Trends in Anemia Prevalence Among Indian Women Using Revised WHO Hemoglobin Cutoffs: Insights From Repeated Cross-Sectional Surveys (1998–2019)

Abstract

Introduction: This study reanalyzes the data from India based on revised cutoffs on hemoglobin (Hb) as updated by World Health Organization (WHO) to inform policy decisions. Methods: The study analyzes change in prevalence of anemia among pregnant women in different trimesters and nonpregnant women in India using data from nationally representative survey (1998-1999 to 2019–2021). Changes in mean Hb concentration and in anemia prevalence using revised Hb cutoffs were analyzed. Mann–Kendall (MK) test was utilized to estimate trend coefficient (τ) with significance to quantify change in anemia prevalence. State-wise anemia prevalence was calculated, categorizing states as controlled, emerging hotspots, hotspots, and arresting momentum, considering 40% prevalence cutoff as severe public health concerns. Results: For 2019–2021, anemia prevalence during pregnancy decreased from 52.2% as per the previous cutoff to 47.1% as per the revised cutoff. As per revised cutoffs, MK test revealed reduction in anemia trends (τ = 0.333, p = 0.734). This decline was most pronounced in the third trimester, where severe anemia dropped by 51.3% from 1998–1999 to 2019–2021. While mild and moderate anemia showed little change over two decades, moderate anemia in the third trimester declined by 3.67%. Reductions in severe anemia were noted across trimesters. States identified as emerging hotspots require urgent, targeted interventions due to persistently high or rising anemia rates. Conclusion: This study highlights a decline in anemia prevalence, particularly in severe cases during pregnancy. Anemia reduction efforts must rely on country-specific data, especially on the Hb distribution against the background of ferritin level, hemoglobinopathies, prevalence of infections, and inflammations in the population.