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

Abstract

ObjectiveThe main objective of this study was to explore the factors affecting anaemia among women of reproductive age (WRA) in Nepal using spatial and multilevel epidemiological analysis.DesignThis cross-sectional study analysed data from the 2016 Nepal Demographic and Health Survey. Spatial analysis was performed using ArcGIS software V.10.8 to identify the hot and cold spots of anaemia among WRA (15–49 years). Data were analysed using multilevel mixed-effect logistic regression analysis.SettingNepal.ParticipantsA total of 6414 WRA were included in the analysis.Main outcome measureAnaemia defined by WHO as haemoglobin level less than 120 g/L in non-pregnant women and less than 110 g/L in pregnant women.ResultsThe spatial analysis showed that statistically significant hotspots of anaemia were in the southern Terai region (four districts in province 1, eight districts in province 2, one district in Bagmati province, two districts in province 5 and one district in Sudurpaschim province) of Nepal. At the individual level, women who underwent female sterilisation (adjusted OR, aOR: 3.61, 95% CI 1.10 to 11.84), with no education (aOR: 1.99, 95% CI: 1.17 to 3.39), and from middle socioeconomic class families (aOR: 1.65, 95% CI: 1.02 to 2.68) were more likely to be anaemic, whereas, older women (>35 years) (aOR: 0.51, 95% CI: 0.26 to 0.97) and those women who were using hormonal contraceptives (aOR: 0.63, 95% CI: 0.43 to 0.90) were less likely to be anaemic. At the community level, women from province 2 (aOR=2.97, 95% CI: 1.52 to 5.82) had higher odds of being anaemic.ConclusionWRA had higher odds of developing anaemia, and it varied by the geographical regions. Nutrition-specific and nutrition-sensitive interventions can be tailored based on the factors identified in this study to curb the high burden of anaemia.

Spatial Variations and Determinants of Anemia among Under-five Children in Nepal, DHS (2006–2016)

“…In 2016, the hotspots were observed in different districts of central east Terai, while coldspots were observed around Kathmandu and Kaski regions. Possible reasons include a lack of safe and appropriate drinking water in the Terai region, which increases the probability of malaria and hookworm infection, as well as a lack of variety in the Terai diet, which increases the risk of anemia [ 18 , 39 , 40 , 41 ]. In addition, Kaski and Pokhara ranked last and fourth last among all districts in Nepal in poverty rate as per the small areas poverty estimation of 2016 [ 42 ].…”

“…Contrary to the recent DHS survey, the spatial distribution of hotspots around Kathmandu in 2006 is unrealistic and hard to explain. However, hotspots in the eastern mountain region in 2006 can be explained by poor healthcare delivery in these areas [ 18 ], which have improved in recent decades [ 43 ].…”

“…Regional administrative divisions may set different boundaries in various directions across sectors and locations [ 17 ]. In a study conducted in Nepal among reproductive-age women, the spatial analysis showed that statistically significant hotspots of anemia were in the southern Terai region (four districts in province 1, eight districts in province 2, one district in Bagmati province, two districts in province 5, and one district in Sudurpaschim province) [ 18 ]. However, no effort has been made to date in Nepal to discover regional variations of under-five anemia, despite the fact that understanding spatial variations and associated variables could be critical for a country’s development.…”

Anemia and Associated Factors Among Lactating Women in Sierra Leone: An Analysis of the Sierra Leone Demographic and Health Survey 2019

“…This finding is contrary to what is scientifically known that modern contraceptive methods (mostly the hormonal contraceptives) reduce menstrual bleeding and hence decrease susceptibility of women to anemia as confirmed by findings from the different studies conducted in Rwanda, East Africa, Ethiopia, and Nepal. 4 , 33 - 35 …”

Prevalence of anemia and its associated factors among women of reproductive age group attending Gaur Provincial Hospital: A cross-sectional study

“…A complex interaction among socio-political, biological, and ecological elements ultimately regulates anemia and its prevalence among women that incorporates rural places of residency, younger age, inadequate nutrition, pregnancy, repeated childbearing, breastfeeding, and lack of hormonal contraceptives. 5 The prevalence of anemia among the WRA group in our belt is significantly under-reported. Adequate reporting helps understand the true burden of anemia.…”