Maternal and Socioeconomic Factors Drive Childhood Anemia in Tajikistan: Examining the Role of Zero Vegetable or Fruit Consumption among under five

ObjectivesTo examine whether complete absence of vegetable and fruit consumption (Zero Vegetable or Fruit - ZVF) independently associates with anemia among children aged 0-59 months in Tajikistan, and to identify key maternal and socioeconomic determinants of childhood anemia. DesignCross-sectional analysis using recent 2023, nationally representative Demographic and Health survey data from Tajikistan. SettingNational population based study across all regions of Tajikistan (urban and rural areas) using two stage stratified cluster sampling. Participants2,355 children in age group 0-59 months with complete data on hemoglobin levels and dietary intake in the preceding 24 hours residing in households selected from 2023 Tajikistan Demographic and Health Survey were included in this study. Main Outcome MeasuresPrimary outcome, childhood anemia status (hemoglobin <10.5g/dl for 6-23 months, <11g/dl for 24-59 months, altitude-adjusted per WHO 2024 criteria). ResultsAmong Tajik children under 5 years, 36.1% of children consumed no vegetables or fruits in the preceding 24 hours and the prevalence of anemia was 33.2%. Adjusted odds in our study revealed no association of ZVF consumption with anemia (OR=0.85, 95% CI: 0.63 to 1.14). Significant associations emerged for maternal anemia which increased child anemia odds by 48% (OR=1.48, 95% CI: 1.16 to 1.88), richest index had 60% lower anemia odds compared to the poorest (OR=0.39, 95% CI: 0.27 to 0.56) and low birth size increased anemia risk two fold (OR=1.92, 95% CI: 1.31 to 2.81).Each additional daily meal consumption reduced anemia odds by 14% (OR=0.86, 95% CI: 0.76 to 0.98). ConclusionsChild anemia in Tajikistan is not primarily driven by specific dietary factors but maternal nutritional status during pregnancy, birth outcomes, and socioeconomic disparities are main drivers. This novel null finding on ZVF intake, underscores that non dietary drivers predominate, informing targeted interventions aligned with SDG2 (Zero hunger). Thus integrated approaches aim to address maternal nutrition, antenatal care, wealth inequalities, and feeding frequency promotion. What is already known on this topicOver 40% of children under five globally are affected by childhood anemia with dietary factors like low fruit and vegetable intake considered important contributors. However, the specific impact of complete absence (zero consumption) of vegetables and fruits on childhood anemia needs to be explored particularly in Central Asian countries like Tajikistan as here the dietary pattern differ from other low- and middle-income settings. What this study addsThis first nationally representative Central Asian study showed that downstream factor thats the zero vegetable or fruit consumption had no association with childhood anemia in Tajikistan. Instead upstream factors like maternal anemia during pregnancy, household wealth disparities, small birth size, and meal frequency emerged as primary determinants, challenging dietary-centric intervention approaches. How this study might affect research, practice or policyThese findings redirect anemia prevention strategies towards integrated interventions addressing maternal nutrition during pregnancy, poverty alleviation, improved antenatal care for fetal growth monitoring, and feeding frequency promotion rather than focusing solely on vegetable or fruit consumption. This evidence informs sustainable development goals (SDG) aligned nutrition policies requiring upstream determinants to be prioritized alongside dietary diversity programs in similar settings. Key PointsO_ST_ABSCore IssuesC_ST_ABSThis study explored whether complete absence of vegetable and fruit consumption (ZVF) associates with childhood anemia (below five years) in Tajikistan thereby challenging dietary-centric intervention approaches by examining maternal and socioeconomic determinants. FindingsThe research found no significant association between zero vegetable or fruit consumption with childhood anemia, but identified maternal anemia during pregnancy, household wealth disparities, small birth size, and meal frequency as primary drivers. MeaningThis novel null finding of our research redirects anemia prevention strategies from dietary diversity alone toward integrated upstream interventions addressing maternal nutrition, poverty alleviation, antenatal care quality, and feeding frequency informing SDG-aligned policies in Central Asia and similar Lower-and Middle-income countries.