Table 1.
Selected sociodemographic and health characteristics of nonpregnant women 15– 49 years, by anaemia status Nepal National Micronutrient Status Survey, Nepal, 2016 (n = 1, 918)
| Anaemia a (n = 355, 20.2%; 95% CI [17.6, 22.8]) | No anaemia a (n = 1, 563, 79.8%; 95% CI [77.1, 82.4]) | Total (n = 1, 918) | |||||
|---|---|---|---|---|---|---|---|
| n | n | P b | n | ||||
| Sociodemographic characteristics | |||||||
| Age group, % | 0.4 | ||||||
| 15– 29 years | 169 | 47.8 (41.8, 53.7) | 801 | 50.9 (47.6, 54.1) | 970 | 50.2 (47.6, 52.8) | |
| 30‐49 years | 186 | 52.2 (46.3, 58.2) | 762 | 49.1 (45.9, 52.4) | 948 | 49.8 (47.2, 52.4) | |
| Lactating, % | 94 | 23.2 (17.5, 29.0) | 440 | 26.0 (22.8, 29.1) | 0.4 | 534 | 25.4 (22.6, 28.2) |
| Gave birth in last 5 years, % | 138 | 37.9 (31.4, 44.4) | 602 | 36.5 (32.9, 40.0) | 0.7 | 740 | 36.7 (33.7, 39.8) |
| Married/ cohabitating, % | 296 | 83.2 (78.3, 88.2) | 1,332 | 85.5 (83.1, 88.0) | 0.4 | 1,628 | 85.1 (82.9, 87.2) |
| Rurality, % | 0.5 | ||||||
| Rural | 314 | 88.0 (80.8, 95.2) | 1,338 | 86.1 (80.0, 92.2) | 1,652 | 86.5 (80.5, 92.5) | |
| Urban | 41 | 12.0 (4.8, 19.2) | 225 | 13.9 (7.8, 20.0) | 266 | 13.5 (7.5, 19.5) | |
| Ecological zone, % | <0.0001 | ||||||
| Mountain | 33 | 3.5 (2.1, 4.9) | 288 | 7.1 (6.3, 7.9) | 321 | 6.4 (5.6, 7.1) | |
| Hill | 109 | 26.8 (20.8, 32.7) | 711 | 48.7 (45.5, 51.9) | 820 | 44.3 (41.5, 47.1) | |
| Terai | 213 | 69.7 (63.6, 75.8) | 564 | 44.2 (41.1, 47.3) | 777 | 49.3 (46.6, 52.0) | |
| Household wealth quintile | 0.06 | ||||||
| Poorest | 96 | 20.1 (14.6, 25.6) | 495 | 22.9 (18.8, 27.1) | 591 | 22.4 (18.4, 26.3) | |
| Middle | 142 | 41.2 (34.4, 48.0) | 516 | 33.1 (28.2, 38.0) | 658 | 34.8 (30.3, 39.2) | |
| Wealthiest | 117 | 38.6 (31.0, 46.3) | 552 | 44.0 (37.0, 50.9) | 669 | 42.9 (36.4, 49.4) | |
| Ethnicity, % | 0.03 | ||||||
| Brahmin or Chettri | 120 | 32.7 (25.1, 40.2) | 655 | 38.8 (33.3, 44.3) | 775 | 37.5 (32.2, 42.9) | |
| Dalit | 54 | 14.2 (8.5, 19.9) | 255 | 15.3 (11.6, 19.0) | 309 | 15.1 (11.4, 18.8) | |
| Janajati | 131 | 35.3 (26.4, 44.2) | 498 | 30.8 (25.3, 36.3) | 629 | 31.7 (26.4, 37.0) | |
| Other Terai ethnicities c | 37 | 13.4 (6.2, 20.7) | 69 | 7.9 (4.1, 11.7) | 106 | 9.0 (5.0, 13.0) | |
| Newar | 4 | 2.1 (0.1, 4.1) d | 60 | 5.5 (2.9, 8.0) | 64 | 4.8 (2.7, 6.9) | |
| Muslim | 9 | 2.3 (0.2, 4.5) d | 26 | 1.8 (0.5, 3.1) | 35 | 1.9 (0.6, 3.2) | |
| Schooling (grades completed), % | 0.5 | ||||||
| No grades | 134 | 34.5 (28.0, 41.1) | 518 | 31.1 (27.1, 35.2) | 652 | 31.8 (28.0, 35.6) | |
