# Determinants of coexistence of undernutrition and anemia among children aged 6–59 months in Nepal: Evidence from the 2022 Nepal Demographic and Health Survey

## TL;DR

This study examines how undernutrition and anemia coexist in young children in Nepal and finds that factors like wealth and maternal education are linked to lower odds of both conditions.

## Contribution

The study identifies socioeconomic and maternal factors associated with the coexistence of undernutrition and anemia in children using recent national survey data.

## Key findings

- The coexistence of undernutrition and anemia was found in 16.0% of children aged 6–59 months in Nepal.
- Children from wealthier households and those with educated mothers had significantly lower odds of coexisting undernutrition and anemia.
- Underweight mothers were associated with an 80% higher odds of coexistence of undernutrition and anemia in their children.

## Abstract

Undernutrition and anemia among children aged 6–59 months are significant public health issues in developing countries like Nepal. The coexistence of these conditions impacts childhood development. This study aimed to determine the prevalence of undernutrition and anemia, assess their coexistence, and identify contributing factors among children aged 6–59 months in Nepal.

We conducted a secondary analysis using data from 2022 Nepal Demographic and Health Survey (NDHS 2022), a nationally representative cross-sectional survey. The outcome variables were undernutrition, anemia, and their coexistence. Undernutrition was defined as the presence of stunting, wasting, underweight, or any combination of these conditions. Anemia was defined as hemoglobin levels <11.0 g/dL (adjusted for altitude). We applied multivariable multinomial logistic regression to determine factors associated with coexistence, and multivariable logistic regression to assess factors associated with undernutrition and anemia separately. We presented the results from the regression analysis using adjusted odds ratio (aOR) and 95% confidence intervals (CI).

Among 2,395 children, the weighted prevalence of undernutrition was 33.5%, anemia was 43.4%, and coexistence of undernutrition and anemia was 16.0%. Children from the richest wealth quintile, whose mothers had at least secondary education, and those whose mothers participated in household decision-making had 53% (aOR: 0.47; 95% CI: 0.26 to 0.86), 48% (aOR:0.52; 95% CI: 0.32 to 0.86), and 34% (aOR: 0.66; 95% CI: 0.47 to 0.94) lower odds of experiencing the coexistence of undernutrition and anemia compared to their counterparts. Children with underweight mothers had 80% (aOR:1.80; 95% CI:1.20 to 2.70) higher odds of coexistence compared to their counterparts.

The prevalence of undernutrition, anemia, and their coexistence among children was high in Nepal. Interventions that improve mothers’ education, strengthen their roles in the family, and enhance the household financial condition are essential to reduce these conditions and improve children’s nutritional status.