Coexistence of Anemia with Stunting, Wasting, and Underweight Among Children Aged 6-59 Months: Insights from the National Family Health Survey

Background: Anemia and undernutrition (stunting, wasting, underweight) remain critical public health challenges among children aged 6–59 months in India, with severe implications for cognitive and physical development. Despite national programs like Poshan Abhiyaan and Anemia Mukt Bharat, the coexistence of these conditions persists, exacerbating long-term health and socioeconomic burdens. This study examines the prevalence and determinants of coexisting anemia with undernutrition using recent national data to inform targeted interventions. Data and Methods: The study utilized data from the National Family Health Survey-5 (NFHS-5, 2019–21), encompassing 208,007 children aged 6–59 months. Anemia was defined as hemoglobin <11.0 g/dL, while undernutrition indicators were derived from WHO standards. Multilevel logistic regression models were employed to assess associations, adjusting for child, maternal, and household factors. The analysis accounted for hierarchical data structure and complex survey design. Results: The prevalence of anemia was 68.0%, with 36.7% stunting, 18.5% wasting, and 32.5% underweight. Coexistence rates were alarmingly high: anemia with stunting (26.0%), underweight (22.9%), and wasting (12.7%). Key risk factors included younger child age (12–35 months), higher birth order, short birth intervals, maternal anemia, and low maternal education. Socioeconomic disparities were evident, with children from the poorest households and marginalized social groups (SC/ST) at higher risk. Regional variations highlighted elevated odds in western India and lower odds in the northeast. Improved maternal BMI (≥25) and higher education were protective. Conclusion: This study highlights the persistent burden of coexisting anemia and undernutrition among Indian children aged 6–59 months, with heightened vulnerability in children aged 12–35 months. Key risk factors include maternal anemia, poor nutrition, and socioeconomic disparities, perpetuating intergenerational malnutrition. Western India faces a higher burden, necessitating targeted interventions for marginalized and disadvantaged groups. Integrated strategies focusing on maternal education, improved nutrition, and enhanced healthcare access are critical to addressing these challenges.