| 1– 8 grades | 107 | 33.1 (26.6, 39.7) | 505 | 32.3 (29.3, 35.4) | 612 | 32.5 (29.7, 35.3) | |
| ≥9 grades | 114 | 32.3 (25.5, 39.1) | 540 | 36.6 (32.4, 40.7) | 654 | 35.7 (32.0, 39.4) | |
| Improved water source e , % | 344 | 96.7 (94.3, 99.1) | 1,497 | 95.2 (91.9, 98.5) | 0.2 | 1,841 | 95.5 (92.5, 98.5) |
| Open defecation, % | 55 | 20.3 (12.3, 28.3) | 111 | 10.0 (5.8, 14.1) | <0.0001 | 166 | 12.0 (7.6, 16.5) |
| Earth floor, % | 253 | 65.9 (58.4, 73.4) | 1,014 | 57.9 (51.3, 64.4) | 0.03 | 1,267 | 59.5 (53.3, 65.6) |
| Severe household food insecurity, % | 31 | 7.1 (3.8, 10.3) | 96 | 5.3 (3.6, 6.9) | 0.3 | 127 | 5.6 (4.1, 7.1) |
| Health characteristics | |||||||
| Hemoglobin f , g/ dL | 355 | 10.9 (10.8, 11.0) | 1563 | 13.3 (13.2, 13.4) | <0.0001 | 1918 | 12.8 (12.7, 12.9) |
| Anaemia severity g | |||||||
| No anaemia | 0 | ‐ | 1,563 | ‐ | <0.0001 | 1,563 | 79.8 (77.1, 82.4) |
| Mild | 224 | 62.7 (57.0, 68.5) | 0 | ‐ | 224 | 12.7 (10.6, 14.7) | |
| Moderate | 125 | 35.3 (29.1, 41.4) | 0 | ‐ | 125 | 7.1 (5.6, 8.7) | |
| Severe | 6 | 2.0 (0.0, 4.0) d | 0 | ‐ | 6 | 0.4 (0.0, 0.8) d | |
| Anthropometry h , % | 0.01 | ||||||
| Underweight | 74 | 18.8 (13.4, 24.1) | 223 | 14.1 (11.8, 16.4) | 297 | 15.0 (12.9, 17.2) | |
| Normal weight | 233 | 64.7 (59.3, 70.2) | 976 | 60.3 (56.8, 63.8) | 1,209 | 61.2 (58.1, 64.2) | |
| Overweight/ obesity | 48 | 16.5 (11.0, 22.0) | 364 | 25.6 (22.3, 28.9) | 412 | 23.8 (20.6, 27.0) | |
| 2‐week morbidity recall, % | |||||||
| Fever | 43 | 10.8 (7.0, 14.6) | 257 | 14.7 (12.2, 17.2) | 0.09 | 300 | 13.9 (11.7, 16.1) |
| Cough | 42 | 10.9 (7.3, 14.6) | 276 | 16.2 (13.7, 18.6) | 0.02 | 318 | 15.1 (12.9, 17.3) |
| Diarrhoea | 29 | 9.4 (5.2, 13.6) | 155 | 9.7 (7.7, 11.6) | 0.9 | 184 | 9.6 (7.8, 11.4) |
| CRP, mg/ L | 355 | 0.44 (0.36, 0.53) | 1,563 | 0.52 (0.47, 0.57) | 0.1 | 1,918 | 0.50 (0.46, 0.55) |
| AGP, g/ L | 355 | 0.56 (0.54, 0.59) | 1,563 | 0.56 (0.55, 0.58) | 0.8 | 1,918 | 0.56 (0.55, 0.58) |
| Inflammation i , % | 36 | 9.0 (5.5, 12.6) | 125 | 8.5 (6.7, 10.4) | 0.8 | 161 | 8.6 (7.1, 10.2) |
| Malaria, % | 0 | ‐ | 0 | ‐ | ‐ | 0 | ‐ |
| Helicobacter pylori, % | 153 | 44.2 (36.3, 52.0) | 639 | 38.8 (35.3, 42.4) | 0.2 | 792 | 39.9 (36.2, 43.6) |
| Visceral leishmaniasis, % | 2 | 0.6 (0.0, 1.5) | 5 | 0.4 (0.0, 0.8) d | 0.6 | 7 | 0.4 (0.1, 0.8) d |
| Soil‐transmitted helminth infection j , % | 49 | 14.2 (9.3, 19.1) | 285 | 19.3 (16.1, 22.6) | 0.05 | 334 | 18.3 (15.2, 21.4) |
| G6PD, % | 89 | 25.5 (18.6, 32.3) | 145 | 10.6 (8.4, 12.7) | <0.0001 | 234 | 13.6 (11.2, 15.9) |
