INTRODUCTION:

Health is a vital component of human capital. Child health is considered to be important factor to country’s present and future development. However, child health outcome parameters in the recent years are becoming a matter of concern specially in lower and middle-income countries like India (Das et al., 2021). There are also evidences on reproductive and child health inequalities (Jothy and Kalaiselvi, 2013). Anemia is a major global health concern that particularly affects young children and pregnant women. According to the estimates of World Health Organization, world wide 40% of all children in the age group 6–59 months is affected by anaemia¹.

National Family Health Survey classified the anemia prevalence among the children (6-59months) as mild (10-10.9g/dL), moderate severe (7-9.9g/dL) and severe (Less than 7g/dL). Iron deficiency related to low dietary iron intake is one of the major causes of anemia in children in India (Thankachan et al., 2008).

Other critical factors also associated with anemia in children are vitamin deficiencies, especially folate, vitamins B12 and A, infections with malaria parasites and hookworms, and hemoglobinopathies (Schneider et al., 2005, Antony et al., 2008). In a study of anemia in children in rural India, Pasricha et al. (2010) indicated that hemoglobin levels were primarily related to children's iron status. In addition, maternal hemoglobin levels, family wealth, and food insecurity were also shown to be critical. Hunshikatti and Viveki (2015) concluded that normocytic normochromic anemia as the most common form of anemia in pregnant women, followed by macrocytic hypochromic anemia. Babu et al. (2016) observed microcytic hypochromic anemia as the most common anemia pattern in their study population, followed by dimorphic or macrocytic anemia. India aims to reduce anemia prevalence in children (6-59months) from 58 percent in 2016 to 40 percent in 2022 through Anemia Mukt Bharat Program¹. As per the report of NFHS-5, anemia prevalence has increased by 8.5 percent in 2019-2020 compared to 2015-16 in India and 514 districts have more than 40per cent of anemia prevalence among the children aged between 6-59months. In this situation the present article aims to discuss the status of anemia prevalence among the children (6-59months) across states of India and analyze the factors influencing it during 2015-16 to 2019-20.

The rest of the paper is organized as follows. In the next section we have mentioned data (and sources) used have explained research methodology, following which the results along with its analysis are narrated in the section 3. Finally, we conclude.

DATA AND METHODOLOGY:

The present study is prepared using data from two sources: (1) factsheets of the National Family Health Survey (NFHS) 4 and 5 published by the Ministry of Health and Family Welfare, Government of India and (2) Reserve Bank of India (RBI). The NFHS is a large scale, multi-round survey conducted throughout India in a representative sample of households. The survey was first conducted in 1992-93. Since then, five rounds of the survey have been conducted. We have used the children (6-59 months) anemia data from the NFHS-4(2015-16) and NFHS-5(2019-20) factsheets because of their data-definition compatibility. For the first three rounds of NFHS, anemia prevalence in children were measured for 6 to 35 months aged children whereas for NFHS 4 and NFHS 5 the same was measured for the children of age group 6 to 59 months. The study has also used some other variables, as mentioned in the table-1 from the factsheets of NFHS-5 and NFHS-4. Besides that, it has considered the data of state-wise share of expenditure on medical and public health and family welfare in (respective state’s) total expenditure as a state-level public health expenditure variable. This data has been taken from the “State Finances: A Study of Budgets of 2021-22” available at the Reserve Bank of India’s website. Descriptions of the variables which are used in the study are presented in table-1.

Table 1: Variable Descriptions

Variable	Description^#	Source
CANEMIC	Children age 6-59 months who are anemic (%)	NFHS-4 and5 factsheets
FEDU	Women with 10 or more years of schooling (%)	NFHS-4 and5 factsheets
MEDU	Men with 10 or more years of schooling (%)	NFHS-4 and5 factsheets
DIET	Total children age 6-23 months receiving an adequate diet	NFHS-4 and5 factsheets
WANEMIC	All women age 15-49 years who are anemic	NFHS-4 and5 factsheets
WORK	Women who worked in the last 12 months and were paid in cash	NFHS-4 and5 factsheets
HEXP	Share of public expenditure on Medical and Public health and family welfare in aggregate expenditure	Reserve Bank of India
D	Time dummies such that D= 0 for 2015-16 and D=1 for 2019-20	…

Note: #- variable descriptions are as per the definitions provided in the NFHS -5 factsheets

Regarding research methodology, we have used some simple exploratory data analysis tools like Box-plot, histogram and density plot. For empirical analysis the present study has derived compound annual growth rate (CAGR) and has applied pooled OLS regression. We have computed the CAGR of anemia prevalence of children (6-59 months) across states of India because anemia data is not available for the continuous years. The NFHS are not conducted annually hence reports are not available for the continuous years.

