Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005-2006.

Priya Vart,Kashif Shafique,Ajay Jaglan

doi:10.1186/s12889-015-1881-4

Abstract

BackgroundCaste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary. Evidence suggests that belonging to lower castes exposes one to social inequalities and affects health adversely. We examined the association of caste with childhood anemia in India and explored the effect modifying role of adult education and household wealth.MethodsA cross-sectional analysis of National Family Health Survey (NFHS) data of 43,484 children aged 6–59 months was performed. Poisson regression analysis was conducted to study the association between caste and childhood anemia accounting for various maternal, child, and household related variables. Caste was categorized as “other caste” (least disadvantageous), “other backward caste”, “scheduled tribe” and “scheduled caste” (most disadvantageous). Anemia was defined as mild (hemoglobin level 7-11 g/dL), moderate (hemoglobin level 5-7 g/dL) and severe (hemoglobin level <5 g/dL).ResultsWe found that children in scheduled caste had higher risk of having anemia [mild anemia: RR = 1.10, 95 % CI = 1.05-1.15; moderate anemia: RR = 1.19, 95 % CI = 1.14–1.24; severe anemia: RR = 1.87, 95 % CI = 1.51 – 2.31] after accounting for child, maternal and household covariates including adult education and household wealth. The interaction of caste with adult education and household wealth was not statistically significant for any level of anemia. Sensitivity analyses for children born to mothers of age ≥ 18 years at first child birth and body mass index (BMI) ≥ 18.5 kg/m2, resulted in similar findings.ConclusionCaste is an independent determinant of childhood anemia in India. The level of adult education and household wealth did not modify the association between caste and childhood anemia. The findings may be used for countering childhood anemia and it may be beneficial to target future public health actions towards disadvantageous castes in India.

Highlights

Caste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary
Our results suggest that the caste based social segregation is associated with mild, moderate and severe levels of anemia in India
In present study, using more recent data (NFHS 2005–2006), we examine the association between caste and childhood anemia independent of adult education and household wealth

Summary

Introduction

Caste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary. Evidence suggests that belonging to lower castes exposes one to social inequalities and affects health adversely. We examined the association of caste with childhood anemia in India and explored the effect modifying role of adult education and household wealth. The proportion of children under 5 years of age having anemia in India is among the highest in the world. Existing research on childhood anemia has mainly focused on factors like maternal age, education, height, child breastfeeding and. A large proportion of people of disadvantageous castes belong to low socioeconomic groups in India. These people are generally exposed to poor living conditions, have poor diet and limited access to health care. Children born in disadvantageous castes are more likely to face infections (e.g. malaria), have iron

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