Who Is Left Behind? Socioeconomic and Geographic Inequalities in Anemia and Micronutrient Deficiencies in Nepal: Evidence from the National Micronutrient Survey
1
Research and Development, Public Health Promotion and Development Organization, Kathmandu, Nepal, Nepal
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Micronutrient deficiencies remain a major public health challenge in Nepal despite long-standing supplementation and fortification programs. Understanding disproportionately affected population by anemia and multiple micronutrient deficiencies is essential for designing equitable and targeted nutrition interventions. Hence, this study aimed to assess the prevalence, socioeconomic and geographic inequalities in anemia and key micronutrient deficiencies among priority population groups in Nepal using data from the National Micronutrient Survey (NMS).
METHODS:
This secondary analysis used nationally representative data from the Nepal NMS. The study population included preschool children (6–59 months), adolescent girls (10–19 years), and women of reproductive age (15–49 years). Outcomes included anemia (hemoglobin concentration adjusted for altitude) and deficiencies of iron (serum ferritin), vitamin A (serum retinol), zinc (serum zinc), and iodine status (urinary iodine concentration). A composite indicator of multiple micronutrient deficiency (≥2 deficiencies) was constructed. Independent variables included household wealth quintile, maternal education, place of residence, ecological zone, and province. Weighted prevalence estimates were generated. Multivariable logistic regression models assessed associations between socioeconomic, geographic factors and micronutrient outcomes. Inequality gradients were examined across wealth quintiles and provinces.
RESULTS:
Anemia and micronutrient deficiencies were disproportionately concentrated among populations from the lowest wealth quintiles, rural areas, and specific ecological zones. The prevalence of ≥2 micronutrient deficiencies was substantially higher among children and women residing in Mountain and Terai regions compared to Hill regions. After adjustment for confounders, individuals from the poorest households had significantly higher odds of anemia and multiple micronutrient deficiencies compared with the richest households. Marked provincial variation was observed, indicating geographic clustering of nutritional disadvantage.
CONCLUSIONS:
Significant socioeconomic and geographic inequalities persist in anemia and micronutrient deficiencies in Nepal. Nationally uniform interventions may be insufficient to address these disparities. Findings highlight the need for equity-focused, geographically targeted nutrition strategies within Nepal’s multisectoral nutrition framework.
Micronutrient deficiencies remain a major public health challenge in Nepal despite long-standing supplementation and fortification programs. Understanding disproportionately affected population by anemia and multiple micronutrient deficiencies is essential for designing equitable and targeted nutrition interventions. Hence, this study aimed to assess the prevalence, socioeconomic and geographic inequalities in anemia and key micronutrient deficiencies among priority population groups in Nepal using data from the National Micronutrient Survey (NMS).
METHODS:
This secondary analysis used nationally representative data from the Nepal NMS. The study population included preschool children (6–59 months), adolescent girls (10–19 years), and women of reproductive age (15–49 years). Outcomes included anemia (hemoglobin concentration adjusted for altitude) and deficiencies of iron (serum ferritin), vitamin A (serum retinol), zinc (serum zinc), and iodine status (urinary iodine concentration). A composite indicator of multiple micronutrient deficiency (≥2 deficiencies) was constructed. Independent variables included household wealth quintile, maternal education, place of residence, ecological zone, and province. Weighted prevalence estimates were generated. Multivariable logistic regression models assessed associations between socioeconomic, geographic factors and micronutrient outcomes. Inequality gradients were examined across wealth quintiles and provinces.
RESULTS:
Anemia and micronutrient deficiencies were disproportionately concentrated among populations from the lowest wealth quintiles, rural areas, and specific ecological zones. The prevalence of ≥2 micronutrient deficiencies was substantially higher among children and women residing in Mountain and Terai regions compared to Hill regions. After adjustment for confounders, individuals from the poorest households had significantly higher odds of anemia and multiple micronutrient deficiencies compared with the richest households. Marked provincial variation was observed, indicating geographic clustering of nutritional disadvantage.
CONCLUSIONS:
Significant socioeconomic and geographic inequalities persist in anemia and micronutrient deficiencies in Nepal. Nationally uniform interventions may be insufficient to address these disparities. Findings highlight the need for equity-focused, geographically targeted nutrition strategies within Nepal’s multisectoral nutrition framework.
| eISSN: | 2654-1459 |
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