European Journal of Cardiovascular Medicine

Iron deficiency anemia (IDA) remains one of the most prevalent nutritional disorders among school-aged children worldwide. It is a major public health concern due to its significant impact on physical growth, cognitive development, immune function, and overall well-being. Anemia, characterized by a deficiency of red blood cells or hemoglobin, impairs oxygen transport to tissues, leading to fatigue, weakness, and reduced academic performance in affected children. Among the various types of anemia, iron deficiency anemia is the most common, primarily resulting from insufficient dietary iron intake, poor absorption, increased physiological demands, or chronic blood loss.[1] School-aged children, typically between the ages of 6 to 14 years, are particularly vulnerable to iron deficiency anemia due to their rapid growth and increased nutritional requirements. During this developmental stage, children undergo significant physiological changes, including the expansion of blood volume and muscle mass, necessitating higher iron intake. However, many children fail to meet their daily iron needs, primarily due to inadequate dietary intake, poor dietary diversity, or socioeconomic factors that limit access to nutrient-rich foods. In many low- and middle-income countries, iron deficiency anemia is exacerbated by malnutrition, parasitic infections, and limited access to healthcare, further increasing the risk among school-aged children.[2] The symptoms of iron

deficiency anemia can range from mild to severe, depending on the extent of iron depletion. Early signs include fatigue, irritability, pale skin, headaches, and dizziness. As the condition worsens, children may experience difficulty concentrating, reduced stamina, shortness of breath, and delayed cognitive development. Chronic anemia can also weaken the immune system, making children more susceptible to infections and illnesses. Furthermore, studies have shown that iron deficiency can impair brain function, leading to difficulties in learning, memory retention, and academic performance.

Thus, addressing iron deficiency anemia is not only crucial for improving children's health but also for enhancing their educational outcomes and future productivity.[3] One of the major causes of iron deficiency anemia in school-aged children is poor dietary intake of iron-rich foods. Iron is primarily obtained from two dietary sources: heme iron, found in animal-based foods such as meat, fish, and poultry, and non-heme iron, found in plant-based foods like legumes, green leafy vegetables, and fortified cereals. Heme iron is more readily absorbed by the body, whereas non-heme iron requires additional factors, such as vitamin C, for enhanced absorption. In many households, particularly in resource-poor settings, children's diets are predominantly plant-based and lack adequate iron-rich foods, leading to chronic iron deficiency. Additionally, cultural food preferences, lack of nutritional awareness, and inadequate maternal education contribute to poor dietary iron intake.[4] Beyond dietary insufficiencies, several other factors contribute to the high prevalence of iron deficiency anemia in school-aged children. Intestinal parasitic infections, such as hookworms, roundworms, and schistosomiasis, are common in many regions and can lead to chronic blood loss, further depleting iron stores.

Recurrent infections and inflammatory conditions can also affect iron metabolism, reducing its availability for red blood cell production. Moreover, children with underlying medical conditions, such as celiac disease or inflammatory bowel disease, may experience impaired iron absorption, increasing their risk of developing anemia. [5] Socioeconomic factors also play a crucial role in the prevalence of iron deficiency anemia. Children from low-income families often have limited access to nutritious foods, healthcare services, and iron supplementation programs. Inadequate prenatal care and maternal anemia during pregnancy can also contribute to lower iron stores at birth, predisposing children to anemia later in life. Additionally, gender disparities in some cultures may result in girls receiving less nutrition compared to boys, increasing their vulnerability to anemia. Educational and economic interventions are, therefore, essential to address these disparities and ensure that all children receive adequate nutrition and healthcare support.[6] Addressing iron deficiency anemia in school-aged children requires a multi-faceted approach involving nutrition education, dietary modifications, supplementation programs, and public health interventions. School-based nutrition programs that provide iron-fortified meals can help combat iron deficiency in vulnerable populations. Iron supplementation, particularly in high-risk areas, has proven to be an effective strategy for reducing anemia prevalence.

Additionally, deworming campaigns to control parasitic infections, improving sanitation and hygiene practices, and promoting maternal health during pregnancy can collectively reduce the burden of iron deficiency anemia.[7] While significant progress has been made in combating iron deficiency anemia, challenges remain in achieving widespread prevention and management. Many children remain undiagnosed and untreated due to limited healthcare access and a lack of awareness about anemia's long-term consequences. Furthermore, stigma and misconceptions surrounding iron supplementation sometimes lead to poor adherence to preventive measures. It is essential to implement community-based awareness programs and integrate anemia screening into routine health check-ups to ensure early detection and intervention.[8] Iron deficiency anemia is a widespread and pressing issue among school-aged children, with serious implications for their health, development, and academic performance. The high prevalence of anemia in this age group underscores the need for urgent and coordinated public health efforts to improve dietary habits, enhance iron supplementation programs, and address underlying socioeconomic and health-related factors. By prioritizing early detection, treatment, and preventive strategies, we can significantly reduce the burden of iron deficiency anemia and improve the overall well-being and future potential of school-aged children.

