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Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India

India is home to the highest global number of women and children suffering from anemia, with one in every two women impacted. India's current strategy for targeting areas with a high anemia burden is based on district-level averages, yet this fails to capture the substantial small area variatio...

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Autores principales: Rajpal, Sunil, Kumar, Akhil, Rana, Md Juel, Kim, Rockli, Subramanian, S. V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9530333/
https://www.ncbi.nlm.nih.gov/pubmed/36203697
http://dx.doi.org/10.3389/fpubh.2022.945970
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author Rajpal, Sunil
Kumar, Akhil
Rana, Md Juel
Kim, Rockli
Subramanian, S. V.
author_facet Rajpal, Sunil
Kumar, Akhil
Rana, Md Juel
Kim, Rockli
Subramanian, S. V.
author_sort Rajpal, Sunil
collection PubMed
description India is home to the highest global number of women and children suffering from anemia, with one in every two women impacted. India's current strategy for targeting areas with a high anemia burden is based on district-level averages, yet this fails to capture the substantial small area variation in micro-geographical (small area) units such as villages. We conducted statistical and econometric analyses to quantify the extent of small area variation in the three grades of anemia (severe, moderate, and mild) among women and children across 36 states/union territories and 707 districts of India. We utilized data from the fifth round of the National Family Health Survey conducted in 2019–21. The final analytic sample for analyses was 183,883 children aged 6–59 months and 690,153 women aged 15–49 years. The primary outcome variable for the analysis was the three anemia grades among women and children. We adopted a three-level and four-level logistic regression model to compute variance partitioning of anemia among women and children. We also computed precision-weighted prevalence estimates of women and childhood anemia across 707 districts and within-district, between-cluster variation using standard deviation (SD). For severe anemia among women, small area (villages or urban blocks) account for highest share (46.1%; Var: 0.494; SE: 0.150) in total variation followed by states (39.4%; Var: 0.422; SE: 0.134) and districts (12.8%; Var: 0.156; SE: 0.012). Similarly, clusters account for the highest share in the variation in severe (61.3%; Var: 0.899; SE: 0.069) and moderate (46.4%: Var: 0.398; SE: 0.011) anemia among children. For mild and moderate anemia among women, however, states were the highest source of variation. Additionally, we found a high and positive correlation between mean prevalence and inter-cluster SD of moderate and severe anemia among women and children. In contrast, the correlation was weaker for mild anemia among women (r = 0.61) and children (0.66). In this analysis, we are positing the critical importance of small area variation within districts when designing strategies for targeting high burden areas for anemia interventions.
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spelling pubmed-95303332022-10-05 Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India Rajpal, Sunil Kumar, Akhil Rana, Md Juel Kim, Rockli Subramanian, S. V. Front Public Health Public Health India is home to the highest global number of women and children suffering from anemia, with one in every two women impacted. India's current strategy for targeting areas with a high anemia burden is based on district-level averages, yet this fails to capture the substantial small area variation in micro-geographical (small area) units such as villages. We conducted statistical and econometric analyses to quantify the extent of small area variation in the three grades of anemia (severe, moderate, and mild) among women and children across 36 states/union territories and 707 districts of India. We utilized data from the fifth round of the National Family Health Survey conducted in 2019–21. The final analytic sample for analyses was 183,883 children aged 6–59 months and 690,153 women aged 15–49 years. The primary outcome variable for the analysis was the three anemia grades among women and children. We adopted a three-level and four-level logistic regression model to compute variance partitioning of anemia among women and children. We also computed precision-weighted prevalence estimates of women and childhood anemia across 707 districts and within-district, between-cluster variation using standard deviation (SD). For severe anemia among women, small area (villages or urban blocks) account for highest share (46.1%; Var: 0.494; SE: 0.150) in total variation followed by states (39.4%; Var: 0.422; SE: 0.134) and districts (12.8%; Var: 0.156; SE: 0.012). Similarly, clusters account for the highest share in the variation in severe (61.3%; Var: 0.899; SE: 0.069) and moderate (46.4%: Var: 0.398; SE: 0.011) anemia among children. For mild and moderate anemia among women, however, states were the highest source of variation. Additionally, we found a high and positive correlation between mean prevalence and inter-cluster SD of moderate and severe anemia among women and children. In contrast, the correlation was weaker for mild anemia among women (r = 0.61) and children (0.66). In this analysis, we are positing the critical importance of small area variation within districts when designing strategies for targeting high burden areas for anemia interventions. Frontiers Media S.A. 2022-09-20 /pmc/articles/PMC9530333/ /pubmed/36203697 http://dx.doi.org/10.3389/fpubh.2022.945970 Text en Copyright © 2022 Rajpal, Kumar, Rana, Kim and Subramanian. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Public Health
Rajpal, Sunil
Kumar, Akhil
Rana, Md Juel
Kim, Rockli
Subramanian, S. V.
Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India
title Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India
title_full Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India
title_fullStr Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India
title_full_unstemmed Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India
title_short Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India
title_sort small area variation in severe, moderate, and mild anemia among women and children: a multilevel analysis of 707 districts in india
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9530333/
https://www.ncbi.nlm.nih.gov/pubmed/36203697
http://dx.doi.org/10.3389/fpubh.2022.945970
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