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Socio-economic inequality and spatial heterogeneity in anaemia among children in India: Evidence from NFHS-4 (2015–16)
Authors: Himani Sharma, S. K.Singh, and Shobhit Srivastava
Source: Clinical Epidemiology and Global Health, DOI:
Topic(s): Anemia
Child feeding
Child health
Children under five
Spatial analysis
Wealth Index
Country: Asia
Published: DEC 2020
Abstract: Objective: Prevalence of anaemia among children has been a major health problem in developing countries. An estimated 73 million children below age five in India (58%) are anaemic (NFHS-4, 2017) despite of a number of vertical interventions across different states. This study has analysed the extent of socio-economic inequalities and spatial heterogeneity in anaemia among children using data from the recent round of Indian DHS, known as National Family Health Survey. Methods: Bivariate and multivariate logistic regression analysis were used to assess the effects of socio-economic and demographic predictors on prevalence of anaemia among children under age five. Socio-economic inequalities in the prevalence of anaemia among children were analysed using Concentration Index and Poor-rich Ratios. Further, the spatial heterogeneity in the prevalence of anaemia were analysed using autocorrelation and auto regression models. Results: The highest negative values of Concentration Index and Poor-rich ratios were observed in Mizoram (-0.204) and Nagaland (-0.120). The univariate Moran's I statistics was 0.63 for child anaemia suggesting a profound and significant spatial heterogeneity in the prevalence of anaemia among children in India. The spatial autocorrelation of anaemia among children with anaemia among mother was 0.46. Other predictors included in the model having significant autocorrelation with anaemia among children were underweight (0.74) and experience of diarrhoea in seven days preceding the survey (0.35). The results of SEM explained that coefficients of mother's anaemia (0.74), uneducated mothers (0.10) and underweight children (0.10) were some of the key predictors of child anaemia in India. Conclusion: The study findings suggest greater investment in addressing micronutrient deficiencies among children and child feeding practices, by adopting differential approaches especially in the regions with higher prevalence of anaemia. Keywords: Anaemia; Socio-economic inequality; Spatial; Burden; Autocorrelation