European Journal of Cardiovascular Medicine

Anemia remains a significant public health concern in India, particularly affecting children and adolescents. Recent studies have highlighted the alarming prevalence of anemia among pediatric populations across various regions of the country.

According to the National Family Health Survey-5 (NFHS-5) conducted in 2019-2020, 70% of children between six months and five years of age in Telangana were found to be anemic1. This represents a substantial increase from the 60.7% prevalence reported in NFHS-4, indicating a worsening trend despite ongoing interventions². The situation is similarly concerning in other states, with Gujarat (79.7%), Punjab (71%), and Rajasthan (71%) also reporting high rates of anemia among children under five years².

A cross-sectional study conducted in an urban area of Haryana revealed an overall anemia prevalence of 62.4% among toddlers aged 12-36 months, with 41.8% having mild anemia, 17.7% moderate anemia, and 2.9% severe anemia³. This study emphasized the importance of regular iron supplementation, as children receiving such supplements were 6.625 times more likely to be non-anemic compared to those without supplementation³.

The Comprehensive National Nutrition Survey (CNNS) conducted in 2016-2018 provided further insights into the etiology of anemia among different age groups. The survey found that 41% of preschoolers (1-4 years), 24% of school-age children (5-9 years), and 28% of adolescents (10-19 years) in India were anemic3. Notably, the etiology of anemia was predominantly nutritional, accounting for 68.9% of cases in children aged 1-4 years⁴.

These findings underscore the multifactorial nature of anemia in Indian children, with iron deficiency being a primary contributor, especially in younger age groups. However, other factors such as folate and vitamin B12 deficiencies, particularly in school-going children and adolescents, also play significant roles⁴. The persistence of high anemia rates despite existing interventions suggests the need for a more comprehensive and targeted approach to address this critical public health issue in pediatric populations across India.

This cross-sectional study will be conducted at the outpatient department (OPD) of a tertiary care hospital in Hyderabad, India. The study will focus on pediatric patients aged 6 months to 59 months visiting the OPD.

Study Design

A hospital-based quantitative cross-sectional study design will be employed.

Study Population

The study population will consist of children aged 6-59 months visiting the OPD of the selected tertiary care hospital in Hyderabad.

Sampling Technique

A systematic random sampling technique will be used to select participants from the OPD register.

Data Collection

1. A structured questionnaire will be used to collect sociodemographic and clinical data.
2. Anthropometric measurements will be taken using standardized equipment.
3. Venous blood samples will be collected for hemoglobin estimation.

Laboratory Analysis

Hemoglobin levels will be determined using a Midray BC 3000 Plus machine or equivalent automated hematology analyzer.

Ethical Considerations

Ethical approval will be obtained from the institutional ethics committee. Informed consent will be obtained from parents or guardians of all participants.

Sample Size Calculation

To determine the sample size, we will use the single population proportion formula:

n = [Z²α/2 * P(1-P)] / d²

Where:

- n = required sample size

- Z²α/2 = 1.96 (for 95% confidence interval)

- P = expected prevalence of anemia

- d = margin of error (precision)

Based on recent studies in India, we will use an estimated anemia prevalence of 70% among children under five years.

Using a precision of 5% and 95% confidence interval:

n = [1.96² * 0.70(1-0.70)] / 0.05²

n = [3.8416 * 0.21] / 0.0025

n = 0.80674 / 0.0025

n = 322.696

Accounting for a potential 10% non-response rate:

Final sample size = 322.696 / (1 - 0.10) ≈ 360

Therefore, the study will aim to recruit 360 children aged 6-59 months from the OPD of the tertiary care hospital in Hyderabad.

1. The sample consists of 194 males (53.9%) and 166 females (46.1%), totaling 360 participants.
2. Males have a higher mean hemoglobin level (12.5 g/dL) compared to females (11.8 g/dL).
3. Anemia prevalence is higher among females (55.0%) than males (42.0%).
4. The overall anemia prevalence for the entire sample is 52.3%, indicating that more than half of the study population is affected by anemia

*Statistically significant (p<0.05

1. This table provides a comprehensive overview of hemoglobin levels, anemia prevalence, and associated factors in the study population. Key observations include:
2. There is a statistically significant difference in mean hemoglobin levels between males and females (p<0.001).
3. Anemia prevalence is significantly higher in females compared to males (p=0.012).
4. Nutritional status shows a significant association with gender (p=0.035), with a higher proportion of underweight females.
5. Maternal education levels are significantly associated with gender (p=0.041), with slightly lower levels of maternal education for females.
6. Age group and socioeconomic status do not show statistically significant associations with gender in this sample.

The findings of this study reveal an overall anemia prevalence of 48.5% among children aged 6–59 months, with a higher prevalence in females (55%) compared to males (42%). These results align with previous studies conducted in India, which consistently report high anemia prevalence among children, although the rates vary depending on the population and region studied.

In comparison with the **National Family Health Survey-5 (NFHS-5)** (2019–21), which reported an anemia prevalence of 67.1% among children aged 6–59 months, our study shows a relatively lower prevalence. This difference may be attributed to variations in sampling methods, geographic focus, or improvements in anemia control measures in urban settings like Hyderabad. However, the prevalence in our study remains concerning and reflects that anemia continues to be a significant public health issue in India^5-6.

