Sociodemographic Factors Associated With Anemia Among Non-pregnant Women of Reproductive Age in Punjab, India

Objectives: Anemia continues to be a public health problem in India with an estimated 57% of women of reproductive age affected. The objective of the current study was to identify individual- and household-level factors associated with anemia among non-pregnant (NPWRA) in Punjab, India. Methods: The current analysis used baseline data from a trial of quintuply-fortified salt in Punjab, India. Hemoglobin concentrations measured from venous blood samples using an automated hematology analyzer (Sysmex XP-300, Kobe, Japan) were available for 798 NPWRA. Anemia was defined as a hemoglobin concentration < 12 g/dL. Bivariate associations between the participant's demographic characteristics (age, education, number of children under five years, employment status), individual factors (dietary diversity, body mass index, and depressive symptoms), household factors (wealth, size, food security, education of household head), and anemia were first employed using Chi-square tests of independence. Variables that were significant at p < 0.1 in the bivariate analysis were included in the multivariate logistic regression model. Results: Mean ± SD age of NPWRA was 30.8 ± 5.6 years, 86% had at least a middle school education, and 52% had a BMI ≥ 25 kg/m2. The mean hemoglobin concentration was 11.9 ± 1.3 g/dL and 46% of NPWRA were anemic. In bivariate models, the following factors were associated with anemia: lower education, dietary diversity and household wealth, and higher household size. In the multivariate analysis, each variable remained associated (p < 0.1), and household size had the strongest association: households with < 6 members were 33% less likely to have anemia vs. households with ≥ 6 members (OR=0.66; 95% CI: 0.50, 0.88, p=0.005). Conclusions: NPWRA living in large households with low socioeconomic status may need intensified interventions to reduce anemia in this setting. Funding Sources: Bill & Melinda Gates Foundation (INV 002945).