Prevalance of anemia in children with acute lower respiratory tract infection: a case control study in children between 6 months to 23 months


  • Rajakumar N. Marol Department of Pediatrics, Shivajyoti Institute of Child Health, Haveri, Karnataka, India
  • Rohitkumar R. Marol Department of Pediatrics, Shivajyoti Institute of Child Health, Haveri, Karnataka, India
  • Renuka R. Marol Department of Pediatrics, Shivajyoti Institute of Child Health, Haveri, Karnataka, India



Anemia, Acute lower respiratory tract infection, Children, Prevalance


Background: Anemia and ALRI are quite common in infants and toddlers in developing countries. ALRI is a leading cause of mortality in children below 5 years of age and it is important to prevent risk factors for development of ALRI. Present study was conducted to know the prevalence of anemia in children between 6 m to 23 m with ALRI and the relation between ALRI and anemia.

Methods: This is a prospective case control study, conducted at Level 2 hospital situated in   backward district over a period of 1 year. Two hundred cases who had ALRI as per WHO criteria and 200 controls  were taken as the study group. Children were divided in to 3 different age groups. Haemoglobin level was estimated in all.Anemia was defined and classified according to WHO criteria.

Results: Out of total 200 children both in cases and controls, 128 (64%) were males and 72 (36%) were females. Overall 190 (95%) of cases and 187 (93.5%) of controls had anemia. The prevalence of anemia was uniform in both sexes and all age groups. Children in the age group 6m -11m were more likely to develop ALRI.

Conclusions: Prevalance of anemia in children between 6 m to 23 m with ALRI and without ALRI was 93.5% and 95% respectively. Authors cannot declare with affirmation that there was no association between Hb levels and ALRI as prevalence of anemia was very high in control group. Screening all children for anemia and taking proper intervention measures is necessary while treating for other ailments like ALRI.


Kabra SK, Verma IC. Acute lower respiratory tract infection: the forgotten pandemic. Indian J Pediatr. 1999;66(6):873-5.

Janus J, Moerschel SK. Evaluation of anemia in children. Am fam physic. 2010;81(12):1462-71.

WHOVitamins and minerals- World Health Organization. Available at: WHO website>nutrition>publications>vitamins_min accessed 15 May 2020.

World Health Organization. The global prevalence of anemia in 2011. Geneva: World Health Organization; 2015. Avaialable at: WHO website >nutrition>publications>micronutrients accessed 15 May 2020.

Registrar General and Census Commissioner, India. Census of India. New Delhi, India: Office of the Registrar General, India; 2001. Available at:

Mclean E, Cogswell M, Egli I, Wojdyla D, Debenoist B. Worldwide prevalence of anemia, WHO vitamin and mineral nutrition information system, 1993-2005. Public Health Nutr. 2009;12(4):444-54.

Pasricha SR, Black J, Muthayya S, Shet A, Bhat V, Nagaraj S, et al. Determinants of anemia among young children in rural India. Pediatr. 2010 Jul 1;126(1):e140-9.

National Family Health Survey (NFHS-3), 2005-2006: Key Findings. Mumbai, India: International Institute for Population Sciences; 2007. Available at:

Bharati S, Pal M, Bharati P. Prevalence of anaemia among 6-to 59-month-old children in India: the latest picture through the NFHS-4. J Biosocial Science. 2020 Jan;52(1):97-107.

Arlappa N, Balakrishna N, Laxmaiah A, Brahmam GNV. Prevalence of Anemia among rural pre-school children of Maharashtra. Indian J Commu Health. 2012;24(1):4-8.

Huang Y, Wang L, Huo J, Wu Q, Wang W, Chang S, et al. Prevalence and causes of anaemia in children aged 6-23 months in rural Qinghai, China: findings from a cross-sectional study. BMJ open. 2019 Sep 1;9(9):e031021.

Joo EY, Kim KY, Kim DH, Lee JE, Kim SK. Iron deficiency anemia in infants and toddlers Blood Res. 2016 Dec; 51(4):268-73.

Kotecha PV. Nutritional Anemia in Young Children with Focus on Asia and India. Indian J Commu Med. 36(1):8-16,

Huang Z, Jiang FX, Li J, Jiang D, Xiao TG, Zeng JH. Prevalence and risk factors of anemia among children aged 6–23 months in Huaihua, Hunan Province. BMC Public Health. 2018 Dec 1;18(1):1267.

Mourad S, Rajab M, Alameddine A, Fares M, Ziade F, Merhi BA. Hemoglobin level as a risk factor for lower respiratory tract infections in Lebanese children. N Am J Med Sci. 2010;2(10):461-6.

