Targeting anaemia without measuring it: surrogate prediction, district decision uncertainty and the value of repeat measurement in India

The study examined whether anaemia prevalence in Indian districts could be predicted without direct measurement, as the fifth national health survey measured anaemia in all 707 districts, but the sixth survey did not. Researchers analyzed data from 183 districts and found that the median standard errors of anaemia estimates were 3.57 percentage points for children and 2.22 percentage points for women. The best surrogate indicator had a root mean squared error of 10.14 percentage points for children, which was approximately 2.5 times higher than measurement error. Among 71 districts prioritized based on current estimates, 19.1% were not among the truly highest-priority districts. Measuring 183 districts selected according to decision value recovered 46.3% of this prioritization gap. The study concluded that available survey indicators could not adequately substitute for direct measurement of anaemia in districts.