian women changed between 2015 and 2016 and between 2019 and 2021. In addition, they examined several factors linked to anemia in the study population.

The researchers analyzed data obtained from adolescent females aged 15 to 19 who participated in rounds 4 (n=116,117) and 5 (n=109,400) of the National Family Health Survey (NFHS). Blood samples were obtained from all participants to measure hemoglobin levels. Multivariate logistic regression modeling was performed, and the adjusted odds ratios (AORs) were determined.

In addition to AOR values, bivariate statistics were used to identify significant risk determinants of anemia. Databases such as the Web of Science, Google Scholar, and PubMed were searched for relevant scientific data, which was analyzed to obtain potential risk factors for anemia. The determinants were divided into socioeconomic, biodemographic, geographic, behavioral, and health-associated groups.

The variables analyzed included marital status, parity, pregnancy and lactation status, education, social groups, religion, household wealth index, residence type, residence region, exposure to mass media, dietary habits, contraceptive usage, alcohol intake, tobacco use, body mass index (BMI) values, diabetes, and amenorrhea.

Non-adolescent individuals aged 20 to 49 years and those with missing information on anemia, social group, body mass index, and age at marriage were excluded from the analysis. Anemia prevalence was evaluated at the national and state levels separately for both periods to increase the granularity of the study findings.

Combining both datasets enabled the evaluation of the independent effects of the year of the survey on anemia prevalence. Variance Influence Factors (VIFs) were calculated before the modeling analysis.

Results and discussion

Among the study participants, 10% of NFHS-4 and 8% of NFHS-5 participants were married prior to 18 years of age. Over 80% of NFHS-5 participants were single, and more than 90% of the female adolescents were nulliparous in both NFHS rounds. Above 90% of participants were not pregnant or lactating during both rounds.

Most adolescents (80%) had attained secondary-level education, and 22% and 25% of NFHS-4 and 5 participants represented the scheduled tribe (ST). In both rounds, over 80% of adolescents were Hindus, 70% resided in rural regions, and 15% to 20% had no prior mass media exposure. Further, over 70% were non-vegetarians, 40% had BMI values lower than 19, and slightly over one percent of adolescents were amenorrhoeic.

Anemia prevalence among Indian adolescent females rose from 54% to 59% from 2015-2016 to 2019-2021. Out of 28 states of India, anemia prevalence increased in 21 states. However, the extent of the elevation varied among the Indian states. Tripura, Chhattisgarh, and Assam showed a considerable increase of 15 percent points, whereas Madhya Pradesh, Bihar, Telangana, Karnataka, and Punjab recorded a slight rise of less than 5 percent points.

Of note, Kerala and Uttarakhand showed a drop in the prevalence rates of anemia during the period of the study. In addition, the count of Indian states with anemia prevalence rates of over 60% increased from five between 2015 and 2016 to 11 between 2019 and 2021.

Multiple anemia-related factors were identified, including being uneducated, multiparous households, representing the lowest economic quintile, belonging to the ST group, being underweight, and the survey year.

In India, anemia is a significant issue among women. Women with higher education levels are less likely to be anemic, as education improves nutrition and health knowledge, leading to better dietary practices and anemia prevention. Wealthier households have better access to nutritious food, healthcare, and improved living conditions, which can help prevent anemia.

However, women from the ST community have a higher risk of anemia due to historical disadvantages, limited access to healthcare, undernutrition, discrimination, and early childbearing. Underweight women also have a higher risk due to inadequate nutrient intake.

Implications

Overall, the study findings showed increased anemia prevalence among Indian adolescent females, providing valuable insights for policymakers and program implementers. The results highlighted the need for increasing investments in maternal and neonatal wellness, as well as health and nutrition-related educational programs, to decrease the anemia burden on Indian adolescent females.

However, the likelihood of anemia was higher for ST group adolescents and those residing in eastern India, highlighting that state-specific and culture-specific interventions are required. Adolescent females who were not underweight showed a lower likelihood of being anemic, emphasizing the need for improved accessibility to health services and nutritious food.

The findings also indicated that anemia programs such as the Poshan Abhiyan and the National Iron Plus Initiative (NIPI) must be continually monitored and evaluated to ensure effectiveness in decreasing anemia in the female adolescent population of India.