Barson WG, Kaplan SL, Torchia MM. Epidemiology, pathogenesis, and etiology of pneumonia in children. Available at: http://www.Up To Date. Accessed 3 November 2016.

Christi MJ, Tebruegge M, La Vincente S, Graham SM. Pneumonia in Severely Malnourished Children in Developing Countries-mortality risk, Etiology and Validity of WHO clinical signs: A systematic review. Trop Med Int Health. 2009;14(10):1173-89.

Sheikh HQ, Ashraf M, Wani JG, Ahmed J. Low hemoglobin level a Risk Factor for acute lower respiratory tract infections (ALRTI) in Children. J Clin Diagn Res. 2014;8(4):1-3.

Bryce J, Boschi-Pinto C, Shibuya K. WHO Estimates of the Causes of Death in Children. Lancet. 2005;365(9465):1147-52.

Bont L, Heijnen C, Kavelaars A, van Aalderen W, Brus F, Draaisma J, et al. Local interferon-levels during respiratory syncytial virus lower respiratory tract infection are associated with disease severity. J Infect Dis. 2009;184(3):355-8.

Ramakrishnan K, Harish PS. Hemoglobin level as a risk factor for lower respiratory tract infections. Indian J Pediatr. 2006;73(10):881-3.

Ganong WF. Gas transport between the lungs and tissues. Review of medical physiology. 22nd ed. New York: McGraw-Hill; 2005:666-669.

Ghio AJ. Disruption of iron homeostasis and lung disease. Biochim Biophys Acta 2009;1790:731-9.

World Health Organization. 2011‎. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. World Health Organization. Available at:

Sahu T, Sahani NC, Patnaik L. Childhood anemia-a study in tribal area of Mohana block in Orissa. Ind J Commu Med. 2007;32(1):43-5.

Zhao, A, Zhang Y, Peng Y, Li J, Yang T, Liu Z, et al. Prevalence of anemia and its risk factors among children 6-36 months old in Burma. Am J Tropic Med Hygiene. 2012;87(2):306-11.

Lutter CK, 2008. Iron deficiency in young children in low-income countries and new approaches for its prevention. J Nutr. 2008;138(12):2523-8.

Broor S, Pandey RM, Ghosh M, Maitreyi RS, Lodha R, Singhal T, et al. Risk factors for severe acute lower respiratory tract infection in under-five children. Indian Pediatr. 2001;38(12):1361-9.

Mghanga FP, Genge CM, Yeyeye L, Twalib Z, Kibopile W, Rutalemba FJ, et al. Magnitude, Severity, and Morphological Types of Anemia in Hospitalized Children Under the Age of Five in Southern Tanzania. Cureus. 2017 Jul 21;9(7):e1499.

Ashraf M, Wani JG, Ahmed J. Low Hemoglobin level a risk factor for acute lower respiratory tract infections in children. JCDR. 2014;8(4):PC01-3.

Malla T, Pathak OK, Malla KK. Is Low Hemoglobin level a risk factor for acute lower respiratory tract infections? J Nepal Pediatr Soc. 2010;30:1-7.

Roma KM, Gupta V, Ahmad S, Ranhotra S, Issrani R, Prabhu N. Assessment of anemia as a risk factor for acute lower respiratory tract infections in children: a case-control study. Int J Clin Pediatr. 2015;4(2-3):149-53.

Savitha MR, Nandeeshwara SB, Pradeep Kumar MJ, ul-Haque F, Raju CK. Modifiable risk factors for acute lower respiratory tract infections. Indian J Pediatr. 2007;74(5):477-82.

Acharya D, Prasanna KS, Nair S, Rao RS. Acute respiratory infections in children: A community based longitudinal study in south India. Indian J Public Health. 2003;47(1):7.

Deb SK. Acute respiratory disease survey in Tripura in case of children below five years of age. J Indian Med Assoc. 1998;96(4):111-6.

Domellöf M, Lönnerdal B, Dewey KG, Cohen RJ, Rivera LL, Hernell O. Sex differences in iron status during infancy. Pediatr. 2002;110(3):545-52.

Soh P, Ferguson EL, McKenzie JE, Homs MY, Gibson RS. Iron deficiency and risk factors for lower iron stores in 6-24-month-old New Zealanders. Eur J Clin Nutr. 2004 Jan;58(1):71-9.

Tsai SF, Chen SJ, Yen HJ, Hung GY, Tsao PC, Jeng MJ, et al. Iron deficiency anemia in predominantly breastfed young children. Pediatr Neonatol. 2014;55(6):466-9.

Wang M. University of California–San Diego, San Diego, California Iron Deficiency and Other Types of Anemia in Infants and Children. Am Fam Physician. 2016 Feb 15;93(4):270-8.






Original Research Articles