Distribution, socioeconomic inequalities and contributing factors of anaemia prevalence across wealth index among Indian adolescent girls: multivariate decomposition analysis of nationally representative survey.

BACKGROUND: Anaemia among adolescent girls aged 15-19 years can adversely affect educational, vocational and reproductive outcomes. Amid rapid urbanisation, understanding its prevalence, determinants and urban-rural inequities is essential. Using National Family Health Survey (NFHS)-5 data in India, this study comprehensively assessed anaemia epidemiology and quantified urban-rural disparities and their contributing factors through multivariate decomposition analysis. METHODOLOGY: NFHS-5 data from 113 606 adolescent girls aged 15-19 years were analysed. Socio-demographic, health, and behavioural factors were assessed through standardised interviews. Haemoglobin was measured using HemoCue Hb 201+, with anaemia defined as <12 g/dL. Decomposition and concentration indices assessed disparities inequities. RESULTS: Anaemia was more prevalent among adolescent girls from rural areas (60.2%, 95% CI 59.9 to 60.5%) compared with those from urban areas (56.6%, 95% CI 56.0 to 57.3%). Multivariate decomposition analysis showed that the largest variable-level contribution to the explained urban-rural disparity in anaemia prevalence was from wealth index (52.4%; richest: -1.497, 95% CI-1.501 to -1.493), followed by region (21.7%; East: -0.750, 95% CI-0.753 to -0.748), caste (17.3%; schedule tribe: -0.406, 95% CI -0.408 to -0.403), accessibility of healthcare centre (12.6%; not accessible: -0.319, 95% CI -0.323 to -0.315) and fruit intake (8.2%; daily: -0.834, 95% CI -0.839 to -0.829). In contrast, media exposure showed a negative contribution (-13.1%; 0.452, 95% CI 0.450 to 0.455), indicating that differences in media exposure reduced the observed urban-rural disparity. The concentration indices were comparable between urban (-0.075, 95% CI -0.089 to -0.061) and rural (-0.071, 95% CI -0.078 to -0.064) populations, indicating modest wealth-related inequality in both settings. CONCLUSION: Anaemia burden was high among Indian adolescent girls, with urban-rural disparities driven by socioeconomic status, dietary patterns and media exposure, requiring comprehensive, multifaceted nationwide interventions.