Determinants of nutritional anaemia in children less than five years age

Sandip Ray, Jagdish Chandra, Jayashree Bhattacharjee, Sunita Sharma, Anuja Agarwala


Background: According to WHO, highest prevalence of anemia is found in pre-school aged children. The objective of this study was to determine demographic, socio-economic & nutritional factors for nutritional anemia in children <5 yrs.

Methods: We conducted a cross-sectional study of children aged 6 to 59 months. Hemoglobin, ferritin, folate, vitamin B12 levels were determined. Anthropometric measurements, nutritional intake, family income and other demographic data were recorded.

Results: Majority of cases (75.0%) were in 6months – 2 years age group. 139 (69.5%) subjects had iron deficiency, 86 (43.0%) had Vitamin B12 deficiency and 28 (14.0%) had folic acid deficiency. On multivariate regression the factors found to be associated were: increasing birth order, low iron intake & symptoms of anemia in mother.

Conclusions: Low iron intake, increasing birth order and symptoms of anemia in mother were significant factors associated with nutritional anemia in children less than 5 years age. 


Nutritional anemia, Children under-5 age, Iron, Pre-school age

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World Health Organization. Iron Deficiency Anaemia: Assessment, Prevention, and Control-A Guide for Programme Managers. Geneva, Switzerland: World Health Organization. 2001. www.who. int/nutrition/publications/micronutrients/ anaemia_iron_deficiency/WHO_NHD_01.3/en/ index.html. Accessesd at April 12, 2010

DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world. World Health Statistics Quarterly. 1985;38:302-16.

National Family Health Survey (NFHS-3). 2005-2006: Key Findings. Mumbai, India: International Institute for Population Sciences; 2007.Available at: pdf/SR128/SR128.pdf. Accessed April 11, 2010.

Rao NP, Singh D, Swaminathan MC. Nutritional Status of Preschool children of rural communities near Hyderabad city. Ind J Med Res. 1969;57:2132-48.

Gupta N, Agarwal KN. Hematological Investigations and plasma proteins in pre-school children. Ind Jour Pediatr. 1972;39:48-51.

Uberoi IS, DeSweemer C, Taylor CE. A study of anemia among rural Punjabi children. Ind Jour Med Res. 1972;60:793-99.

Preschool children studies on anemia: Indian Council of Medical Research. Technical Report Series, No. 26:22. 1977.

Singla PN, Gupta HP, Ahuja C, Agarwal KN. Deficiency Anemia in preschool Children- Estimation of prevalence based on response to haematinic supplementation, Jour Trop Pediatr. 1982;28:77-80.

Agarwal DK, Bharadwaj B, Singla PN, Tripathi AM, Agarwal KN. Etiology of maternal and early childhood deficiency anemia. Ind Jour Pediatr. 1986;53:389-96.

Gomber S, Kumar S, Rusia U, Gupta P, Agarwal KN, Sharma S. Prevalence and etiology of nutritional anemia in early childhood in an urban slum. Ind J. Med Res. 1998;107:269-73.

Pasricha SR, Black J, Muthayya S. Determinants of Anemia Among Young Children in Rural India. Pediatrics. 2010;126:e140-9.

Chatterjee P. Child malnutrition rises in India despite economic boom. Lancet. 2007;369(9571):1417-8.

Kumar A. National nutritional anaemia control programme in India. Indian J Public Health. 1999;43(1):3-5.

Yadav D, Chandra J. Iron deficiency: beyond anemia, Indian J Pediatr. 2011;78(1):65-72.

PHNI/MEDS/USAID. Anaemia prevention and control: What works; Part I; The Population, Health and Nutrition/Monitoring, Evaluation and Design Support/US USA: Assistance for International Development. 2003.

Dallman PR, Simes MA. Percentile curves for hemoglobin and red cell volume in infancy and childhood. J Pediatr. 1979;94:28.

Patro BK, Jeyashree K, Gupta PK, Kuppuswamy's socioeconomic status scale 2010-the need for periodic revision, Indian J Pediatr. 2012;79(3):395-6.

Osório MM, Lira PI, Ashworth A. Factors associated with Hb concentration in children aged 6–59 months in the State of Pernambuco, Brazil. Br J Nutr. 2004;91(2):307-15.

Adish AA, Esrey SA, Gyorkos TW, Johns T. Risk factors for iron deficiency anaemia in preschool children in northern Ethiopia. Public Health Nutr. 1999;2(3):243-52.

Almeida CA, Ricco RG, Ciampo LA, Souza AM, Pinho AP, Oliveira JE. Factors associated with iron deficiency anemia in Brazilian preschool children. J Pediatr (Rio J). 2004;80(3):229-34.

Tengco LW, Rayco-Solon P, Solon JA, Sarol JN, Solon FS. Determinants of Anemia among Preschool Children in the Philippines, J Am Coll Nutr. 2008;27(2):229-43.

Nawal. Assessment of the prevalence and potential determinants of nutritional anaemia in Upper Egypt.

Food and Nutrition Bulletin. 1997;20(4):417-21.

Duque X, Flores-Hernández S, Flores-Huerta S. Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute. BMC Public Health. 2007;7:345.

Keikhaei B, Zandian K, Ghasemi A, Tabibi R. Iron-deficiency anemia among children in southwest Iran. Food Nutr Bull. 2007;28(4):406-11.

Souganidis ES, Sun K, De Pee S. Determinants of Anemia Clustering Among Mothers and Children in Indonesia. Journal of Tropical Pediatrics. 2011.

Bortolii GA, Vitolo MR. Relationship between iron deficiency and anemia in children younger than 4 years. J Pediatr (Rio J). 2010;86(6):488-92.

Chandra J, Jain V, Narayan S. Folate and Cobalamin Deficiency in Megaloblastic Anemia in Children. Indian Pediatr. 2002;39(5):453-7.

Schneider JM, Fujii ML, Lamp CL, Lönnerdal B, Dewey KG, Zidenberg-Cherr S. The use of multiple logistic regression to identify risk factors associated with anemia and iron deficiency in a convenience sample of 12–36-mo-old children from low-income families. Am J Clin Nutr. 2008;87(3):614-20.

Cotta RM, Oliveira Fde C, Magalhães KA. Social and biological determinants of iron deficiency anemia, Cad Saude Publica. 2011;27(2):S309-20.

Sharma A, Sharma SK, Grover AK, Tewari AD, Abrol P. Anemia in protein-energy malnutrition. Indian Pediatr. 1985;22(11):841-4

Monarrez J, Martinez H, Martinez V, Greiner T. Nutritional status of indigenous children at boarding schools in Nortern Mexico. Eur J. Clin Nutr. 2004;58:532-40.

Pasricha SR, Black J, Muthayya S. Determinants of Anemia Among Young Children in Rural India. Pediatrics. 2010;126;e140-9.

Halileh S, Gordon NH. Determinants of Anemia in Pre-School Children in the Occupied Palestinian Territory ; J Trop Pediatr. 2006;52(1):12-8.

Kotecha PV. Nutritional anemia among young children withfocus on Asia and India. Indian J Community Med. 2011;36:8-16.