Date Published: June 12, 2019
Publisher: Public Library of Science
Author(s): Sujan Gautam, Haju Min, Heenyun Kim, Hyoung-Sun Jeong, Russell Kabir.
Anemia is a condition in which the number of red blood cells is not sufficient to meet the physiological need of the body. Women of reproductive age and pregnant women are at a high risk of anemia, which in turn may contribute to maternal morbidity and mortality. We aimed to describe the prevalence of anemia and the factors associated with the risk of developing anemia in women of reproductive age in Nepal. Additionally, we examined the association of women’s decision-making autonomy regarding healthcare and experience of intimate partner violence (IPV) with anemia. Data from the 2016 Nepal Demographic and Health Survey (NDHS) were used in this study. The data were adjusted for sampling weight, stratification, and cluster sampling design. A battery-operated portable HemoCue was used to measure hemoglobin and detect anemia. Using complex sample logistic regression, the association between dependent and independent variables were examined; crude and adjusted odds ratio were reported. The mean (± SD) hemoglobin concentration was 12.13 g/dL (± 1.48). Overall, about 41% (95% CI 38.6–43.0%) of women aged 15–49 years were anemic. Women in households with wells as the source of drinking water (aOR 1.93; 95% CI 1.58–2.37) were significantly associated with an increased risk of developing anemia. While women who were currently using hormonal contraceptives (aOR 0.63, 95% CI 0.52–0.76) were significantly less likely to be anemic. After adjusting for background characteristics among women who were married at the time of the survey, decision-making autonomy regarding healthcare, and experience of IPV did not have a significant association with anemia. The high prevalence of anemia suggests the need for substantial improvement in the nutritional status of women. The increased disease burden compared with the past survey highlights the needs to reconsider the existing nutritional policy in Nepal.
Anemia or low concentration of hemoglobin (Hb) is a condition in which the number of red blood cells of the body is insufficient to meet physiological needs . Iron deficiency is thought to be the most common cause of anemia worldwide. Children, women of reproductive age, and pregnant women are at high risk of developing anemia [2, 3]. Maternal anemia is associated with maternal and child morbidity and mortality such, as increased risk of miscarriage, stillbirth, prematurity, and low birth weight of the baby . About 20% of perinatal mortality and 10% of maternal mortality in developing countries is attributed to iron deficiency .
The 65th World Health Assembly, 2012 approved an action plan and global targets for maternal and child health nutrition including infants, with a commitment to decrease the prevalence of anemia among women of reproductive age by to halve by 2025, from 2011 levels . This study was carried out to understand the influence of a wide range of socio-demographic, reproductive, nutritional, and behavioral factors on the prevalence of anemia among women of reproductive age in Nepal. Additionally, we studied the role of women’s decision-making autonomy regarding her healthcare and experience of IPV on the risk of developing anemia. After controlling for available independent variables, women in a household with a well as the source of drinking water, and those who had undergone sterilization were more likely to be anemic. On the other hand, women who were using a hormonal contraceptive method, were overweight/obese and were smoking cigarette/tobacco were less likely to be anemic. These findings provide a national estimate of anemia among women of reproductive age in Nepal and could serve as a benchmark to evaluate the national nutrition programs.
This study demonstrates the factors associated with the prevalence of anemia in Nepal. It is quite evident from the study findings that the general health status of the women of reproductive age in Nepal needs substantial improvement. This study found that about 41% of the women of reproductive age was anemic. Thus, anemia could be considered as a severe public health problem. The higher prevalence of anemia revealed in this study compared to the past survey highlights the needs to reconsider the existing nutritional policy in Nepal. The prevalence of anemia was higher among underweight women, while obese women were less likely to become anemic. Both, anemia and lower BMI are the indicators of poor nutritional status. Poor diet quality may result in the lower bioavailability of dietary iron, thus increasing the risk of developing anemia. An overall higher prevalence of anemia suggests the necessity of developing appropriate nutrition interventions; iron supplementation could be the immediate measure to cure anemia while periodic deworming, food diversification, and food fortification might be the long-term measures for the management of anemia. Given that a larger proportion of households are using well-water as the source of drinking water, appropriate measures to protect the well-water such as protecting the wells and disinfection of water before use may decrease the likelihood of parasite infestation, and in turn, reduce the prevalence of anemia. Mobilization of community health workers and volunteers can be a strategic measure to reach a large section of adolescents including women of reproductive age. Anemia surveillance and interventions programs specific to targeted groups and high-risk populations are recommended for reduction of anemia. Further research studies are advised to understand the prevalence and determinants of anemia.