Abstract
Anemia remains one of the most intractable public health challenges in South Asia. This paper analyzes individual‐level and household‐level determinants of anemia among children and women in Nepal and Pakistan. Applying multivariate modified Poisson models to recent national survey data, we find that the prevalence of anemia was significantly higher among women from the poorest households in Pakistan (adjusted prevalence ratio [95% CI]: 1.10 [1.04–1.17]), women lacking sanitation facilities in Nepal (1.22 [1.12–1.33]), and among undernourished women (BMI < 18.5 kg/m2) in both countries (Nepal: 1.10 [1.00–1.21] and Pakistan: 1.07 [1.02–1.13]). Similarly, children in both countries were more likely to be anemic if stunted (Nepal: 1.19 [1.09–1.30] and Pakistan: 1.10 [1.07–1.14]) and having an anemic mother (Nepal: 1.31 [1.20–1.42] and Pakistan: 1.21 [1.17–1.26]). Policies and programs need to target vulnerable and hard‐to‐reach subpopulations who continue to bear a disproportionate burden of anemia. Covariates of poverty underpin rates of anemia among children and their mothers, but income growth alone will not suffice to resolve such deeply entrenched problems. Greater understanding of the relative role of various diet, health, sanitation, and educational factors by local context should guide investments to resolve anemia in tandem with stunting and maternal underweight.
Highlights
Anemia remains a major public health problem, affecting one third of all adults and almost two billion people worldwide (Global Burden of Disease disability‐adjusted life years (DALYs) et al, 2015; Kassebaum et al, 2014)
Anemia was prevalent among children and women in our sample from Nepal and Pakistan, indicating a moderate to severe public health concern in these populations
Bangladesh is the only country in South Asia that is on track to meet the World Health Assembly goal to reduce by 50% the prevalence of anemia in women of reproductive age (WRA) by 2025
Summary
Anemia remains a major public health problem, affecting one third of all adults and almost two billion people worldwide (Global Burden of Disease DALYs et al, 2015; Kassebaum et al, 2014). Defined broadly as a condition associated with lower than normal hemoglobin concentration, anemia impairs the circulation of oxygen in the blood, which in turn has detrimental effects on maternal and birth outcomes, suboptimal child growth, impaired learning, and reduced work productivity and income earning during adulthood (International Food Policy Research Institute, 2016). Such effects compounded across the entire populations lead to significant economic losses, through foregone gross domestic product (GDP) and treatment costs (Balarajan, Ramakrishnan, Özaltin, Shankar, & Subramanian, 2011). The modeled data suggest that between 1995 and 2011, the prevalence of anemia among nonpregnant women in South Asia declined slightly from 53% (95% credibility interval: 42–64%) to 47% (33–59%) and there
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