| Hemoglobinopathies k % | 47 | 17.0 (9.0, 25.0) | 44 | 3.7 (2.2, 5.2) | <0.0001 | 91 | 6.4 (4.0, 8.8) |
| Received deworming l , % | 161 | 38.5 (32.0, 44.9) | 740 | 40.4 (36.6, 44.3) | 0.6 | 901 | 40.0 (36.5, 43.6) |
| Hormonal birth control use, % | 35 | 8.4 (5.5, 11.3) | 322 | 19.3 (16.8, 21.7) | <0.0001 | 357 | 17.1 (14.8, 19.3) |
| Micronutrient status | |||||||
| Serum ferritin m , μg/ L | 355 | 20.4 (17.7, 23.5) | 1,563 | 33.2 (31.6, 35.0) | <0.0001 | 1,918 | 30.1 (28.6, 31.7) |
| Iron deficiency n , % | 135 | 38.8 (32.1, 45.6) | 198 | 13.4 (11.1, 15.6) | <0.0001 | 333 | 18.5 (16.0, 21.0) |
| Serum sTfR m , mg/ L | 355 | 7.5 (7.1, 8.2) | 1,563 | 5.3 (5.2, 5.5) | <0.0001 | 1,918 | 5.7 (5.6, 5.9) |
| Serum RBP, μmol/ L | 355 | 1.21 (1.16, 1.25) | 1,563 | 1.43 (1.41, 1.45) | <0.0001 | 1,918 | 1.38 (1.36, 1.41) |
| Vitamin A deficiency o , % | 5 | 1.0 (0.0, 2.0) d | 6 | 0.4 (0.0, 0.9) d | 0.2 | 11 | 0.5 (0.2, 0.9) |
| RBC folate, nmol/ L | 355 | 547.5 (513.4, 583.8) | 1563 | 532.9 (509.6, 557.4) | 0.4 | 1,918 | 535.8 (513.2, 559.4) |
| Risk of folate deficiency p , % | 49 | 11.9 (8.0, 15.9) | 183 | 10.4 (8.0, 12.8) | 0.5 | 232 | 10.7 (8.6, 12.8) |
| Serum zinc, μg/ dL | 355 | 74.4 (70.4, 78.7) | 1,563 | 78.4 (75.5, 81.5) | 0.1 | 1,918 | 77.6 (75.0, 80.3) |
| Zinc deficiency q , % | 105 | 28.2 (22.5, 34.0) | 380 | 23.0 (19.8, 26.3) | 0.09 | 485 | 24.1 (21.1, 27.1) |
| Dietary and supplement intake | |||||||
| Prior day food consumption, % | |||||||
| Flesh, organ, or blood‐based foods | 264 | 74.6 (68.0, 81.1) | 1,065 | 68.4 (64.6, 72.3) | 0.1 | 1,329 | 69.7 (66.3, 73.0) |
| Legumes | 89 | 24.9 (19.3, 30.5) | 412 | 25.1 (21.6, 28.6) | 0.9 | 501 | 25.1 (21.8, 28.4) |
| Green, leafy vegetables | 191 | 51.2 (44.8, 57.6) | 798 | 50.0 (45.9, 54.2) | 0.7 | 989 | 50.3 (46.6, 53.9) |
| Vitamin A‐rich fruits or vegetables | 285 | 81.0 (76.2, 85.8) | 1,257 | 78.2 (74.3, 82.1) | 0.3 | 1,542 | 78.8 (75.4, 82.1) |
| Tea or Tibetan tea | 186 | 55.6 (49.1, 62.1) | 965 | 62.2 (57.5, 66.9) | 0.02 | 1,151 | 60.9 (56.3, 65.4) |
| Minimum dietary diversity r | 157 | 46.9 (40.0, 53.8) | 738 | 50.0 (45.5, 54.4) | 0.3 | 895 | 49.4 (45.0, 53.7) |
| Pica, % | 28 | 5.6 (2.8, 8.5) | 111 | 5.1 (3.7, 6.5) | 0.7 | 139 | 5.2 (3.9, 6.5) |
| Any micronutrient supplement intake s , % | 25 | 5.9 (3.2, 8.7) | 85 | 6.6 (4.6, 8.6) | 0.7 | 110 | 6.5 (4.8, 8.1) |
Note. Ns are unweighted. Values presented are geometric mean (95% CI) or percent (95% CI). All estimates account for weighting and complex sampling design.