The CAGR (r) is derived as follows:

x_n= x₀(1+r)^t

= r=(x_n/ x₀)^1/t-1

here,

x_n:Value of the variable (here children anemia) for the terminal year (here, 2019-20)

x₀:Value of the variable (here children anemia) for the initial year (here 2015-16)

r : CAGR

t : Difference between initial and terminal years

RESULTS AND DISCUSSIONS:

Status of Anemia among the children across the states in India: The anemia prevalence in children aged 6 to 59 months has increased to 67 per cent in 2019-2020, from 59 percent in 2015-16 (NFHS 4 and NFHS 5). The compound annual growth rate is found to be 3.44 per cent between these two time periods.

The prevalence of anemia in children (6-59 months) has increased for the states Assam, Chhattisgarh, Gujarat, Jammu and Kashmir, Maharashtra, Manipur, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, Tripura and West Bengal in 2019-20 compared to 2015-16 whereas it has remained stagnant in both periods for the Andhra Pradesh, Arunachal Pradesh, Bihar, Goa, Haryana, Himachal Pradesh, Jharkhand, Karnataka, Kerala, Madhya Pradesh, Meghalaya, Sikkim, Uttarakhand and Uttar Pradesh states of India. We have plotted the state-level child-anemia data in Figure-1.

Figure 1: Status of Anemia among the children across the states in India

Figure 2: gives the box-plot of anemia prevalence in children across states of India for the two years 2015-16 and 2019-20.

Figure 2: Box-plots of prevalence of anemia in children (6-59 months) across Indian states

Figure 3: Histogram with Density Plot of CAGR (%) of anemic children in states of India during 2015-16 to 2019-20

The median value of anemia prevalence among children was higher in 2019-20 (64.9 per cent) than that of in 2015-16 (54 per cent). However, the spread of child-anemia is found to be more or less same (Inter-quartile range for 2015-16 and 2019-20 are 13.3% and 12.95% respectively). Moreover, form the boxplots it is evident that child anemia (%) data series is negatively skewed for 2019-20 while for 2015-16 it is to some extent symmetric. Both the boxplots also show the presence of outliers.

The compound annual growth rates of anemia across the states of India for the period 2015-16 to 2019-20 are presented in form of histogram in the figure 3. States like Mizoram, Manipur, Assam and Tripura has reported considerable level of positive annual growth rate during this period with Mizoram has the highest CAGR of child anemia prevalence during this period.

DESCRIPTIVE RESULTS:

Table-2 gives the descriptive statistics of the variables used in empirical analysis. It shows three categories of standard deviations: overall, between and within. The between variation implies the variation of the anemia prevalence in children over time, whereas, within variation refers to variation of the anemia prevalence in children among the different states in different time periods. The overall variation result shows that on an average near about 57 per cent of children aged between 6 to 59 months were anemic with standard deviation of almost 13 per cent during 2015-16 to 2019-20. We have also found that within group variation is dominated by between group variations for all the cross-sectional variables.

Table 2: Summary Statistics

Variable		Mean	SD.	Min.	Max.	Observations
CANEMIC	Overall	56.902	12.981	19.3	79.7	N = 58
	Between		11.083	32.85	71.15	n = 29
	Within		6.916	40.552	73.252	T = 2
FEDU	Overall	41.231	13.027	22.8	77	N = 58
	Between		12.650	23.3	74.6	n = 29
	Within		3.535	34.131	48.331	T = 2
MEDU	Overall	49.881	11.801	29.4	76.6	N = 58
	Between		11.385	32.45	71.9	n = 29
	Within		3.452	40.281	59.481	T = 2
DIET	Overall	13.324	6.765	3.4	30.7	N = 58
	Between		6.137	5.55	26.65	n = 29
	Within		2.959	6.124	20.524	T = 2
WANEMIC	Overall	50.686	11.710	24.8	71.4	N = 58
	Between		11.111	27.9	66.95	n = 29
	Within		3.978	40.736	60.636	T = 2
WORK	Overall	26.245	9.091	12.3	45.1	N = 58
	Between		8.815	12.55	44.9	n = 29
	Within		2.511	19.845	32.645	T = 2
HEXP	Overall	5.162	0.976	3.1	7.9	N = 58
	Between		0.900	3.7	7.75	n = 29
	Within		0.396	4.062	6.262	T = 2
D	Overall	0.5	0.504	0	1	N = 58
	Between		0	0.5	0.5	n = 29
	Within		0.504	0	1	T = 2

