Burden of Anemia Among Ever-married Women in Bangladesh: Does Household Economic Inequality Matter?
Condition: Anemia
MeSH terms: Anemia
Study type: Observational

Summary: 
      Despite significant advances in the field of medicine and healthcare, anemia continues to be
      a major public health problem worldwide. The situation is particularly acute in developing
      countries where females belonging to the reproductive age category are especially vulnerable
      to the malady. Given the multifactorial nature of this disease, correcting anemia often
      requires the adoption of an integrated approach. Therefore, it is imperative that the role
      played by the "causes of the causes" (i.e., the sociodemographic determinants of risk), along
      with other contributing factors, must be identified, and addressed in order to effectively
      combat this disease. In general, it is terrible to sort out the psychosocial factors from the
      demographics, environmental and poverty-related causes. Therefore, the objective of this
      study is to use a nationwide representative survey to explore the magnitude of household
      economic inequalities contribute towards the prevalence of anemia among ever-married women in
      Bangladesh. The study also aims to examine the inference of other explanatory variables that
      frequently had supposed decomposing on the burden of anemia. Thus, this study answers the
      questions: (a) what are the strengths and likelihoods of having mild, moderate or severe
      anemia among the ever married women of different SES?; (b) do other factors viz.,
      demographics, diabetes, maternity, and BMI affects the strength and form of the association
      between SES and anemia?; (c) which explanatory variable is more prone to pose anemia among
      the women? As the burden of anemia is one of the key policy issues facing Bangladesh, the
      findings generated by this study are expected to contribute towards further policy making by
      virtue of identifying associated risk factors. This is expected to be instrumental for
      program purposes designed to prevent anemia among Bangladeshi women.
    

Detailed description: 
      This study was carried out with the approval of ICF International ( Address: 11785 Beltsville
      Drive Suite 300 Calverton, MD 20705 USA). The data from the 2011 Bangladesh Demographic and
      Health Survey (BDHS), conducted under the authority of the National Institute of Population
      Research and Training (NIPORT) of the Ministry of Health and Family Welfare of Bangladesh
      will be used for this study. Mitra and Associates, a Bangladeshi research firm located in
      Dhaka implemented the survey and ICF International of Calverton, Maryland, USA, arranged the
      technical support to the mission as the part of its international Demographic and Health
      Surveys database (MEASURE DHS). Procedures and questionnaires for standard DHS surveys have
      been reviewed and approved by the ICF International Institutional Review Board (IRB). (See
      more at:
      http://www.dhsprogram.com/What-We-Do/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm#sth
      ash.qc30dbXO.dpuf) The data collection processes for the BDHS was executed as per the
      approval of the ORC Macro-institutional review board. The survey protocol was reviewed and
      approved by the National Ethics Review Committee of the Bangladesh Ministry of Health and
      Family Welfare. As per BDHS guidelines, informed consent was obtained from all respondents
      before starting the interview along with an oral clarification offered by the interviewers
      themselves. Respondents were well informed with regards to the intended use of the gathered
      data (assessment of health needs and planning health services), the voluntary nature of the
      study, potential risks of participation in the study, the confidentiality of answers/results
      of the individual interview and biomarker assay, and that the examination was free of cost.
      Prior to the blood collection and examination, participants were also well informed about the
      purpose of the study.

      A stratified, multistage cluster sampling strategy was followed in order to construct a
      national representative household-based sample. To generate this, 600 primary sampling units
      (207 from urban areas and 393 from rural areas) were raised from the sampling frame created
      for the 2011 Bangladeshi census. From each primary sampling unit, households were nominated
      randomly and 17,964 households were selected for interview. Face-to-face interviews were
      effectively completed among 17,141 selected households. Finally, in these households a total
      of 18,222 ever married women age 12-49 were identified and 17,842 were interviewed
      successfully. A total of 5920 ever-married women aged between 15-49 years who resided in
      one-third of the randomly selected households were selected as subjects for the biomarker
      assay for anemia study.
    

Observational model: Ecologic or Community
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Ever married Women in Bangladesh
      
Keywords: Anemia; Ever married women; Economic inequality; Diabetes; Maternity; BMI