Anemia Among Children Under 5 Years in India: A District-Level Spatial Analysis Using NFHS-5 Data

Diagnostic Validation and Feasibility of a Non-invasive Haemoglobin Screening Device (EzeCheck) for 'Anaemia Mukt Bharat' in India

Anaemia remains a major public health issue in India despite several efforts. It is crucial to introduce technology-based innovations for the mass screening and early diagnosis of anaemia. Traditional anaemia screening requires drawing blood and laboratory analysis and can be logistically expensive in resource-constrained settings. A non-invasive haemoglobin test for mass screening in such settings is vital which can quickly and efficiently screen large populations. This study validated the haemoglobin estimation between the invasive haematology analyzer and the non-invasive EzeCheck (EzeRx Health Tech Pvt. Ltd., Bhubaneswar, Odisha, India) in the community setting. We conducted a cross-sectional study among 416 urban slum members in Bhubaneswar, India. We used inter-rater reliability (kappa statistic) of haemoglobin estimation between the haematology analyzer and EzeCheck devices. The finding showed a moderate agreement between both devices (kappa=0.4221). Between both devices, 91.59% of the results were with +/-1.5 difference; 43.51%, no difference; 33.65%, less than one difference; and 14.42%, +/-1 to +/-1.5 difference of haemoglobin estimation. There was no significant difference in overall anaemia status estimates between the devices. Mass screening in schools and communities with non-invasive haemoglobin tests can help identify anaemic people for early diagnosis and bring patients for timely treatment, which can be used in remote areas to support 'Anaemia Mukt Bharat'.

Interaction between micronutrients and lipid profile in prediabetes and diabetes among school-aged children (5-9 y) in India

OBJECTIVES

Lipids and micronutrients play a major role in the pathophysiology of diabetes, and several studies have established the association between lipids and diabetes. The aim of this study was to determine the interaction between lipid profile and micronutrient status with different prediabetes and diabetes diagnosis criteria among school-aged children in India.

METHODS

The data used in this study was from Comprehensive National Nutritional Survey conducted in India from 2016 to 2018. Glycosylated hemoglobin values and fasting blood glucose were used to classify normal, prediabetes, and diabetes. The interaction analysis between the lipid profile and eight micronutrients was conducted using multiple logistic regression analyses, and the predicted probabilities were determined.

RESULTS

Among micronutrients, the highest deficiency was observed for hemoglobin (27%), and in the lipid profile, triacylglycerol was high in 34% of children. The interaction between high total cholesterol and vitamin B12 deficiency showed the highest average probability for prediabetes (66%). The highest average probability for diabetes was observed from the interaction between normal high-density lipoprotein and vitamin A deficiency (3%).

CONCLUSION

The interaction between micronutrients and lipids suggests complex multidimensional pathways involving folate, vitamin B12, ferritin, zinc, hemoglobin, and iodine deficiencies. These interactions should be considered when planning diabetes management strategies.

Small area variation in severe, moderate, and mild anemia among women and children: A multilevel analysis of 707 districts in India

India is home to the highest global number of women and children suffering from anemia, with one in every two women impacted. India's current strategy for targeting areas with a high anemia burden is based on district-level averages, yet this fails to capture the substantial small area variation in micro-geographical (small area) units such as villages. We conducted statistical and econometric analyses to quantify the extent of small area variation in the three grades of anemia (severe, moderate, and mild) among women and children across 36 states/union territories and 707 districts of India. We utilized data from the fifth round of the National Family Health Survey conducted in 2019-21. The final analytic sample for analyses was 183,883 children aged 6-59 months and 690,153 women aged 15-49 years. The primary outcome variable for the analysis was the three anemia grades among women and children. We adopted a three-level and four-level logistic regression model to compute variance partitioning of anemia among women and children. We also computed precision-weighted prevalence estimates of women and childhood anemia across 707 districts and within-district, between-cluster variation using standard deviation (SD). For severe anemia among women, small area (villages or urban blocks) account for highest share (46.1%; Var: 0.494; SE: 0.150) in total variation followed by states (39.4%; Var: 0.422; SE: 0.134) and districts (12.8%; Var: 0.156; SE: 0.012). Similarly, clusters account for the highest share in the variation in severe (61.3%; Var: 0.899; SE: 0.069) and moderate (46.4%: Var: 0.398; SE: 0.011) anemia among children. For mild and moderate anemia among women, however, states were the highest source of variation. Additionally, we found a high and positive correlation between mean prevalence and inter-cluster SD of moderate and severe anemia among women and children. In contrast, the correlation was weaker for mild anemia among women (r = 0.61) and children (0.66). In this analysis, we are positing the critical importance of small area variation within districts when designing strategies for targeting high burden areas for anemia interventions.