Nguyen Phuong Hong, Scott Samuel, Avula Rasmi, Tran Lan Mai, Menon Purnima
Poverty, Health, and Nutrition Division, International Food Policy Research Institute (IFPRI), Washington, District of Columbia, USA.
FHI360, Hanoi, Vietnam.
BMJ Glob Health. 2018 Oct 19;3(5):e001010. doi: 10.1136/bmjgh-2018-001010. eCollection 2018.
India carries the largest burden of anaemia globally. Progress to reduce anaemia has been slow despite substantial economic growth and 50 years of programmatic efforts. Identification of the factors that contribute to anaemia reductions is needed to accelerate progress. We examined changes in haemoglobin (Hb) and anaemia among women and children in India from 2006 to 2016 and identified drivers of changes in these outcomes over time.
We used two rounds of National Family Health Survey data collected in 2005-2006 and 2015-2016 (n=245 346 children 6-59 months; 37 165 pregnant women (PW) 15-49 years; 760 460 non-pregnant women (NPW) 15-49 years). We first examined trends in Hb and anaemia, and changes in 30 selected variables (including immediate and underlying determinants, and nutrition and health interventions (NHIs)). We identified drivers of Hb and anaemia using multivariate regression and estimated their contribution to changes in these outcomes over time using regression-based decomposition.
Hb and anaemia improved significantly between 2006 and 2016 in children (4.5 g/L and 11 percentage points (pp), respectively) and PW (3.2 g/L and 7.6 pp), but not in NPW. Despite these changes, anaemia is still very high (>50%) and progress varied considerably by state (-33 pp to +16 pp). Most immediate and underlying determinants, and NHIs improved significantly over time. Changes among a set of drivers common to children and PW accounted for the changes in Hb; these included maternal schooling (children, 10%; PW, 24%), coverage of NHIs (children, 18%; PW, 7%), socioeconomic status (children, 7%; PW, 17%), sanitation (children, 3%; PW, 9%), and meat and fish consumption (children, 3%; PW, 1%). The decomposition models moderately explained Hb changes over time (children, 49%; PW, 66%).
Multiple common drivers have contributed to the anaemia changes among children and pregnant women in India. Further improvements in these drivers can have population-level effects by simultaneously influencing both maternal and child anaemia.
印度是全球贫血负担最重的国家。尽管经济取得了显著增长且经过了50年的规划努力，但减少贫血的进展一直缓慢。需要确定有助于减少贫血的因素，以加速进展。我们研究了2006年至2016年期间印度妇女和儿童血红蛋白（Hb）和贫血情况的变化，并确定了这些结果随时间变化的驱动因素。
我们使用了2005 - 2006年和2015 - 2016年两轮全国家庭健康调查数据（245346名6 - 59个月的儿童；37165名15 - 49岁的孕妇（PW）；760460名15 - 49岁的非孕妇（NPW））。我们首先研究了Hb和贫血的趋势，以及30个选定变量（包括直接和潜在决定因素，以及营养和健康干预措施（NHIs））的变化。我们使用多元回归确定Hb和贫血的驱动因素，并使用基于回归的分解方法估计它们随时间对这些结果变化的贡献。
2006年至2016年期间，儿童（分别为4.5 g/L和11个百分点（pp））和孕妇（3.2 g/L和7.6 pp）的Hb和贫血情况有显著改善，但非孕妇没有。尽管有这些变化，贫血率仍然很高（>50%），且各邦进展差异很大（-33 pp至+16 pp）。大多数直接和潜在决定因素以及NHIs随时间有显著改善。儿童和孕妇共有的一组驱动因素的变化导致了Hb的变化；这些因素包括母亲受教育程度（儿童为10%；孕妇为24%）、NHIs覆盖率（儿童为18%；孕妇为7%））、社会经济地位（儿童为7%；孕妇为17%）、卫生设施（儿童为3%；孕妇为9%）以及肉类和鱼类消费（儿童为3%；孕妇为1%）。分解模型适度解释了Hb随时间的变化（儿童为49%；孕妇为66%）。
多种共同驱动因素促成了印度儿童和孕妇贫血情况的变化。这些驱动因素的进一步改善可通过同时影响母婴贫血情况而产生人群层面的效果。
