Offer for Students ₹ 999 INR ( offer valid till 31st December 2025)
55. Anemia in Children of India
Authors & Affiliation
1.Bugubaeva Makhabat Mitalipovna.
2.Srinivaspur Krishnamurthy Yashaswini .
Associate Professor , HOD Clinical Disciplines , Osh State Medical University , International Medical Faculty .)
(2 .Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan.)
Introduction
Anemia is a condition where the body does not have enough healthy red blood cells (RBCs) or hemoglobin to carry oxygen to body tissues. In children, this results in tiredness, poor growth, weak immunity, and delayed development.
In India, anemia is one of the most common health problems among children and adolescents. According to the National Family Health Survey (NFHS-5, 2019–21), more than 67% of children aged 6–59 months are anemic. This is a serious concern for the country’s public health system because anemia affects physical, mental, and social growth.
Epidemiology
Anemia is widespread across India but is more common in rural areas, among low-income families, and in children under five years of age.
Key statistics from national surveys:
NFHS-5 (2019–21): 67.1% of children aged 6–59 months are anemic.
NFHS-4 (2015–16): 58.6% — showing that the rate has increased despite control programs.
States like Bihar, Uttar Pradesh, Jharkhand, and Madhya Pradesh have the highest prevalence.
Urban areas show lower rates (~55%) compared to rural areas (~70%).
Factors such as malnutrition, parasitic infections, poverty, and lack of health education contribute to the high burden.
Types of Anemia in Children
There are many types of anemia, but in Indian children, the following are most common:
1. Iron Deficiency Anemia (IDA):
Caused by low iron intake or poor absorption.
The most common type (about 70–80% of all cases).
2. Megaloblastic Anemia:
Due to deficiency of vitamin B₁₂ or folic acid.
Causes large, immature red cells (megaloblasts).
3. Hemolytic Anemia:
RBCs are destroyed faster than they are made.
Can be hereditary (like thalassemia, sickle cell anemia) or acquired (due to infections or autoimmune diseases).
4. Aplastic Anemia:
The bone marrow fails to produce enough RBCs, WBCs, and platelets.
May occur due to drugs, toxins, or viral infections.
5. Anemia of Chronic Disease:
Occurs in children with long-term illnesses such as kidney disease or tuberculosis.
Causes and Risk Factors
1. Nutritional Deficiency
Low intake of iron-rich foods like meat, green vegetables, and pulses.
Poor diet in growing children, especially after stopping breastfeeding.
Deficiency of vitamin B₁₂ and folic acid due to lack of fruits, vegetables, and animal products.
2. Increased Demand
Rapid growth periods (infancy, adolescence) require more iron.
Inadequate intake cannot meet the increased need.
3. Blood Loss ,Hookworm infections cause slow, chronic blood loss.Frequent infections or menstruation in adolescent girls can add to loss.
4. Poor Absorption Chronic diarrhea or intestinal diseases reduce nutrient absorption.
5. Genetic Disorders Thalassemia and sickle cell anemia are common in some regions of India.
6. Socioeconomic and Environmental Factors
Poverty, low maternal education, and poor hygiene increase risk.
Early weaning and low birth weight are also strong predictors.
Pathophysiology
Anemia develops when the balance between RBC production and destruction is disturbed.
Iron deficiency leads to smaller (microcytic) and paler (hypochromic) RBCs.
Vitamin B₁₂ or folate deficiency causes large (macrocytic) RBCs.
Hemolytic anemia increases bilirubin due to RBC breakdown.
Reduced oxygen transport causes fatigue, breathlessness, and pallor.
Clinical Features
Symptoms vary depending on the severity and duration.
General Symptoms
Pale skin, lips, and nails
Weakness, tiredness, dizziness
Loss of appetite
Shortness of breath during exertion
Rapid heartbeat (tachycardia)
Specific Signs
Iron deficiency anemia: brittle nails, smooth tongue, spoon-shaped nails (koilonychia).
Megaloblastic anemia: swollen tongue, numbness, and tingling due to nerve involvement.Hemolytic anemia: jaundice and dark urine.
In Children
Poor school performance
Delayed growth and development
Irritability and lack of concentration
Repeated infections due to weak immunity
Diagnosis
Diagnosis requires both clinical assessment and laboratory tests.
1. History and Examination
Diet history, growth records, and any chronic illnesses
Physical signs like pallor, jaundice, or bone deformities
2. Laboratory Investigations
Test Purpose
Hemoglobin estimation (Hb%) Confirms anemia (Hb < 11 g/dL in children)
Peripheral blood smear Identifies cell size and type (microcytic, macrocytic, etc.)
Serum ferritin, iron, TIBC To confirm iron deficiency
Vitamin B₁₂ and folate levels For megaloblastic anemia
Reticulocyte count Shows bone marrow activity
Stool examination Detects hookworm or parasites
Hemoglobin electrophoresis For thalassemia and sickle cell anemia
Treatment
Treatment depends on the cause but generally includes correction of deficiency, treatment of underlying disease, and dietary improvement.
