Abstract
BackgroundThe geographical differences that cause anaemia can be partially explained by the variability in environmental factors, particularly nutrition and infections. The studies failed to explain the non-linear effect of the continuous covariates on childhood anaemia. The present paper aims to investigate the risk factors of childhood anaemia in India with focus on geographical spatial effect.MethodsGeo-additive logistic regression models were fitted to the data to understand fixed as well as spatial effects of childhood anaemia. Logistic regression was fitted for the categorical variable with outcomes (anaemia (Hb < 11) and no anaemia (Hb ≥ 11)). Continuous covariates were modelled by the penalized spline and spatial effects were smoothed by the two-dimensional spline.ResultsAt 95% posterior credible interval, the influence of unobserved factors on childhood anaemia is very strong in the Northern and Central part of India. However, most of the states in North Eastern part of India showed negative spatial effects. A U-shape non-linear relationship was observed between childhood anaemia and mother’s age. This indicates that mothers of young and old ages are more likely to have anaemic children; in particular mothers aged 15 years to about 25 years. Then the risk of childhood anaemia starts declining after the age of 25 years and it continues till the age of around 37 years, thereafter again starts increasing. Further, the non-linear effects of duration of breastfeeding on childhood anaemia show that the risk of childhood anaemia decreases till 29 months thereafter increases.ConclusionStrong evidence of residual spatial effect to childhood anaemia in India is observed. Government child health programme should gear up in treating childhood anaemia by focusing on known measurable factors such as mother’s education, mother’s anaemia status, family wealth status, child health (fever), stunting, underweight, and wasting which have been found to be significant in this study. Attention should also be given to effects of unknown or unmeasured factors to childhood anaemia at the community level. Special attention to unmeasurable factors should be focused in the states of central and northern India which have shown significant positive spatial effects.
Highlights
The geographical differences that cause anaemia can be partially explained by the variability in environmental factors, nutrition and infections
The functional relationship between childhood anaemia and mother’s age depicts almost a U shape pattern. This indicates that mothers of young and old ages are more likely to have children who are anaemic
Except for Mizoram, Manipur, Nagaland, Assam, and Kerala for all the states and union territories (UTs,) anaemia is a matter of concern, whereas for states like Haryana, Jharkhand, and Madhya Pradesh it is of extremely serious concern
Summary
The geographical differences that cause anaemia can be partially explained by the variability in environmental factors, nutrition and infections. The present paper aims to investigate the risk factors of childhood anaemia in India with focus on geographical spatial effect. A vegetarian diet may increase the risk of anemia due to lack of iron fortification [8]. Evidence from previous studies reported that maternal anaemia, and child nutritional statuses such as wasting, stunting and underweight increase the risk of anaemia [11, 12]. During the first 5 years of life, children are most vulnerable to iron-deficiency anaemia because of increased iron requirements due to their rapid growth [13]. Iron deficiency in children is a serious concern because it may increase childhood morbidity, impaired growth development, and have long term effects on cognitive development and school performance [13]
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