The Risk Factors for Child Anemia are Consistent Across Three National Surveys in Nepal



Anemia is an etiologically heterogeneous condition affecting over half of preschool-aged children in South Asia. An urgent need exists to elucidate context-specific causes of anemia to effectively address this issue.


This study investigated national trends and stability in the prevalence of child anemia and associated risk factors from 2013–2016.


Same-season national surveys were administered in 2013, 2014 and 2016 in 63 sites across 21 districts, selected using multi-stage random sampling, representing the mountains, hills and Tarai. Among consenting households with children 6–59 months, a random sample of capillary blood was selected each year for anemia assessment using a Hb 201+ hemoglobinometer, with n = 835, 807, and 881 children assessed, respectively. Prevalence of child anemia, defined as hemoglobin <11.0 g/dL with adjustment for altitude, was estimated each year and disaggregated by region and child age. Prevalence ratios were estimated using log-binomial regression models with robust standard errors or robust Poisson regression when models failed to converge. Interaction terms between each risk factor and year were created to test for consistencies in associations over time.


The national prevalence of child anemia decreased from 63.3% (95% CI: 59.0%, 67.5%) in 2013 to 51.9% (95% CI: 46.5%, 57.2%) in 2014 and increased to 59.3% (95% CI: 54.7%, 63.8%) in 2016. Across years, prevalence was highest in the Tarai (58.4–70.2%), followed by the mountains (53.0–61.1%) and hills (37.5–51.4%). Nationally and across time, child age and maternal anemia were significantly associated with child anemia. Child diarrhea and stunting, maternal thinness, and poor water and sanitation conditions also showed consistent trends towards higher anemia prevalence.


Anemia affects more than half of Nepalese children 6–59 months. Although prevalence varies year-to-year, the stability of observed risk factors suggests the need to focus on reducing gastrointestinal infection, promoting adequate household sanitation, and improving maternal and child health.

Publication Type
Research Themes