Coexistence of Anaemia and Common Morbidities Among Children in India Below the Age of Five Years: Evidence From the National Family Health Survey-5 (2019-21).

Introduction Childhood anaemia remains one of the most persistent public health problems in India. At the same time, common childhood morbidities such as diarrhoea, fever, and acute respiratory infection continue to affect a large proportion of children under five. This study, therefore, aims to examine the association between anaemia and common morbidities among children in India. Material and methods This cross-sectional study used the fifth nationally representative National Family Health Survey (NFHS-5) data for children aged 6-59 months born in the five years preceding the survey conducted in India during 2019-21. The analysis included 179,262 children. Three common morbidities were considered: acute respiratory infection (ARI), fever, and diarrhoea reported in the two weeks preceding the survey. Anaemia status was assessed using haemoglobin measurement. Bivariate associations between anaemia and covariates were examined using chi-square tests. Binary logistic regression models were fitted in four stages to estimate the adjusted association between child morbidities and anaemia. Results The overall prevalence of anaemia among children aged 6-59 months was high, with about two-thirds of children classified as anaemic. The prevalence of recent morbidity was 2.8% for ARI, 13.7% for fever, and 7.4% for diarrhoea. In bivariate analysis, children with ARI (69.9%), fever (70.1%), and diarrhoea (73.9%) had significantly higher anaemia prevalence than those without these conditions. In multivariable analysis, diarrhoea remained independently associated with anaemia after full adjustment (OR: 1.09, 95% CI: 1.04-1.14, p < 0.001), while fever showed a smaller but significant association (OR: 1.06, 95% CI: 1.02-1.10, p = 0.001). The attenuation of ARI (OR: 1.03, 95% CI: 0.97-1.10, p = 0.354) after adjustment suggests that the observed crude association may largely reflect shared socio-economic and nutritional vulnerabilities rather than an independent relationship. Children aged 24-41 months and 42-59 months have substantially lower odds of anaemia (OR: 0.57, 95% CI: 0.56-0.59, p < 0.001) and (OR: 0.33, 95% CI: 0.32-0.34, p < 0.001), respectively, than those aged 6-23 months. Children born to mothers less than 18 years were at higher risk of anaemia (OR: 1.30, 95% CI: 1.19-1.41, p < 0.001). The likelihood of being anaemic was highest among children born to mothers with no schooling (OR: 1.44, 95% CI: 1.39-1.50, p < 0.001) compared with children born to mothers with 12 or more years of schooling. Higher odds of any anaemia were observed among children from the poorest households (OR: 1.17, 95% CI: 1.11-1.23, p < 0.001) and in several high-burden regions. Predicted probability estimates showed that the probability of anaemia was higher among children with ARI (70.5%), fever (69.7%), and especially diarrhoea (73.0%) compared with children without these morbidities. Conclusion The study demonstrates that anaemia among Indian children is not only highly prevalent but also closely linked with common childhood morbidities, particularly diarrhoea. Special attention is needed for children in the first two years of life, when vulnerability is highest. These findings suggest that anaemia control strategies in India should be integrated with stronger prevention and treatment of childhood infections, improved maternal education, and targeted support for the poorest and most disadvantaged in high-burden regions.