Predictors of anaemia in mothers and children in Uttar Pradesh, India

Objective:Anaemia affects more than half of Indian women and children, but the contribution of its causes remains unquantified. We examined interrelationships between Hb and nutritional, environmental, infectious and genetic determinants of anaemia in non-pregnant mothers and children in Uttar Pradesh (UP).Design:We conducted a cross-sectional survey of households in twenty-five districts of UP between October and December 2016. We collected socio-demographic data, anthropometry and venous blood in 1238 non-pregnant mothers and their children. We analysed venous blood samples for malaria, Hb, ferritin, retinol, folate, Zn, vitamin B12, C-reactive protein, alpha 1-acid glycoprotein (AGP) and beta-thalassaemia. We used path analysis to examine pathways through which predictors of anaemia were associated with Hb concentration.Setting:Rural and urban households in twenty-five districts of UP.Participants:Mothers 18-49 years and children 6-59 months in UP.Results:A total of 36 center dot 4 % of mothers and 56 center dot 0 % of children were anaemic, and 26 center dot 7 % of women and 44 center dot 6 % of children had Fe deficiency anaemia. Ferritin was the strongest predictor of Hb (beta (95 % CI) = 1 center dot 03 (0 center dot 80, 1 center dot 27) g/dL in women and 0 center dot 90 (0 center dot 68, 1 center dot 12) g/dL in children). In children only, red blood cell folate and AGP were negatively associated with Hb and retinol was positively associated with Hb.Conclusions:Over 70 % of mothers and children with anaemia had Fe deficiency, needing urgent attention. However, several simultaneous predictors of Hb exist, including nutrient deficiencies and inflammation. The potential of Fe interventions to address anaemia may be constrained unless coexisting determinants are jointly addressed.