Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 7;1(5):e182899.
doi: 10.1001/jamanetworkopen.2018.2899.

Trends in Socioeconomic Inequalities and Prevalence of Anemia Among Children and Nonpregnant Women in Low- and Middle-Income Countries

Fan Yang  1 , Xueyi Liu  1 , Panpan Zha  1
Affiliations

Trends in Socioeconomic Inequalities and Prevalence of Anemia Among Children and Nonpregnant Women in Low- and Middle-Income Countries

Fan Yang et al. JAMA Netw Open. .

Abstract

Importance: Anemia remains a major challenge for women's and children's health in low- and middle-income countries (LMICs).

Objective: To assess the socioeconomic inequalities and prevalence of anemia among children and nonpregnant girls and women in LMICs over time.

Design, setting, and participants: This cross-sectional and repeated cross-sectional analysis used data from the Demographic and Health Surveys collected from January 1, 2000, through December 31, 2014. Initial cross-sectional data sets constructed from the most recent surveys included 163 419 children aged 6 to 59 months and 304 202 nonpregnant girls and women aged 15 to 49 years (hereinafter referred to as nonpregnant women) from 45 LMICs. Repeated cross-sectional data sets from the most recent and the earliest surveys consisted of 322 088 nonpregnant women from 25 LMICs and 182 273 children from 24 LMICs. Analyses were conducted from June 1, 2016, through July 3, 2018.

Main outcomes and measures: Total and severe anemia for children aged 6 to 59 months (hemoglobin level, <11 and <7 g/dL, respectively) and nonpregnant women aged 15 to 49 years (<12 and <8 g/dL, respectively) were defined according to the World Health Organization hemoglobin cutoff levels. The slope index of inequality (SII) and the relative index of inequality (RII) were calculated to determine anemia inequalities.

Results: Among the 163 419 children aged 6 to 59 months and the 304 202 nonpregnant women aged 15 to 49 years in the initial cross-sectional data sets, 34 of 45 countries had anemia prevalence levels for children greater than 40% and 37 of 45 had anemia prevalence levels greater than 20% for nonpregnant women. Among the 182 273 children from 24 LMICs and 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.67 to 3.98 percentage points in 16 of the 24 LMICs; for cases of severe anemia, the decrease was 0.03 to 0.82 percentage points in 15 LMICs. Among 322 088 nonpregnant women from 25 LMICs in the repeated cross-sectional data sets, the annualized absolute decreases in the prevalence of anemia ranged from 0.49 to 2.59 percentage points in 17 of 25 LMICs; for severe anemia, the decrease was 0.03 to 0.29 percentage points in 15 LMICs. The SII was significantly negative and the RII was significantly less than 1 in 37 of the 45 LMICs among children and in 26 of the 45 LMICs for nonpregnant women. The annualized changes in the SII approached 0 in 16 of the 24 LMICs among children and in 11 of 25 LMICs among nonpregnant women.

Conclusions and relevance: Most LMICs continue to exhibit a high prevalence of anemia among children and nonpregnant women, although the prevalence of total and severe anemia have decreased in many LMICs. Anemia inequalities among children and nonpregnant women persist in most LMICs.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Mr Yang reported receiving grants from the National Natural Science Fund of China during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Absolute and Relative Inequality of Anemia Prevalence Among Children in Low- and Middle-Income Countries
The absolute inequality (slope index of inequality) (A) and relative inequality (relative index of inequality) (B) are shown for prevalence of anemia among children aged 6 to 59 months for each low- and middle-income country. Error bars indicate 95% CIs. Specific numbers of participants, absolute and relative inequality values, and 95% CIs are provided in eTable 5 in the Supplement and omitted here for clarity. SES indicates socioeconomic status.
Figure 2.
Figure 2.. Absolute and Relative Inequality of Anemia Prevalence Among Nonpregnant Women in Low- and Middle-Income Countries
The absolute inequality (slope index of inequality) (A) and relative inequality (relative index of inequality) (B) are shown for prevalence of anemia among nonpregnant women aged 15 to 49 years for each low- and middle-income country. Error bars indicate 95% CIs. Specific numbers of participants, absolute and relative inequality values, and 95% CIs are provided in eTable 6 in the Supplement and omitted here for clarity. SES indicates socioeconomic status.
Figure 3.
Figure 3.. Annualized Changes of Absolute and Relative Inequality in Anemia Prevalence Among Children in Low- and Middle-Income Countries
The annualized changes in absolute inequality (slope index of inequality [SII]) (A) and relative inequality (relative index of inequality [RII]) (B) for anemia prevalence among children aged 6 to 59 months are shown for each low- and middle-income country. Error bars represent 95% CIs. Specific numbers of participants, annualized changes of SII and RII values, and 95% CIs are provided in eTable 7 in the Supplement and omitted here for clarity.
Figure 4.
Figure 4.. Annualized Changes of Absolute and Relative Inequality in Anemia Prevalence Among Nonpregnant Women in Low- and Middle-Income Countries
The annualized changes in absolute inequality (slope index of inequality [SII]) (A) and relative inequality (relative index of inequality [RII]) (B) for anemia prevalence among nonpregnant women aged 15 to 49 years are shown for each low- and middle-income country. Error bars represent 95% CIs. Specific numbers of participants, annualized changes of SII and RII values, and 95% CIs are provided in eTable 8 in the Supplement and omitted here for clarity.
See this image and copyright information in PMC

References

    1. Marn H, Critchley JA. Accuracy of the WHO Haemoglobin Colour Scale for the diagnosis of anaemia in primary health care settings in low-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2016;4(4):-. doi:10.1016/S2214-109X(16)00005-X - DOI - PubMed
    1. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. . A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-624. doi:10.1182/blood-2013-06-508325 - DOI - PMC - PubMed
    1. Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011;378(9809):2123-2135. doi:10.1016/S0140-6736(10)62304-5 - DOI - PubMed
    1. World Health Organization Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia. Geneva, Switzerland: World Health Organization; 2008.
    1. Waage J, Banerji R, Campbell O, et al. . The Millennium Development Goals: a cross-sectoral analysis and principles for goal setting after 2015 Lancet and London International Development Centre Commission. Lancet. 2010;376(9745):991-1023. doi:10.1016/S0140-6736(10)61196-8 - DOI - PMC - PubMed

Publication types