title: Caste-based social inequalities and childhood anemia in India: results from the National Family Health Survey (NFHS) 2005-2006.
abstract: BACKGROUND
  Caste is one of the traditional measures of social segregation in India and differs from other indicators as it is both, endogamous and hereditary. Evidence suggests that belonging to lower castes exposes one to social inequalities and affects health adversely. We examined the association of caste with childhood anemia in India and explored the effect modifying role of adult education and household wealth.
  
  
  METHODS
  A cross-sectional analysis of National Family Health Survey (NFHS) data of 43,484 children aged 6-59 months was performed. Poisson regression analysis was conducted to study the association between caste and childhood anemia accounting for various maternal, child, and household related variables. Caste was categorized as "other caste" (least disadvantageous), "other backward caste", "scheduled tribe" and "scheduled caste" (most disadvantageous). Anemia was defined as mild (hemoglobin level 7-11 g/dL), moderate (hemoglobin level 5-7 g/dL) and severe (hemoglobin level <5 g/dL).
  
  
  RESULTS
  We found that children in scheduled caste had higher risk of having anemia [mild anemia: RR = 1.10, 95% CI = 1.05-1.15; moderate anemia: RR = 1.19, 95% CI = 1.14-1.24; severe anemia: RR = 1.87, 95% CI = 1.51-2.31] after accounting for child, maternal and household covariates including adult education and household wealth. The interaction of caste with adult education and household wealth was not statistically significant for any level of anemia. Sensitivity analyses for children born to mothers of age ≥ 18 years at first child birth and body mass index (BMI) ≥ 18.5 kg/m(2), resulted in similar findings.
  
  
  CONCLUSIONS
  Caste is an independent determinant of childhood anemia in India. The level of adult education and household wealth did not modify the association between caste and childhood anemia. The findings may be used for countering childhood anemia and it may be beneficial to target future public health actions towards disadvantageous castes in India.
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. vart.priya@yahoo.co.uk.
authors.forename: Priya
authors.initials: P
authors.lastname: Vart
authors.affiliation: Department of Paediatrics, Medical College Guwahati, Guwahati, India. jaglanajay8@gmail.com.
authors.forename: Ajay
authors.initials: A
authors.lastname: Jaglan
authors.affiliation: School of Public Health, Dow University of Health Sciences, Karachi, Pakistan. kashif.shafique@Glasgow.ac.uk.|Institute of Health & Wellbeing, Public Health, University of Glasgow, 1-Lilybank Gardens, Glasgow, UK. kashif.shafique@Glasgow.ac.uk.
authors.forename: Kashif
authors.initials: K
authors.lastname: Shafique
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005192:Family Health; D005260:Female; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012044:Regression Analysis; D012923:Social Class; D055815:Young Adult