Socioeconomic, Demographic, and Environmental Determinants of Hemoglobin Levels Among Women: A Multilevel Analysis in South and Southeast Asia

Anemia, mainly caused by hemoglobin (Hb) deficiency, is a serious health issue in countries that are developing, such as Bangladesh, India, Nepal, the Maldives, and Myanmar. This study examines the factors influencing Hb levels in women aged 15-49 across these nations using data from the Demographic Health Surveys (2011-2016). Analyzing 716,273 women from 71 subnational regions, we employed multilevel linear mixed-effect modeling to identify key determinants. The study revealed that its mean Hb level was 117.5 g/L with a standard deviation (SD) of 16.5 g/L overall, with its highest mean in Nepal (123 g/L) with SD 15.4 g/L and the lowest in the Maldives (115.3 g/L) with SD 3.8 g/L. Anemia affected 51.3% of women, with the highest prevalence in the Maldives (58.5%) and the lowest in Nepal (40.6%). Regarding socioeconomic status and education level, Nepal exhibited the highest mean Hb levels among different socioeconomic groups, while the Maldives had the lowest. Linear mixed models identified several factors affecting Hb levels, including socioeconomic status, education level, contraceptive method, menstrual cycle, literacy, pregnancy, marriage, breastfeeding, amenorrhea, age, BMI, parity, access to water, and sanitation. Furthermore, a four-level random intercept model proved more effective than other models in fitting the data. Our findings highlight the need for targeted interventions to reduce anemia rates in South and Southeast Asia, emphasizing socioeconomic, demographic, and environmental influences. These insights are crucial for policymakers and program managers aiming to enhance women's health in these regions.