Trends in Anemia Prevalence Among Indian Women Using Revised WHO Hemoglobin Cutoffs: Insights From Repeated Cross-Sectional Surveys (1998-2019).

Introduction: This study reanalyzes the data from India based on revised cutoffs on hemoglobin (Hb) as updated by World Health Organization (WHO) to inform policy decisions. Methods: The study analyzes change in prevalence of anemia among pregnant women in different trimesters and nonpregnant women in India using data from nationally representative survey (1998-1999 to 2019-2021). Changes in mean Hb concentration and in anemia prevalence using revised Hb cutoffs were analyzed. Mann-Kendall (MK) test was utilized to estimate trend coefficient (τ) with significance to quantify change in anemia prevalence. State-wise anemia prevalence was calculated, categorizing states as controlled, emerging hotspots, hotspots, and arresting momentum, considering 40% prevalence cutoff as severe public health concerns. Results: For 2019-2021, anemia prevalence during pregnancy decreased from 52.2% as per the previous cutoff to 47.1% as per the revised cutoff. As per revised cutoffs, MK test revealed reduction in anemia trends (τ = 0.333, p=0.734). This decline was most pronounced in the third trimester, where severe anemia dropped by 51.3% from 1998-1999 to 2019-2021. While mild and moderate anemia showed little change over two decades, moderate anemia in the third trimester declined by 3.67%. Reductions in severe anemia were noted across trimesters. States identified as emerging hotspots require urgent, targeted interventions due to persistently high or rising anemia rates. Conclusion: This study highlights a decline in anemia prevalence, particularly in severe cases during pregnancy. Anemia reduction efforts must rely on country-specific data, especially on the Hb distribution against the background of ferritin level, hemoglobinopathies, prevalence of infections, and inflammations in the population.