Multilevel multinomial logistic regression model for identifying factors associated with anemia in children 6–59 months in northeastern states of India

Objective: To examine the factors influencing the occurrence of childhood anemia in northeast India. Method: A nationally representative systematic multistage stratified cross-sectional sample of singleton children aged 6–59 months from all states of India. Data consist of 10,136 children in the age group 6–59 months in eight northeastern states. The level of anemia was the outcome variable with four ordinal categories (severe, moderate, mild, and non-anemic). A two-level random intercept multivariate logistic regression model was considered with state of residence as the level-2 variable. Results: About 53% of the children are anemic in the northeastern states of India. Tripura has the highest prevalence of anemia cases (74%), whereas the lowest percentage of anemia cases was in Manipur (42%). Multivariate analysis suggests that age at marriage (OR = 1.13, 95% CI: 1.05, 1.21) and the number of children ever born (OR = 1.09, 95% CI: 1.03, 1.15) have significant effects on being at or below a hemoglobin level (severely anemic). Furthermore, age of the child (OR = 0.92, 95% CI: 0.86 − 1.00) was a significant predictor, indicating that odds of severe anemia decrease if the child is 48 months or older. Conclusions: The high prevalence of mild and moderate anemia demands due emphasis in the programs and policies of the government so that the overall prevalence of anemia among children aged 6–59 months can be reduced. Comprehensive strategies need to focus more at state level followed by individual level for combating anemia.