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Cluster and regional level variation of hemoglobin concentration of ever-married women in Bangladesh: a linear mixed model approach

Biometrics & Biostatistics International Journal
Md Atiqul Islam, Ruhul Amin, Abdullah Al Islam, Rukhsana Ferdous, Luthful Alahi Kawsar


Background: The hemoglobin protein plays an essential role in health and development in the human body. Women with inadequate Hb levels develop anemia. In light of the regional heterogeneity in Bangladesh, the aim of this study is to identify the risk factors associated with low Hb concentration in ever-married women. Methods: The study extracted data from the Bangladesh Demographic Health Surveys (BDHS) conducted in 2011. Since the hemoglobin level was not measured in BDHS 2014 and BDHS 2017, the study used BDHS 2011. A total of 5,699 ever-married women aged (15-49) years were used in the study. Both descriptive and inferential statistics applied to answer the research questions. Multilevel linear mixed effect modelling was applied to identify the risk factors of hemoglobin level at different hierarchical levels simultaneously and the different level variations were observed. Results: The average age of women was 31 years with standard deviation of 9.33 years. The mean (SD) of hemoglobin level of women was 120.95 (13.81) g/L. The highest mean (SD) level of hemoglobin was found in the Khulna 122.48 (13.26) g/L and the lowest in the Barisal 119.61 (13.21) g/L. The multilevel model resulted that using the contraceptive method, pregnant women, married women, breastfeeding mother, age of mother, body mass index, and total children ever born had significant effect on the low hemoglobin level. Conclusion: Analyzing the individual, cluster, and regional influence, the current study determined the most relevant socioeconomic, demographic, and environmental risk factors for low hemoglobin levels of women in Bangladesh.


anemia, BDHS, cluster, hemoglobin, multilevel