Source: Authors’ own calculation

Table 3: Determinants of Child Anemia aged 6-59 months across states of India

	Coefficient	S.E.	p	Coefficient	S.E.	p
CANEMIC	(Model-1)			(Model-2)
FEDU	0.072	0.081	0.382	…	…	…
MEDU	…	…	…	0.138	0.082	0.099
WANEMIC	0.700	0.089	0.000***	0.717	0.085	0.000***
DIET	-0.407	0.165	0.017**	-0.401	0.157	0.013**
WORK	-0.144	0.099	0.153	-0.136	0.098	0.168
HEXP	-2.387	1.096	0.034**	-2.097	1.089	0.060*
D	8.467	1.986	0.000***	8.076	1.927	0.000***
Constant	35.772	9.352	0.000***	29.385	9.967	0.005**
N:	58			58
F(6, 50)	27.86			29.30
Prob>F	0.000			0.000
R²	0.7662			0.7752
Adj. R²	0.7387			0.7487

Note: ***=> significant at <1%, **=> significant at <5%, *=> significant at < 10% level of significance

Source: Authors’ own calculation

Factors influencing Children Anemia across states:

In this section we have determined the factors which were influencing the prevalence of child (6-59 months) anemia across the states of India. For the empirical analysis we have fitted two separate pooled regression models, one with MEDU (Model-1) and another with FEDU (Model-2). If, we include both MEDU and FEDU as regressors in the same regression model then the problem of multicollinearity arises in model. All other regressors are same for both the models. The regression models are given as follows:

CANEMIC_it= b₀+ + b₁MEDU_it + b₂ WANEMIC_it + b₃DIET_it + b₄ WORK_it + b₅ HEXP_it + b₆D + u_it ……………………………………(1)

CANEMIC_it = p₀ + + p₁ MEDU_it + p₂ WANEMIC_it + p₃DIET_it + p₄ WORK_it + p₅ HEXP_it + p₆D + v_it ……………………………………(2)

The table 3 summarizes the pooled OLS regression results for both models. The overall goodness of fit of both models is good enough and also both the estimated models are statistically significant at less than 1 per cent level of significance.

The estimated coefficient of time dummy in both models is statistically significant and positive. This suggests that anemia in children aged 6-59 months across states of India has exaggerated overtime during 2015-16 to 2019-20. The factors arrived to be significant in our analysis (both models) are WANEMIC, DIET and HEXP. The results suggest prevalence of anemia in children across Indian states decreases with the public expenditure on Medical and Public health. States with higher prevalence of iron-deficiency in women (age 15-49 years) tend to experience higher child-anemia prevalence during these years. Moreover, prevalence of iron deficiency in children is found to have a negative relation with adequate diet intake. The study has not found any statistically significant relation between child-anemia with schooling variable(s) and working-status of women.

The Variance Inflating Factors (VIFs) of the regressors are presented in table-4. It shows all the regressors considered in the analysis (both models) have fairly low value of VIF suggesting no (severe) problem of perfect multicollinearity in our econometric framework and corresponding results.

Table 4: VIF of two regression models

Variable	VIF (Model-1)	VIF (Model-2)
FEDU	1.45	…
MEDU	…	1.26
WANEMIC	1.42	1.35
DIET	1.61	1.51
D	1.30	1.27
WORK	1.06	1.06
HEXP	1.48	1.52
Mean VIF	1.39	1.33

Source: Authors’ own calculation

CONCLUSION:

Using data from NFHS-4 and 5 datasheets, published by the Ministry of Health and Family Welfare, Government of India, present study has analyzed the status and drivers of anemia prevalence among the children (6-59 months) across the states of India. It has also used state-level public health expenditure data from the RBI. The study finds that anemia in children aged 6-59 months across states of India has intensified overtime during 2015-16 to 2019-20. The prevalence of anemia in children (6-59 months) has increased for the states Assam, Chhattisgarh, Gujarat, Jammu and Kashmir, Maharashtra, Manipur, Mizoram, Nagaland, Odisha, Punjab, Rajasthan, Tripura and West Bengal in 2019-20 compare to 2015-16. The compound annual growth rate of anemia prevalence anemia in children is found to be 3.44 percent during this period in India with Mizoram has the highest CAGR of child anemia prevalence. The factors arrived to be significant in the study are prevalence of iron-deficiency in women (age 15-49 years), public health expenditure and proper diet intake by children. The latter two factors have negative relation with child anemia prevalence whereas the former one has a positive relation with child anemia. Education status and working status are found to have no significant impact of anemia prevalence among children.

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Received on 13.06.2023 Modified on 24.07.2023

Asian Journal of Management. 2023;14(4):260-264.

DOI: 10.52711/2321-5763.2023.00043