Two-Level Logistic Regression Analysis of Factors Influencing Anemia Among Nonpregnant Married Women of Reproductive Age in Bangladesh

  • Md. Golam HossainEmail author
  • Kamruzzaman
  • Abdul Wadood
Part of the India Studies in Business and Economics book series (ISBE)


Anemia is a common and difficult health problem in Bangladesh. Study on anemia of Bangladeshi nonpregnant married women is weakly recognized. This study examined how various anthropometric, socioeconomic, and demographic factors associated with anemia of married women in Bangladesh. For this is a cross-sectional study, data was taken from Bangladesh Demographic and Health Survey (BDHS)-2011. The nationally representative sample (5293 married women) was selected by multistage cluster sampling. Multilevel logistic regression analysis was used in this study. The prevalence of anemia among Bangladeshi married women is more than 41% and among anemic women, 35.5, 5.6, and 0.2% were, respectively, mildly, moderately, and severely affected. Multilevel logistic regression model demonstrated that women, who are currently breastfeeding and with amenorrhea, are more likely (p < 0.01) to get anemia than their counterparts. Underweight women have a higher chance (p < 0.01) to get anemia than normal weight, overweight, and obese. Uneducated women are more likely to get anemia (p < 0.01) than secondary and higher educated. Anemia is particularly marked among married women who have electricity at home (p < 0.01), currently use contraceptive (p < 0.05), are non-Muslim (p < 0.01) and come from highest wealth quintile family (p < 0.01). Moreover, women who are 30–49 years old are more likely to get anemia than those who are younger. Undernutrition is the most important predictor for anemia among Bangladeshi married women and undernourished women are usually living under poor condition. Government of Bangladesh should take administrative steps to improve economic condition for removing anemia among married women.


Anemia Bangladesh Nonpregnant married women Two levels logistic regression 



The authors would like to thank the Bangladesh Demographic and Health Survey (BDHS) for providing nationally representative data collected in 2011.


