Temporal trends and differential patterns in the prevalence of severe anaemia in India: observations from country-wide haemoglobin determinations 2008-2018.

Abstract

To assess temporal trends in the occurrence of severe anaemia in India over the past decade, encompassing every state and union territory. For the period 2008-09 to 2017-18, annual estimates (%) of severe anaemia (haemoglobin<7g/dl) for India were derived from Health Management Information System datasets, along with 95% confidence intervals (CIs) to construct temporal trends. Differential patterns in the distribution of severe anaemia by geography, epidemiological transition level and socio-demographic index values were also investigated. Severe anaemia occurred in 3.29% (95% CI: 3.28-3.30%) of all haemoglobin determinations in India in 2017-18, which was less than a third of the number in 2008-09. This decline (overall 7.8% or 0.78% per year) over the past decade was consistent (χ2trend =1557296, P<0.001). Distribution of severe anaemia was heterogeneous between states and union territories (in 2017-18), ranged from<1% (in Kerala and Lakshadweep) to>8% (in Telangana). Significant variations were observed according to geographical region (highest in Central zone), epidemiological transition level (highest at higher middle epidemiological transition level) and socio-demographic index (highest at middle socio-demographic index). Severe anaemia burden between rural and urban areas also differed significantly. Although the prevalence of severe anaemia has decreased in India over the last decade, it remains substantial and differs widely with respect to geography, epidemiological transition level, and socio-economic conditions. A detailed assessment of the various aetiologies and documentation of their spatial epidemiology is desirable to understand their relative contribution to the severe anaemia burden and to design appropriate interventions.