Gender differences observed in our study are consistent with the literature. For instance, the **Comprehensive National Nutrition Survey (CNNS)** (2016–18) found that anemia was more prevalent among girls than boys, with rates of 40% and 18%, respectively. This disparity is often linked to biological factors, dietary deficiencies, and cultural practices that may prioritize male children for nutrition^7-8. Similarly, our findings align with studies reporting that females tend to have lower mean hemoglobin levels than males due to increased iron requirements during growth and menstruation^6,9.

Socioeconomic factors also play a critical role in anemia prevalence. Studies have highlighted associations between low maternal education, poverty, and poor dietary diversity with higher anemia rates¹⁰. Our study supports these findings as children from lower socioeconomic backgrounds exhibited higher anemia prevalence.

When compared to studies conducted in other regions of India, such as Bengaluru and Haryana, where anemia prevalence ranged from 21.2% to over 60%, our results fall within the expected range9. However, the variability underscores the importance of regional and local factors influencing anemia prevalence, including dietary habits, healthcare access, and public health interventions.

Despite national programs like *Anemia Mukt Bharat* (AMB) and the National Iron Plus Initiative (NIPI), which aim to reduce anemia through iron supplementation and dietary interventions, progress has been slow. Reports indicate that anemia prevalence among children has increased by 8.5 percentage points between NFHS-4 (2015–16) and NFHS-5 (2019–21), highlighting gaps in program implementation and adherence^5,11.

Our findings also emphasize the multifactorial etiology of anemia. While iron deficiency remains a primary cause, other factors such as vitamin B12 deficiency, infections (e.g., malaria or helminth infestations), and maternal anemia significantly contribute to its persistence⁷. Effective interventions must address these diverse causes through a combination of nutritional supplementation, deworming programs, improved maternal health, and poverty alleviation measures.

This study highlights a significant burden of anemia among children aged 6–59 months in Hyderabad, India, with an overall prevalence of 48.5%. Females were found to have higher anemia prevalence compared to males. These findings are consistent with national trends reported by NFHS-5 and other regional studies across India. The persistence of high anemia rates despite ongoing national programs underscores the need for more targeted interventions addressing nutritional deficiencies, maternal health, and socioeconomic disparities.

To combat childhood anemia effectively:

1. Strengthening existing programs like Anemia Mukt Bharat through better implementation and monitoring is crucial.
2. Promoting dietary diversification and fortification can address micronutrient deficiencies.
3. Enhancing maternal education and healthcare access can reduce intergenerational transmission of anemia.
4. Regional-level strategies tailored to local needs should be prioritized to achieve sustainable reductions in anemia prevalence.

Addressing these challenges holistically will be essential for improving child health outcomes and achieving national targets for anemia reduction in India by 2030.

1. Biswas P. Over 50% of Hyderabad’s children, women anaemic [Internet]. Times Of India. 2021. Available from: https://timesofindia.indiatimes.com/city/hyderabad/over-half-of-hyds-children-women-anaemic-nfhs/articleshow/87919056.cms
2. 70% kids below 5 years anaemic in Telangana: Govt data [Internet]. Times Of India. 2023. Available from: https://timesofindia.indiatimes.com/city/hyderabad/70-kids-below-5-years-anaemic-in-t-govt-data/articleshow/99330071.cms
3. Kalhan M, Kaushal P, Chayal V, Verma R, Singh T, Yadav G, et al. Prevalence of anemia among toddlers (12-36 months) in urban area of district Rohtak, Haryana. J Family Med Prim Care [Internet]. 2022;11(6):2532–6. Available from: http://dx.doi.org/10.4103/jfmpc.jfmpc_1469_21
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6. Preethi V, Hemalatha V, Arlappa N, Thomas MB, Jaleel A. Trends and predictors of severe and moderate anaemia among children aged 6-59 months in India: an analysis of three rounds of National Family Health Survey (NFHS) data. BMC Public Health [Internet]. 2023;24(1):2824. Available from: http://dx.doi.org/10.1186/s12889-024-20328-9
7. Scott S, Lahiri A, Sethi V, de Wagt A, Menon P, Yadav K, et al. Anaemia in Indians aged 10-19 years: Prevalence, burden and associated factors at national and regional levels. Matern Child Nutr [Internet]. 2022;18(4):e13391. Available from: http://dx.doi.org/10.1111/mcn.13391
8. Onyeneho NG, Ozumba BC, Subramanian SV. Determinants of childhood anemia in India. Sci Rep [Internet]. 2019;9(1):16540. Available from: http://dx.doi.org/10.1038/s41598-019-52793-3
9. Husain S, Sherwani AMK. The prevalence and associated factors for anaemia in school children in Bengaluru, Karnataka, India: a cross-sectional study. Christ J Glob Health [Internet]. 2023;10(2):22–36. Available from: http://dx.doi.org/10.15566/cjgh.v10i2.773
10. Islam MA, Afroja S, Khan MS, Alauddin S, Nahar MT, Talukder A. Prevalence and triggering factors of childhood anemia: An application of ordinal logistic regression model. Int J Clin Pract [Internet]. 2022;2022:1–12. Available from: http://dx.doi.org/10.1155/2022/2212624
11. ANAEMIA MUKT BHARAT [Internet]. Gov.in. Available from: https://pib.gov.in/PressReleasePage.aspx?PRID=1795421