  1. Arnold, D. L., Williams, M. A., Miller, R. S., Qiu, C., & Sorensen, T. K. (2009). Iron deficiency anemia, cigarette smoking and risk of abruptio placentae. Journal of Obstetrics and Gynaecology Research, 35(3), 446–452.CrossRefGoogle Scholar
  2. Ayoya, M. A., Bendech, M. A., Zagré, N. M., & Tchibindat, F. (2012). Maternal anaemia in West and Central Africa: Time for urgent action. Public Health Nutrition, 15(5), 916–927.CrossRefGoogle Scholar
  3. Balarajan, Y. S., Fawzi, W. W., & Subramanian, S. V. (2013). Changing patterns of social inequalities in anaemia among women in India: Cross-sectional study using nationally representative data. BMJ Open, 19; 3(3). doi:10.1136/bmjopen-2012-002233.
  4. Bangladesh Bureau of Statistics (BBS). (2003). Statistics division, ministry of planning (p. 56). Population & Housing Census: Preliminary Results.Google Scholar
  5. Bari, M. A., Sutradhar, S. R., Sarker, C. N., Ahmed, S., Miah, A. H., Alam, M. K., et al. (2013). Assessment of anaemia in patients with rheumatoid arthritis. Mymensingh Medical Journal, 22(2), 248–254.Google Scholar
  6. Benoist, B. D., McLean, E., Egli, I., & Cogswell, M. (Eds.). (2008). Worldwide prevalence of anemia 1993–2005: WHO global database on anemia (p. 1). Geneva, Switzerland: World Health Organization.Google Scholar
  7. CDC: Recommendations to prevent and control iron deficiency in the United States. (1998). Centers for disease control prevention. MMWR Recommendations and Reports, 47(RR-3), 1–29.Google Scholar
  8. Chan, Y. H. (2004). Biostatistics 202: Logistic regression analysis. Singapore Medical Journal, 45(4), 149–153.Google Scholar
  9. Coimbra, C. E., Jr., Santos, R. V., Welch, J. R., Cardoso, A. M., de Souza, M. C., Garnelo, L., et al. (2013). The first national survey of indigenous people’s health and nutrition in Brazil: Rationale, methodology, and overview of results. BMC Public Health, 13, 52. doi:10.1186/1471-2458-13-52.CrossRefGoogle Scholar
  10. Dangour, A. D., Hill, H. L., & Ismail, S. J. (2001). Haemoglobin status of adult non-pregnant Kazakh women living in Kzyl-Orda region, Kazakhstan. European Journal of Clinical Nutrition, 55(12), 1068–1075.CrossRefGoogle Scholar
  11. Dunn, O. J., & Clark, V. A. (1974). Applied statistics: Analysis of variance and regression (p. 33). Toronto: Wiley.Google Scholar
  12. Heck, J. E., Chen, Y., Grann, V. R., Slavkovich, V., Parvez, F., & Ahsan, H. (2008). Arsenic exposure and anemia in Bangladesh: A population-based study. Journal of Occupational and Environmental Medicine, 50(1), 80–87.CrossRefGoogle Scholar
  13. HKI/IPHN. (2002). Anemia is a severe public health problem in pre-school children and pregnant women in rural Bangladesh. NSP Bulletin Number 10, 1–4.Google Scholar
  14. Khan, M. H. R., & Shaw, J. E. H. (2011). Multilevel logistic regression analysis applied to binary contraceptive prevalence data. Journal of Data Science, 9, 93–110.Google Scholar
  15. Lee, H. S., Kim, M. S., Kim, M. H., Kim, Y. J., & Kim, W. Y. (2006). Iron status and its association with pregnancy outcome in Korean pregnant women. European Journal of Clinical Nutrition, 60(9), 1130–1135.CrossRefGoogle Scholar
  16. Liao, Q. K. (2004). Prevalence of iron deficiency in pregnant and premenopausal women in China: A nationwide epidemiological survey. Zhonghua Xue Ye Xue Za Zhi, 25(11), 653–657.Google Scholar
  17. Massawe, S. N., Urassa, E. N., Nyström, L., & Lindmark, G. (2002). Anaemia in women of reproductive age in Dar-es-Salaam, Tanzania. East African Medical Journal, 2002, 79(9), 461–466.Google Scholar
  18. Massot, C., & Vanderpas, J. (2003). A survey of iron deficiency anemia during pregnancy in Belgium: Analysis of routine hospital laboratory data in Mons. Acta Clinica Belgica, 58(3), 169–177.CrossRefGoogle Scholar
  19. Merrill, R. D., Shamim, A. A., Ali, H., Jahan, N., Labrique, A. B., Schulze, K., et al. (2011). Iron status of women is associated with the iron concentration of potable groundwater in rural Bangladesh. Journal of Nutrition, 141(5), 944–949.CrossRefGoogle Scholar
  20. Mulayim, B., Celik, N. Y., & Yanik, F. F. (2008). Helicobacter pylori infection detected by 14C-urea breath test is associated with iron deficiency anemia in pregnant women. Journal of Obstetrics and Gynaecology Research, 34(6), 980–985.Google Scholar