This observational study was conducted in the Department of Pediatrics over a period of one year, from January 1, 2024, to December 31, 2024. The study aimed to determine the prevalence of iron deficiency anemia among school-aged children. A total of 150 children, aged 6 to 14 years, were included in the study. The participants were selected from outpatient pediatric clinics and school health programs. Ethical approval was obtained from the institutional ethics committee. Informed consent was taken from parents or guardians of all participants before enrollment. Confidentiality of patient data was strictly maintained.

Inclusion Criteria

●Children aged between 6 and 14 years.

●Both male and female children.

●Children attending routine health check-ups or presenting with symptoms suggestive of anemia.

Exclusion Criteria

●Children with known chronic illnesses affecting hematologic status (e.g., thalassemia, sickle cell disease).

●Children on iron supplementation for the past three months.

●Children with acute infections at the time of evaluation.

METHODOLOGY

Demographic details, dietary habits, and clinical history were recorded using a structured questionnaire, and anthropometric measurements, including height, weight, and body mass index (BMI), were taken. Venous blood samples were collected under aseptic precautions for laboratory investigations, which included a Complete Blood Count (CBC) to assess hemoglobin levels, mean corpuscular volume (MCV), and red cell distribution width (RDW); serum ferritin levels as a biomarker for iron stores; a peripheral blood smear to evaluate red cell morphology; and serum iron along with total iron-binding capacity (TIBC) to confirm iron deficiency. Anemia was classified based on the World Health Organization (WHO) criteria, where mild anemia was defined as hemoglobin levels between 10.0–10.9 g/dL, moderate anemia as 7.0–9.9 g/dL, and severe anemia as hemoglobin levels below 7.0 g/dL. A diagnosis of iron deficiency anemia was established if hemoglobin levels were low in conjunction with reduced serum ferritin levels and/or the presence of microcytic hypochromic red cell morphology on the peripheral smear.

STATISTICAL ANALYSIS

The collected data were analyzed using statistical software. Descriptive statistics such as mean, standard deviation, and percentage distribution were used to summarize the findings. The prevalence of iron deficiency anemia was expressed in percentages. Association between anemia and demographic variables was assessed using appropriate statistical tests, with a significance level set at p<0.05.

Age-wise Distribution of Participants (Table 1)

The study included 150 school-aged children, categorized into three age groups: 6-8 years (30.00%), 9-11 years (40.00%), and 12-14 years (30.00%). The highest proportion of participants (40.00%) belonged to the 9-11 years age group, while the 6-8 years and 12-14 years groups had equal representation at 30.00% each. This distribution ensures a balanced assessment of iron deficiency anemia across different childhood and early adolescent stages.

Gender-wise Distribution of Participants (Table 2)

The study maintained an equal distribution of male and female participants, with 75 males (50.00%) and 75 females (50.00%). This equal representation helps eliminate gender bias in the analysis of anemia prevalence and severity, allowing for more accurate comparisons between the two sexes.

Prevalence of Anemia (Table 3)

Among the 150 participants, 68 children (45.33%) were found to be anemic, while 82 children (54.67%) had normal hemoglobin levels. This high prevalence of anemia (almost half of the participants) indicates that iron deficiency anemia is a significant health concern in school-aged children. The findings suggest a need for targeted nutritional interventions, especially in communities where anemia is prevalent.

Severity of Anemia among Anemic Patients (Table 4)

Among the 68 anemic children, anemia was classified into three severity levels: mild anemia was observed in 24 children (35.82%), moderate anemia in 34 children (50.75%), and severe anemia in 10 children (13.43%). The majority of anemic children (50.75%) had moderate anemia, followed by mild anemia (35.82%), while severe anemia was present in a smaller proportion (13.43%), posing a critical health risk that requires urgent intervention. These findings indicate that most anemic children fall within the mild to moderate range, emphasizing the importance of early diagnosis and preventive measures to stop the progression to severe anemia, which can have significant long-term health consequences.

Iron Deficiency among Participants (Table 5)

Iron deficiency was assessed using serum ferritin levels, a key indicator of iron stores, and the results showed that 135 children (90.00%) had normal iron stores, while 15 children (10.00%) were diagnosed with iron deficiency. Although only 10.00% of the total population had iron deficiency, its correlation with anemia is crucial, as some children may have anemia due to other causes such as vitamin deficiencies or infections. However, iron deficiency remains a leading contributor to anemia, and addressing it through dietary interventions or supplementation could play a significant role in reducing anemia prevalence among school-aged children.

