Association of multiple micronutrient powders, vitamin A supplementation and deworming with anaemia among children aged 6–59 months in Nepal: analysis of the 2022 Nepal Demographic and Health Survey

Background Childhood anaemia remains a substantial public health challenge in Nepal, affecting a large proportion of children despite the implementation of national intervention programmes, including multiple micronutrient powders (MNPs), vitamin A supplementation and deworming. This study examined the association between receipt of these interventions and anaemia among children aged 6–59 months using nationally representative data from Nepal.Methods We conducted a cross-sectional analysis using data from the 2022 Nepal Demographic and Health Survey. The study included children aged 6–59 months with available haemoglobin measurements. The primary exposures were receipt of MNPs (Baal Vita), vitamin A supplementation and deworming. Combined receipt of vitamin A supplementation and deworming and receipt of all three age-eligible interventions were also examined. Multivariable logistic regression was used to assess associations between receipt of interventions and anaemia, adjusting for sociodemographic, household and geographical characteristics. Survey weights, clustering and stratification were applied to account for the complex sampling design.Results Among children aged 6–59 months, 40.7% were anaemic. Vitamin A supplementation was reported for 86.2% of eligible children, while 85.2% of children aged 12–59 months had received deworming. Among children aged 6–23 months, 28.4% had received MNPs. After adjustment for potential confounders, deworming (aOR 0.67, 95% CI 0.47 to 0.94; p=0.022) was significantly associated with lower odds of anaemia. Receipt of both vitamin A supplementation and deworming was also associated with lower odds of anaemia (aOR 0.66, 95% CI 0.49 to 0.88; p=0.006), whereas receipt of vitamin A supplementation and MNPs considered separately were not significantly associated with anaemia.Conclusions Receipt of both vitamin A and deworming, and deworming alone, was significantly associated with lower odds of anaemia among children in Nepal, whereas no significant association was observed for MNP receipt. These findings support continued implementation and strengthening of vitamin A supplementation and deworming programmes and highlight the need to improve MNP coverage and adherence.