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

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

SUBMITTER: Rai A

PROVIDER: S-EPMC7507699 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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

Rai Anjana A Khan Md Nuruzzaman MN Thapa Subash S

Maternal & child nutrition 20200706 4

In Nepal, the prevalence of anaemia decreased by 1% from 2006 to 2011 but increased by 6% from 2011 to 2016. In this study, we examined the changes in prevalence by possible factors from 2006 to 2016 along with the factors associated with anaemia among women of reproductive age (15-49 years) using the Nepal Demographic and Health Survey (NDHS) data from years 2006, 2011 and 2016. We used rate of change analysis to explore average annual rate of change (AARC) in anaemia prevalence and concentrati ...[more]

PMID: 32627381

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Project description:BACKGROUND:The prevalence of iron deficiency anaemia remains high in pregnant women and the situation may be worse for pregnant adolescents. This study aimed to comparatively analyse the trends and determinants of anaemia between adult and teenage pregnant women in rural Ghana. METHODS:A retrospective study design was employed. Data including primarily pregnancy history, haemoglobin levels and anaemia status were collected from the manual medical records of 1002 women stored in the repositories of two rural district hospitals in the Ashanti Region of Ghana over the years 2011-2015. Data was analysed using chi-square analysis, t-test, two-way ANOVA and binary logistic regression. Bivariate and multivariate analyses were also done to establish associations and predictors of anaemia. RESULTS:An overall drop in mean haemoglobin from 11.1?g/dl in 2011 to 10.6?g/dl in 2015 was observed for adults, while an overall increase from 9.4?g/dl to 10.2?g/dl occurred in teenagers. Further, anaemia prevalence declined at the 36th week of pregnancy, and from 2011 to 2015, for both teenagers and adults. Among factors tested for association with haemoglobin levels using bivariate and multivariate analyses, gestational age alone was significant (P =?0.028). Between-subject effects determined using 2-way ANOVA indicated year of pregnancy alone, as well as in combination with age group (F?=?3.1, P =?0.019) significantly affected haemoglobin levels. From binary regression analysis, BMI (OR 0.967, 95% CI:0.936-0.999, P =?0.042), gestational age (OR 1.058, 95% CI:1.013-1.106, P =?0.011) and pregnancy year (OR-2012(0.402); 2013(0.53); 2014(0.569); 2015(0.817), 95% CI: 2012(0.256-0.631); 2013(0.338-0.829); 2014(0.366-0.886); 2015(0.501-1.333), P =?0.001) were found to be significant predictors of anaemia at first antenatal visit. Also, the trimester of reporting for antenatal care, specifically the second trimester (OR-0.261, 95% CI: 0.072-0.951, P =?0.042) and the pregnancy year (OR-2012(0.235); 2013(0.206); 2014(0.530); 2015(0.222), 95% CI: 2012(0.101-0.545); 2013(0.081-0.522); 2014(0.197-1.428); 2015(0.049-1.018), P =?0.003) were more significant at the 36th pregnancy week. CONCLUSIONS:Although the trends observed were decreasing in both adults and teenagers in the years reported, anaemia levels remained high for each year in either group. Anaemia, therefore remains a major health problem, especially in the areas studied, and antenatal interventions need a second look to know what might make them more effective.

Project description:INTRODUCTION:In Nepal, a substantial proportion of women still deliver their child at home. Disparities have been observed in utilisation of institutional delivery and skilled birth attendant services. We performed a disaggregated analysis among marginalised and non-marginalised women to identify if different factors are associated with home delivery among these groups. MATERIALS AND METHODS:This study used data from the 2016 Nepal Demographic and Health Survey. It involves the analysis of 3,837 women who had experienced at least one live birth in the five years preceding the survey. Women were categorised as marginalised and non-marginalised based on ethnic group. Bivariate and multivariable logistic regression analysis were performed to identify factors associated with home delivery. RESULTS:A higher proportion of marginalised women delivered at home (47%) than non-marginalised women (26%). Compared to non-marginalised women (35%), a larger proportion of marginalised women (64%) felt that it was not necessary to give birth at health facility. The multivariable analysis indicated an independent association of having no or basic education, belonging to middle, poorer and the poorest wealth quintile, residing in Province 2 and not having completed of four antenatal care visits per protocol with home delivery among both marginalised and non-marginalised women. Whereas residing in a rural area, residing in Province 7, and at a distance of >30 minutes to a health facility were factors independently associated with home delivery only among marginalised women. CONCLUSION:We conclude that poor education, poor economic status, non-completion of four ANC visits and belonging to Province 2 particularly determined either group of women to deliver at home, whereas residing in rural areas, living far from health facility, and belonging to Province 7 determined marginalised women to deliver at home. Preventing mothers from delivering at home would thus require focusing on specific geographical areas besides considering wider socio-economic determinants.

Dataset Information

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

Publications

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

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