Prevalence of and Factors Associated with Depression, Anxiety and Stress among Adolescents of Bangladesh during the COVID-19 Pandemic: A Population-Based Study

## **Determining Spatial Heterogeneity in the Prevalence of Anemia among Women Aged 15-49 in India for the Years 2019–2021**

**Ashi Khare, Thirumal Vennam, Dripta Roy Choudhury, Amit Arora, and Satish Agnihotri** Indian Institute Of Technology Bombay, Mumbai, India

Anemia is a major public health concern in India, and nutritional anemia accounts for about 70% of anemia

prevalence among Indian children and adolescents. The fifth round of the National Family and Health Survey (NFHS-5), 2019–2021 depicts a 4% increase in the prevalence of anemia among Indian women (57%) in the past few years. This study determines the spatial heterogeneity in the prevalence of anemia among women aged 15-49 years using the NFHS-5 data. Online-available NFHS-5 data are used for analysis. The prevalence of anemia among 15-49-year-old women in India was mapped using QGIS. Univariate local indicators of spatial analysis (LISA) were applied to identify the hotspots of high anemia prevalence among women. Bivariate LISA was used to assess spatial autocorrelation between women's anemia and different risk factors (independent variables). Moran's I value of univariate LISA for 707 districts of India is 0.688 (p≤0.05), which indicates that anemia among women is spatially clustered. About 132 districts (about 18.6%) are found in the hotspot region (high-high clusters), which are concentrated in Assam, Bihar, Chhattisgarh, Gujarat, Jharkhand, Odisha, and West Bengal, while 91 districts (about 12.8%) are found in cold spots (lowlow clusters). Bivariate LISA depicts anemia among women to be spatially autocorrelated with child anemia, women's BMI, and literacy (child anemia: Moran's I = 0.45, p≤0.05; women's BMI: Moran's I = 0.33, p≤ 0.05; women's literacy: Moran's I = -0.31, p≤0.05). This analysis suggests that there is heterogeneity in the anemia prevalence among 15-49-year-old women in India. The high-burden clusters need immediate and prioritized interventions. Current supplementation and fortification practices alone may not be able to reduce the anemia prevalence in these clusters and need a review of strategies urgently. This analysis can help bring focus on implementing preventive measures in low-burden clusters, which may prove to be economically efficient and fruitful in addressing micronutrient deficiencies in the long term. This is particularly relevant in the post-pandemic years, where preventive public health measures will need to come to the center stage of health policy rather than the curative ones.

Ashi Khare, Thirumal Venam, Dripta Roy Choudhury, Amit Arora, and Satish Agnihotri

Centre for Technology Alternatives for Rural Areas, IIT Bombay, Mumbai, India

Aim: To determine the spatial heterogeneity in the prevalence of anaemia among women aged 15-49 years using the recent National Family and Health Survey (NFHS-5) 2019-21 data.

#### Introduction

Anaemia is a condition marked by low haemoglobin (Hb) concentration and is a serious public health concern in India.(CNNS,2019). Every second woman in the country is anaemic!(NFHS-5, 2021). Iron deficiency is the strongest predictor of anemia among adolescents in India. (Lahiri et al., 2020). Low Dietary intake of iron from cereal based Indian diets

(7-10mg/meal) with less bioavailable (<5%) non-heme iron content are few of the prominent causes. (Nair et al., 2016). Various government policies involving supplementation and fortification exist but fail to have desired impact. (Anand et al., 2014).

#### Methods

Online available NFHS-5 data is used for analysis. Prevalence of anemia among 15-49y women in India was mapped using QGIS. Univariate local indicators of spatial analysis (LISA) was applied to identify the hotspots of high anemia prevalence among women. Bivariate LISA was used to assess spatial autocorrelation between women's anemia and different risk factors (independent variables).

#### Conclusions


#### Acknowledgements

1. Prof. Satish B. Agnihotri and Prof. Amit Arora, CTARA, IITB, IndiaGHF 2022 Grants