  21. Ndyomugyenyi, R., Kabatereine, N., Olsen, A., & Magnussen, P. (2008). Malaria and hookworm infections in relation to hemoglobin and serum ferritin levels in pregnancy in Masindi district, western Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene, 102(2), 130–136.CrossRefGoogle Scholar
  22. NIPORT. (2013). Bangladesh Demographic and Health Survey, 2011. National Institute of Population Research and Training, Dhaka; Mitra & Associates and ORC Macro, Bangladesh and Calverton, MD, USA, 1–8.Google Scholar
  23. Pala, K., & Dundar, N. (2008). Prevalence & risk factors of anaemia among women of reproductive age in Bursa, Turkey. Indian Journal of Medical Research, 128(3), 282–286.Google Scholar
  24. Park, S., & Lake, E. T. (2005). Multilevel modeling of a clustered continuous outcome: Nurses’ work hours and burnout. Nursing Research, 54(6), 406–413.CrossRefGoogle Scholar
  25. Pei, L., Ren, L., Wang, D., & Yan, H. (2013). Assessment of maternal anemia in rural Western China between 2001 and 2005: A two-level logistic regression approach. BMC Public Health, 13, 366. doi:10.1186/1471-2458-13-366.CrossRefGoogle Scholar
  26. Rakic, L., Djokic, D., Drakulovic, M., Pejic, A., Radojicic, Z., & Marinkovic, M. (2013). Risk factors associated with anemia among Serbian non-pregnant women 20–49 years old. A cross-sectional study. Hippokratia, 17(1), 47–54.Google Scholar
  27. Rasmussen, K. (2001). Is there a causal relationship between iron deficiency or iron-deficiency anemia and weight at birth, length of gestation and perinatal mortality? Journal of Nutrition, 131 (2S-2), 590–601S.Google Scholar
  28. Rawat, R., Saha, K. K., Kennedy, A., Rohner, F., Ruel, M., & Menon, P. (2014). Anaemia in infancy in rural Bangladesh: Contribution of iron deficiency, infections and poor feeding practices. British Journal of Nutrition, 111(1), 172–181.CrossRefGoogle Scholar
  29. Sadeghian, M., Fatourechi, A., Lesanpezeshki, M., & Ahmadnezhad, E. (2013). Prevalence of anemia and correlated factors in the reproductive age women in rural areas of Tabas. Journal of Family and Reproductive Health, 7(3), 139–144.Google Scholar
  30. Scholl, T. O., Hediger, M. L., Fischer, R. L., & Shearer, J. W. (1992). Anemia vs iron deficiency: Increased risk of preterm delivery in a prospective study. The American Journal of Clinical Nutrition, 55(5), 985–988.Google Scholar
  31. Scholz, B. D., Gross, R., Schultink, W., & Sastroamidjojo, S. (1997). Anaemia is associated with reduced productivity of women workers even in less-physically-strenuous tasks. British Journal of Nutrition, 77(1), 47–57.CrossRefGoogle Scholar
  32. Shamah-Levy, T., Villalpando-Hernández, S., García-Guerra, A., Mundo-Rosas, V., Mejía-Rodríguez, F., & Domínguez-Islas, C. P. (2009). Anemia in Mexican women: Results of two national probabilistic surveys. Salud Pública de México, 51(4), S515–S522.Google Scholar
  33. Shill, K. B., Karmakar, P., Kibria, M. G., Das, A., Rahman, M. A., Hossain, M. S., et al. (2014). Prevalence of iron-deficiency anaemia among university students in Noakhali region, Bangladesh. Journal of Health, Population and Nutrition, 32(1), 103–110.Google Scholar
  34. Smagulova, I. E., Sharmanov, T Sh, & Balgimekov, Sh A. (2013). The prevalence of anemia among children and women of reproductive age in Kazakhstan and basis of its prevention. Voprosy Pitaniia, 82(5), 58–63.Google Scholar
  35. Stevens, G. A., Finucane, M. M., De-Regil, L. M., Paciorek, C. J., Flaxman, S. R., Branca, F., et al. (2013). Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: A systematic analysis of population-representative data. Lancet Global Health, 1(1), 16–25.CrossRefGoogle Scholar
  36. Szerafin, L., & Jakó, J. (2010). Anemia in pregnancy: Characteristics in Szabolcs- Szatmár-Bereg County, Hungary. Orvosi Hetilap, 151(33), 1347–1352.CrossRefGoogle Scholar
  37. Takimoto, H., Yoshiike, N., Katagiri, A., Ishida, H., & Abe, S. (2003). Nutritional status of pregnant and lactating women in Japan: A comparison with non-pregnant/non-lactating controls in the National Nutrition Survey. Journal of Obstetrics and Gynaecology Research, 9(2), 96–103.CrossRefGoogle Scholar
  38. USDHEW. (1966). The Nutrition Survey of East Pakistan. US Department of Health, Education and Welfare and Department of Biochemistry, Dhaka University, Dhaka, 50–60.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of StatisticsUniversity of RajshahiRajshahiBangladesh
  2. 2.Medical CentreUniversity of RajshahiRajshahiBangladesh

Personalised recommendations