ArticleBMJ paediatrics open2026
Distribution, socioeconomic inequalities and contributing factors of anaemia prevalence across wealth index among Indian adolescent girls: multivariate decomposition analysis of nationally representative survey.
Article in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnaemia among adolescent girls aged 15-19 years can adversely affect educational, vocational and reproductive outcomes. Amid rapid urbanisation, understanding its prevalence, determinants and urban-rural inequities is essential. Using National Family Health Survey (NFHS)-5 data in India, this study comprehensively assessed anaemia epidemiology and quantified urban-rural disparities and their contributing factors through multivariate decomposition analysis. METHODOLOGY: NFHS-5 data from 113 606 adolescent girls aged 15-19 years were analysed. Socio-demographic, health, and behavioural factors were assessed through standardised interviews. Haemoglobin was measured using HemoCue Hb 201+, with anaemia defined as <12 g/dL. Decomposition and concentration indices assessed disparities inequities.
resultsAnaemia was more prevalent among adolescent girls from rural areas (60.2%, 95% CI 59.9 to 60.5%) compared with those from urban areas (56.6%, 95% CI 56.0 to 57.3%). Multivariate decomposition analysis showed that the largest variable-level contribution to the explained urban-rural disparity in anaemia prevalence was from wealth index (52.4%; richest: -1.497, 95% CI-1.501 to -1.493), followed by region (21.7%; East: -0.750, 95% CI-0.753 to -0.748), caste (17.3%; schedule tribe: -0.406, 95% CI -0.408 to -0.403), accessibility of healthcare centre (12.6%; not accessible: -0.319, 95% CI -0.323 to -0.315) and fruit intake (8.2%; daily: -0.834, 95% CI -0.839 to -0.829). In contrast, media exposure showed a negative contribution (-13.1%; 0.452, 95% CI 0.450 to 0.455), indicating that differences in media exposure reduced the observed urban-rural disparity. The concentration indices were comparable between urban (-0.075, 95% CI -0.089 to -0.061) and rural (-0.071, 95% CI -0.078 to -0.064) populations, indicating modest wealth-related inequality in both settings.
conclusionAnaemia burden was high among Indian adolescent girls, with urban-rural disparities driven by socioeconomic status, dietary patterns and media exposure, requiring comprehensive, multifaceted nationwide interventions.
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