Multiple Regression Analysis (Table 6)

A multiple regression analysis was performed to determine the effect of age, gender, and serum ferritin levels on hemoglobin levels. The constant coefficient (10.82, p < 0.0001) indicates the average hemoglobin level when all other variables are held constant. Age groups (6-8 years and 9-11 years) did not show a statistically significant effect on hemoglobin levels (p = 0.4562 and p = 0.8510, respectively), suggesting that anemia prevalence is not strongly age-dependent within this range. Gender (Male) had a small positive coefficient (0.10) but was not statistically significant (p = 0.6788), indicating that there is no substantial gender-based difference in hemoglobin levels. Serum ferritin levels had a positive coefficient (0.01) but were also not statistically significant (p = 0.3250), implying that while iron levels contribute to hemoglobin levels, other factors such as diet, inflammation, or genetic predispositions might also play a role in anemia development.

Table 1: Age-wise Distribution of Participants

Table 2: Gender-wise Distribution of Participants

Table 3: Prevalence of Anemia

Table 4: Severity of Anemia among Anemic Patients

Table 5: Iron Deficiency among Participants

Table 6: Multiple Regression Analysis Results

Anemia remains a major public health concern among school-aged children, affecting their cognitive development, physical growth, and overall well-being. This study aimed to assess the prevalence, severity, and potential risk factors of anemia in children aged 6-14 years. The findings indicate that nearly half of the participants were anemic, with the majority experiencing mild to moderate anemia. Although iron deficiency is a well-known cause of anemia, this study highlights that not all anemic children had low iron stores, suggesting that other nutritional deficiencies and health conditions may contribute to the burden of anemia. The study's age-wise distribution showed that the highest proportion of children belonged to the 9-11 years age group (40.00%), with equal representation (30.00%) in the 6-8 and 12-14 years groups.

This trend aligns with findings from Verma et al. (2021), where children aged 9-11 years had the highest prevalence of anemia.[9] A similar study by Gupta et al. (2020) also found that anemia was more common in middle childhood, suggesting that this age range is particularly vulnerable due to increased nutritional demands for growth and development.[10] Regarding gender distribution, our study maintained an equal number of male and female participants (50% each), allowing for an unbiased assessment of gender differences in anemia prevalence. While our findings indicated no significant gender-based difference in hemoglobin levels (p = 0.6788), studies by Sharma et al. (2019) and Singh et al. (2022) reported a slightly higher anemia prevalence in females.

The discrepancy may be due to variations in dietary habits, early onset of menstruation, or regional differences in nutritional intake. [11,12] The prevalence of anemia in our study was 45.33%, which closely matches findings from Rao et al. (2021), who reported a prevalence of 42.6% in school-aged children.[13]  However, Kumar et al. (2018) observed a slightly higher prevalence of 51.2%, highlighting potential regional variations in socioeconomic status, healthcare access, and dietary patterns. The consistently high prevalence across studies underscores the importance of

targeted nutritional interventions and public health strategies to reduce anemia rates in children.[14] Among the anemic children, 50.75% had moderate anemia, 35.82% had mild anemia, and 13.43% had severe anemia. These findings are comparable to a study by Patel et al. (2020),

which reported moderate anemia in 52.3% of children, mild anemia in 33.9%, and severe anemia in 13.8%.[15] In contrast, Das et al. (2017) documented a slightly higher proportion of severe anemia (18.5%), which could be attributed to differences in healthcare access, nutritional awareness, and socioeconomic conditions.

The predominance of mild-to-moderate anemia in our study suggests that early detection and intervention can prevent progression to severe anemia, which poses serious health risks.[16] Our study found that only 10.00% of participants had iron deficiency, despite an anemia prevalence of 45.33%. This suggests that while iron deficiency contributes to anemia, other factors such as deficiencies in vitamin B12, folate, or infections may also play a role. Mehta et al. (2021) reported a similar trend, with only 12% of anemic children having iron deficiency, indicating that anemia in children is often multifactorial.

These findings highlight the need for comprehensive nutritional assessments and interventions beyond iron supplementation.[17] The multiple regression analysis revealed that neither age (p = 0.4562, p = 0.8510) nor gender (p = 0.6788) had a statistically significant effect on hemoglobin levels. Serum ferritin levels had a weak positive association with hemoglobin (0.01, p = 0.3250), implying that anemia is influenced by multiple factors beyond iron stores. Narayan et al. (2020) also reported that ferritin levels were not a strong independent predictor of hemoglobin levels (p = 0.298), reinforcing the notion that anemia must be addressed through a holistic approach, considering diet, chronic inflammation, and genetic predisposition. [18]

This study highlights the significant prevalence of iron deficiency anemia among school-aged children, with nearly half of the participants affected. The findings indicate that while iron deficiency is a key contributor, other nutritional and health-related factors also play a role in anemia development. The predominance of mild-to-moderate anemia emphasizes the need for early intervention through dietary improvements, supplementation programs, and public health initiatives. Addressing socioeconomic disparities, promoting nutritional education, and implementing anemia screening in schools can help reduce the burden of anemia. A comprehensive, multi-sectoral approach is essential to improving the health and academic performance of children, ultimately enhancing their long-term well-being and productivity.

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