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Keywords
Defecation
Female
Sanitation
Water Supply
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Abstract
Introduction: Anaemia remains highly prevalent among young women in India, and water and sanitation conditions are biologically plausible contributors through faecal exposure and helminth-related blood loss. Among the studies identified, we found no NFHS-5 analysis of women aged 15–24 years that examined moderate-to-severe Anaemia using cumulative water/sanitation disadvantage score and a separate household open-defecation measure. This analysis was conducted to evaluate associations of cumulative household water/sanitation disadvantage and household open defecation with moderate-to-severe Anaemia. Methods: This cross-sectional analysis used NFHS-5 (2019–2021) data for women aged 15–24 years. The primary complete-case sample included 219,819 women, and multiple imputation included 232,082 women with observed water and sanitation exposures. The cumulative score combined drinking-water disadvantage with sanitation disadvantage, defined as unimproved sanitation technology or improved facility shared with one or more other households. Survey-weighted logistic regression adjusted for prespecified covariates and state fixed effects. Results: In the primary complete-case sample, the survey-weighted prevalence of moderate-to-severe Anaemia was 31.71%. The cumulative score was associated with the outcome overall (p=0.002). One disadvantage was associated with higher adjusted odds (AOR 1.06, 95%CI: 1.02, 1.09), whereas two disadvantages were not statistically significant (AOR 1.07, 95%CI: 0.98, 1.16). Sanitation disadvantage (AOR 1.06, 95%CI: 1.03, 1.10) and open defecation (AOR 1.08, 95%CI: 1.04, 1.12) were positively associated, while drinking-water disadvantage was not. Multiple-imputation findings were nearly identical, and no statistically significant interactions were observed, either before or after multiplicity correction. Conclusion: Sanitation disadvantage and open defecation were associated with modestly higher adjusted odds of moderate-to-severe Anaemia.
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