Trends in Socioeconomic Inequalities and Prevalence of Anemia Among Children and Nonpregnant Women in Low- and Middle-Income Countries

Fan Yang,Panpan Zha,Xueyi Liu

doi:10.1001/jamanetworkopen.2018.2899

Abstract

Anemia remains a major challenge for women's and children's health in low- and middle-income countries (LMICs). To assess the socioeconomic inequalities and prevalence of anemia among children and nonpregnant girls and women in LMICs over time. This cross-sectional and repeated cross-sectional analysis used data from the Demographic and Health Surveys collected from January 1, 2000, through December 31, 2014. Initial cross-sectional data sets constructed from the most recent surveys included 163 419 children aged 6 to 59 months and 304 202 nonpregnant girls and women aged 15 to 49 years (hereinafter referred to as nonpregnant women) from 45 LMICs. Repeated cross-sectional data sets from the most recent and the earliest surveys consisted of 322 088 nonpregnant women from 25 LMICs and 182 273 children from 24 LMICs. Analyses were conducted from June 1, 2016, through July 3, 2018. Total and severe anemia for children aged 6 to 59 months (hemoglobin level, <11 and <7 g/dL, respectively) and nonpregnant women aged 15 to 49 years (<12 and <8 g/dL, respectively) were defined according to the World Health Organization hemoglobin cutoff levels. The slope index of inequality (SII) and the relative index of inequality (RII) were calculated to determine anemia inequalities. Among the 163 419 children aged 6 to 59 months and the 304 202 nonpregnant women aged 15 to 49 years in the initial cross-sectional data sets, 34 of 45 countries had anemia prevalence levels for children greater than 40% and 37 of 45 had anemia prevalence levels greater than 20% for nonpregnant women. Among the 182 273 children from 24 LMICs and 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.67 to 3.98 percentage points in 16 of the 24 LMICs; for cases of severe anemia, the decrease was 0.03 to 0.82 percentage points in 15 LMICs. Among 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.49 to 2.59 percentage points in 17 of 25 LMICs; for severe anemia, the decrease was 0.03 to 0.29 percentage points in 15 LMICs. The SII was significantly negative and the RII was significantly less than 1 in 37 of the 45 LMICs among children and in 26 of the 45 LMICs for nonpregnant women. The annualized changes in the SII approached 0 in 16 of the 24 LMICs among children and in 11 of 25 LMICs among nonpregnant women. Most LMICs continue to exhibit a high prevalence of anemia among children and nonpregnant women, although the prevalence of total and severe anemia have decreased in many LMICs. Anemia inequalities among children and nonpregnant women persist in most LMICs.

Highlights

Most lowand middle-income countries (LMICs) continue to exhibit a high prevalence of anemia among children and nonpregnant women, the prevalence of total and severe anemia have decreased in many LMICs
Anemia inequalities among children and nonpregnant women persist in most LMICs
Evidence existed of greater inequality with respect to anemia among children than in nonpregnant women

Summary

Introduction

Anemia remains a major challenge for the health and development of women and children in lowand middle-income countries (LMICs).[1,2,3,4] Anemia is a serious public health problem affecting 293.1 million children and 468.4 million nonpregnant women in LMICs.[1,3,4] In most LMICs, anemia is a major cause of child and maternal mortality[1,2] and is associated with an increased risk of low birth weight, cognitive impairment,[3] increased susceptibility to infection,[1] and delayed physical and mental development with diminished ability to work.[1,3] Significantly, anemia serves as an indicator of socioeconomic disadvantage because it is inversely related to the socioeconomic status of households in developing settings[1,3,4]; individuals with low socioeconomic status are at a higher risk of exposure to anemia and its sequelae.[3]. Previous studies have estimated the magnitude of anemia among children and nonpregnant women,[4,7,8,9] few systematic attempts have been made to monitor the socioeconomic inequalities of anemia and how anemia inequalities vary over time in LMICs. anemia inequalities have not been explored for comparison across countries[10] because standardized measurement tools and similar surveys have not been used. We used data from the Demographic and Health Surveys (DHS) to systematically evaluate the socioeconomic inequalities and prevalence of anemia among children and nonpregnant women in LMICs over time

Methods

Results

Discussion

Conclusion