Abbreviations: AGP, ɑ‐1 acid glycoprotein; CI, confidence interval; CRP, C‐reactive protein; G6PD, glucose‐6‐phosphate dehydrogenase deficiency; RBC, red blood cell; RBP, retinol binding protein; sTfR, transferrin receptor.
Anaemia defined as altitude‐and smoking‐adjusted Hb <12.0 g/ dL (WHO, 2017a).
P values calculated for Rao–Scott chi square tests for categorical variables and linear contrast tests for continuous variables.
Other Terai cases include Terai/ Madhesi ethnicities not including Terai/ Madhesi Brahmin/ Chettri.
Interpret with caution. Estimates may be unstable due to small n.
Water source based on self‐report. Improved water source defined as piped water, tube well borehole, protected well or spring, stone tap, rainwater, or bottle water (WHO and UNICEF, 2017).
Haemoglobin adjusted for altitude and smoking (WHO, 2017a).
Anaemia severity categorized as mild (adjusted Hb 11.0– 11.9 g/ dL), moderate anaemia (adjusted Hb 8.0– 10.9 g/ dL), and severe (adjusted Hb < 8.0 g/ dL; WHO, 2017a).
Underweight defined as BMI <18.5 kg/ m2. Normal weight defined as BMI 18.5– 24.9 kg/ m2. Overweight/ obesity defined as BMI ≥25.0 kg/ m2 (WHO, 2004).
Inflammation defined as elevated CRP (>5 mg/ L) or elevated AGP (>1 g/ L; Namaste et al., 2017).
Soil‐transmitted helminths including hookworm, Trichuris trichura, and Ascaris lumbricodes.
Haemoglobinopathies include ɑ‐and β‐thalassemia, haemoglobin E, and sickle cell.
Receiving deworming during the 6 months preceding the survey.
Biomarker was regression‐adjusted to a pooled country reference to adjust for inflammation, using CRP and AGP (ferritin) or AGP only (sTfR; Namaste et al., 2017).
Iron deficiency defined as inflammation‐adjusted serum ferritin <15.0 μg/ L (WHO, 2017a).
Vitamin A deficiency was defined as RBP <0.64 μmol/ L. The population‐specific RBP cut‐point equivalent to serum retinol <0.70 μmol/ L was calculated by regressing RBP on retinol in a subsample of 100 WRA for whom serum retinol was assessed using HPLC from the same blood draw as RBP (WHO, 1996).
Folate cutoff based on the risk of megaloblastic anaemia defined as RBC folate <305.0 nmol/ L (Institute of Medicine 1998).
Zinc deficiency defined as serum zinc <66.0 μg/ dL for nonfasted, morning (i. e. before 12 pm) samples and < 59.0 μg/ dL for nonfasted, afternoon (i. e. after 12 p.m.) samples (IZiNCG 2012).
Minimum dietary diversity defined as intake from ≥5 of the 10 main food groups (grains, legumes, nuts, dairy, flesh foods, eggs, green leafy vegetables, vitamin A‐rich fruits and vegetables, other fruits, and other vegetables) the day preceding the survey based on Food and Agriculture Organization recommendations for minimum dietary diversity for women (FAO and FHI 360, 2016).
Micronutrient supplement intake includes: multivitamin, iron–folic acid tablets, iron tablets, and/or zinc tablets consumed the 7 days preceding the survey.