1. Iron Deficiency Anemia
Oral iron therapy:
Elemental iron 3–6 mg/kg/day (as ferrous sulfate or fumarate) for 3 months after normalization of Hb.
Parenteral iron: used if oral iron is not tolerated or absorption is poor.
Dietary advice: include liver, meat, fish, green vegetables, jaggery, and pulses.
Deworming: albendazole 400 mg once every 6 months.
2. Megaloblastic Anemia
Folic acid: 1–5 mg/day orally for 3 months.
Vitamin B₁₂: 1000 µg intramuscular weekly for 4–6 weeks, then monthly maintenance.
3. Hemolytic Anemia
Treat the cause; in severe hereditary cases, blood transfusion and folate supplementation are needed.
Splenectomy may be considered in some cases.
4. Aplastic Anemia
Supportive care with transfusions.
Bone marrow transplant is the only curative therapy in severe cases.
5. Anemia of Chronic Disease
Manage the underlying illness . Use of erythropoietin in chronic kidney disease
Complications
If untreated, anemia can cause:
Delayed growth and development
Reduced learning ability and school performance
Frequent infections , Heart problems (tachycardia, heart failure in severe cases) ,Maternal and neonatal morbidity (in older girls who become pregnant early)
Prevention
Prevention is the most effective approach to reduce childhood anemia.
1. Nutritional Measures
Promote exclusive breastfeeding for 6 months.
Introduce iron-rich complementary foods after 6 months.
Fortify staple foods (like flour and salt) with iron and folic acid.
Encourage consumption of vitamin C-rich foods (like citrus fruits) to enhance iron absorption.
2. Infection Control
Regular deworming programs.
Improvement in sanitation and hygiene to reduce parasitic infections.
3. Health Education
Educate families about balanced diets and iron sources.
Promote awareness in schools and communities.
4. Screening
Routine Hb testing in children, especially in high-risk areas.
Screening at schools and primary health centers.
Government and National Programs
India has implemented several initiatives to control anemia among children.
1. National Iron Plus Initiative (NIPI, 2013)
Provides iron and folic acid (IFA) supplementation to children, adolescents, and women.
Dosage schedule for children (6–59 months): 1 mL IFA syrup (containing 20 mg iron + 100 µg folic acid) biweekly.
For 5–10 years: one IFA tablet weekly (45 mg iron + 400 µg folic acid).
Biannual deworming with albendazole is included.
2. Anemia Mukt Bharat (AMB) Programme (2018)
Aims to reduce anemia prevalence by 3% per year.
Covers six beneficiary groups: children 6–59 months, 5–9 years, adolescent girls and boys, pregnant women, lactating mothers, and women of reproductive age.
Focuses on 6x6x6 strategy:
Six target groups,
Six interventions (IFA, deworming, testing, behavior change, fortification, and delayed cord clamping),
Six institutional mechanisms for monitoring.
3. Integrated Child Development Services (ICDS)
Provides nutritional supplements through Anganwadi centers.
Monitors growth and health of preschool children.
4. Mid-Day Meal Scheme
Offers nutritious cooked meals in schools to improve diet quality and reduce micronutrient deficiencies.
Recent Research and Challenges
Despite several programs, anemia remains a major health issue. Reasons include:
Poor compliance with iron supplements due to taste and side effects.
Lack of awareness among parents.
Persistent poverty and malnutrition.
Inadequate monitoring and supply chain problems.
Recent studies suggest using multiple micronutrient powders and double-fortified salt as additional strategies.
Conclusion
Anemia in Indian children is a major public health concern that affects physical growth, cognitive development, and future productivity.Most cases are preventable through simple measures like adequate nutrition, iron supplementation, deworming, and health education.Government programs such as Anemia Mukt Bharat and NIPI have created a strong framework, but their success depends on community participation, awareness, and continuous monitoring.For medical students and healthcare workers, early detection and proper management of childhood anemia can significantly improve a child’s quality of life and the nation’s future health outcomes.
References
1. Ministry of Health and Family Welfare (MoHFW). (2021). National Family Health Survey (NFHS-5) 2019–21: India Report. Government of India.
2. National Health Mission. (2018). Anemia Mukt Bharat Strategy Document. Government of India.
3. WHO. (2021). Worldwide prevalence of anemia 2019: Global Health Observatory data. World Health Organization.
4. Bhatia, J., & Seshadri, S. (2020). Nutritional anemia in Indian children. Indian Journal of Pediatrics, 87(6), 453–460.
5. UNICEF India. (2022). Anemia prevention and control among children and adolescents. UNICEF India Publications.
6. Kapur, D., Agarwal, K. N., & Agarwal, D. K. (2019). Nutritional anemia and its control. Indian Journal of Pediatrics, 86(8), 710–717.
7. National Iron Plus Initiative (NIPI). (2013). Guidelines for Control of Iron Deficiency Anemia. MoHFW, Government of India.
8. Kotecha, P. V. (2021). Nutritional anemia in young children with focus on Asia and India. Indian Journal of Community Medicine, 46(1), 3–9.
