Original Geographic variation and factors associated with anemia among under-fives in India: A multilevel approach

This study investigates the individual, household, and community-level determinants of anemia and to report the locations with poor anemia status among under-fives. A secondary data derived from the fourth round of the National Family Health Survey conducted in India in the period 2015-2016 was used. The study focused on the percentage of under-fives who had anemia across India. A choropleth map was obtained to present the distribution of anemia among under-fives in India. A multilevel logistic regression model was used to investigate the factors associated with anemia among under-fives. Stata and R software were used for the analysis. The age of the child, size of child at birth, birth interval, mother's age at the time of birth, mother's and father's education, religion, social group, wealth quintile, and region of residence are significant predictors of the childhood anemia. Communally underprivileged children are highly likely to be anemic as compared to those in other areas requiring special attention. The occurrence of childhood anemia was highest in Central India followed by North, Union Territories, East, West, and South of India. In addition to the biological naivety of young mothers, being from a communally underprivileged group also affects health outcomes among under-fives. A consistent effort on increasing the education level of women in India along with a well-planned awareness program is needed to enable women in making informed decisions towards the health outcome of children. These programs must also focus the incentives of delaying first birth until the mother is 25.